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Hyperparathyroidism and Peripheral Arterial Disease.

Pier Luigi Antignani1, Mateja K Jezovnik2, Ales Blinc3,4

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Current Vascular Pharmacology
|January 29, 2024
PubMed
Summary

Primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism increase parathyroid hormone (PTH) levels, contributing to atherosclerosis and cardiovascular risks. Parathyroidectomy is the main treatment for severe PHPT.

Keywords:
Parathyroid hormonechronic hypercalcaemiahyperparathyroidism.parathyroidectomyperipheral arterial diseasevascular calcifications

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Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Nephrology

Background:

  • Hyperparathyroidism (HPT), including primary (PHPT) and secondary (SHPT) forms, involves elevated parathyroid hormone (PTH) levels.
  • SHPT is often triggered by vitamin D deficiency or kidney failure.
  • PHPT presents in various forms, such as classic, normohormonal, and normocalcemic.

Purpose of the Study:

  • To review the role of HPT in the development of atherosclerosis, including peripheral arterial disease (PAD).
  • To explore the association between elevated PTH and cardiovascular morbidity and mortality.

Main Methods:

  • Literature review focusing on the pathophysiological mechanisms linking HPT to vascular disease.
  • Analysis of studies investigating the impact of PTH on endothelial function, vascular stiffness, and hypertension.

Main Results:

  • Increased PTH levels are linked to endothelial dysfunction, vascular stiffness, hypertension, and both coronary and peripheral arterial diseases.
  • Chronic hypercalcemia in HPT promotes vascular and atherosclerotic plaque calcification.
  • HPT is an independent risk factor for cardiovascular morbidity and mortality.

Conclusions:

  • Elevated PTH significantly contributes to atherosclerosis and cardiovascular complications.
  • While treatments like calcimimetics exist for SHPT, parathyroidectomy remains the primary therapeutic option for severe PHPT.