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Published on: March 14, 2017
Arterial structure and function in mild primary hyperparathyroidism is not directly related to parathyroid hormone,
Margareta Ring1, Parastou Farahnak, Tomas Gustavsson
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. margareta.ring@ki.se
Insights
Mild primary hyperparathyroidism (PHPT) patients without cardiovascular risk factors showed normal arterial function. Cardiovascular risks linked to high calcium and parathyroid hormone (PTH) may stem from blood pressure effects, not direct arterial damage.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Primary hyperparathyroidism (PHPT) is characterized by elevated calcium and parathyroid hormone (PTH).
- These biochemical changes are potential risk factors for cardiovascular morbidity and mortality.
- The direct vascular effects of mild PHPT in individuals without other risk factors require clarification.
Purpose of the Study:
- To evaluate the vascular effects of elevated calcium and PTH in patients with mild PHPT.
- To assess arterial structure and function using standard and advanced imaging techniques.
- To compare these parameters in patients before and after parathyroidectomy (PTX) against healthy controls.
Main Methods:
- A prospective case-control study involving 48 patients with mild PHPT and 48 matched healthy controls.
- Measurements included biochemical markers, augmentation index (AIx), pulse wave velocity (PWVao), intima-media thickness (IMT) of radial and carotid arteries, and grayscale median (IM-GSM).
- Assessments were conducted at baseline and one year post-parathyroidectomy (PTX) for patients.
Main Results:
- No significant baseline differences in AIx, IMT, or IM-GSM between PHPT patients and controls.
- A slight increase in PWVao was observed in PHPT patients (p<0.05).
- Higher systolic blood pressure, calcium, and PTH levels in patients decreased post-PTX; vitamin D levels increased. PWVao showed weak correlations with PTH and calcium, which disappeared after adjusting for age and SBP.
Conclusions:
- Patients with mild PHPT and no cardiovascular risk factors exhibit normal arterial function.
- Elevated calcium, PTH, and low vitamin D levels in PHPT do not appear to directly impair arterial structure.
- The cardiovascular risk associated with these hormonal imbalances may be mediated through effects on blood pressure and other systemic factors.
Objective:
Elevated levels of calcium and parathyroid hormone (PTH), characteristics of primary hyperparathyroidism (PHPT), may be associated with cardiovascular morbidity and mortality in the general population. We evaluated the possible vascular effects of these risk factors in patients with mild PHPT by using standard methods and new imaging techniques.
Design:
A prospective case-control study.
Subjects And Methods:
Forty-eight patients with mild PHPT without any known cardiovascular risk factors were studied at baseline and at one year after parathyroidectomy (PTX) in comparison with 48 healthy age- and gender-matched controls. We measured biochemical variables, augmentation index (AIx), aortic pulse wave velocity (PWV(ao)), radial (IMT(rad)) and common carotid artery (IMT(cca)) intima media thicknesses, and the grayscale median (IM-GSM) of the latter.
Results:
No significant differences were observed between PHPT patients and controls at baseline for AIx (28.6±12.2 vs. 27.7±12.8%), IMT(rad) (0.271±0.060 vs. 0.255±0.053 mm), IMT(cca) (0.688±0.113 vs. 0.680±0.135 mm), or IM-GSM (82.3±17.2 vs. 86.5±15.3), while PWV(ao) was slightly higher in patients (8.68±1.50 vs. 8.13±1.55, p<0.05). Systolic blood pressure (SBP), calcium, and PTH were higher in patients compared with controls, and decreased after PTX, while vitamin D was lower in patients and increased after PTX. While AIx, PWV(ao), IMT(rad), and IMT(cca) were related to SBP, neither correlated to vitamin D levels. Only PWV(ao) correlated weakly to plasma PTH (r = 0.29, p<0.01) and ionized calcium (r = 0.22, p<0.05) but showed no relation when age and SBP were adjusted for.
Conclusion:
We found normal arterial function despite high calcium, PTH, and low vitamin D levels, in patients with mild PHPT without cardiovascular risk factors. The cardiovascular risk associated with low vitamin D and/or high PTH and calcium levels may be explained by their coupling to blood pressure and other risk factors rather than direct effects on arterial structure.
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