In a Surprising Finding, Paricalcitol Fails to Improve Cardiac Measures

The active vitamin D compound paricalcitol had no effect on left ventricular mass index (LVMI) or measures of diastolic dysfunction in patients with chronic kidney disease (CKD), according to the results of a multinational, double-blind, randomized, placebo-controlled trial. The fi ndings, from the Paricalcitol Capsule Benefits in Renal Failure-Induced Cardiac Morbidity (PRIMO) trial, were published in the Journal of the American Medical Association (JAMA 2012;307:674-684). The negative result surprised the PRIMO investigators. “Animal studies suggested paricalcitol would have a dramatic effect and improve cardiovascular health, but that did not translate to the human studies,” said lead author Ravi Thadhani, MD, MPH, Associate Professor of Medicine at Harvard Medical School, in an interview. “In the human studies, we found that there were fewer hospitalizations for cardiovascularrelated disease and lower levels of BNP [brain natriuretic peptide], which is a marker of cardiac stress, but we didn’t fi nd changes in the cardiac mass, and this was surprising,” Dr. Thadhani said. “This suggests that, if indeed this type of agent has a dramatic effect on the heart, it’s not because it reduces cardiac mass; it works through other mechanisms that may play a role in heart failure.” Paricalcitol is used to treat elevated parathyroid hormone levels in patients with CKD who are vitamin D defi cient. Data have suggested that the compound may also decrease cardiovascularrelated morbidity and mortality, In a Surprising Finding, Paricalcitol Fails to Improve Cardiac Measures