High normal parathyroid hormone and cardiovascular and total mortality: sex and age disparities in the ELSA-Brasil study
Authors' conclusion
In this large, community-based cohort, PTH levels at the upper end of the reference range were associated with greater CV and all-cause mortality. The excess CV risk was restricted to females and younger adults, suggesting that PTH may serve as an early, sex-sensitive biomarker of cardiometabolic risk.
Study context
- Population
- Normocalcemic, middle-aged adults from the general population, ELSA-Brasil study; mean age 51.7 years, 55% females
- Participants
- 4,736 participants
- Exposure
- Baseline parathyroid hormone (PTH) >56 pg/mL vs lower PTH
- Outcome
- CV mortality and all-cause mortality
- Follow-up
- Median 11.2 years
Methodological detailscommunity-based
- Community-based
Main finding
As reported in the abstract
median 11.2 years
PTH >56 pg/mL vs PTH ≤56 pg/mLEstimate (95% CI)
Fine-Gray model, competing risks; adjusted for total calcium and other covariates
sHR (CV mortality) 1.92(1.22–3.01)
Cox regression; adjusted
HR (all-cause mortality) 1.61(1.25–2.07)
Observational data: associations, not effects.
Further findings
Cardiovascular (CV) mortality, by sex
- Females with elevated PTH: sHR (95% CI); 179% increased CV mortality risk
- 2.79 (1.37-5.70)
- Males: no significant association
- Sex-stratified analysis
CV mortality, by age
- Adults ≤64 years with elevated PTH: sHR
- 1.80 (1.05-3.09) (95% CI)
- Older individuals: no association
- Age-stratified analysis
All-cause mortality, by sex and age
- Females with PTH >56 pg/mL: HR
- 1.75 (1.15-2.66) (95% CI)
- Males with PTH >56 pg/mL: HR
- 1.59 (1.16-2.19) (95% CI)
- Consistent associations across both age groups (≤64 and >64 years)
Original publication
High normal parathyroid hormone and cardiovascular and total mortality: sex and age disparities in the ELSA-Brasil study. J Clin Endocrinol Metab. Published 24 February 2026. doi:10.
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