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Ultrasound evaluation of carotid artery in primary hyperparathyroidism
Francesco Fallo1, Giuseppe Camporese, Elena Capitelli
1Department of Medical and Surgical Sciences, University of Padova, Italy. francesco.fallo@unipd.it
Insights
Primary hyperparathyroidism (PHPT) patients face higher cardiovascular risks. Classic risk factors, not high calcium or PTH alone, significantly worsen carotid artery atherosclerosis in PHPT patients.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Primary hyperparathyroidism (PHPT) is linked to increased cardiovascular morbidity and mortality.
- The roles of hypercalcemia, parathyroid hormone (PTH), and traditional atherosclerosis risk factors in PHPT cardiovascular complications require clarification.
Purpose of the Study:
- To differentiate the impact of hypercalcemia/high PTH from major cardiovascular risk factors on carotid artery structure in PHPT patients.
- To investigate the contribution of classic risk factors (diabetes, hyperlipidemia, hypertension, obesity, smoking) to atherosclerosis in PHPT.
Main Methods:
- Ultrasonographic assessment of carotid artery intima-media thickness and lumen diameter.
- Study included 26 PHPT patients (10 without risk factors, 16 with risk factors) and 15 healthy controls.
Main Results:
- PHPT patients with co-existing risk factors showed significantly increased carotid intima-media thickness (P < 0.001) and reduced lumen diameter (P < 0.05) compared to other groups.
- No significant carotid changes were observed in PHPT patients without traditional risk factors or in controls.
Conclusions:
- Hypercalcemia and/or elevated PTH alone do not appear to be the primary drivers of carotid atherosclerosis in PHPT.
- The increased cardiovascular risk in PHPT is likely attributable to the synergistic effect of traditional cardiovascular risk factors.
Abstract:
Patients with primary hyperparathyroidism (PHPT) have an increased cardiovascular morbidity and mortality. Elevated serum calcium and/or PTH may directly contribute to vascular tissue damage, but the role of classic factors for atherosclerosis has not fully been evaluated in this disease. The aim of our study was to dissect the potential effect of hypercalcemia and/or high PTH from that of major cardiovascular risk factors (i.e. diabetes mellitus, hyperlipidemia, hypertension, obesity, smoking habit) on the carotid artery structure of patients with PHPT. Twenty-six consecutive patients with PHPT [subdivided into two groups according to the absence (n = 10) or the presence (n = 16) of one or more risk factors] and 15 normocalcemic healthy subjects as controls were studied. At ultrasonography, a significant increase (P < 0.001) of carotid mean and maximum intima-media thickness, as well as a significant reduction of lumen diameter (P < 0.05) were found in the PHPT group with risk factors, compared with the other two groups. This suggests that hypercalcemia and/or PTH elevation per se are not determinant of carotid atherosclerosis in PHPT, and that increased cardiovascular mortality and morbility in this disease is attributable to the combined presence of classic cardiovascular risk factors.