Cardiovascular Morbidity in Patients Undergoing Successful Surgery for Primary Hyperparathyroidism

Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT).

The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls.

Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors.

TIA was increased in patients pre-and postoperatively with a peak 1-4 years before PTX (IRR: 2.06, CI 95%: 1.31-3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51-6.85), and heart failure (IRR: 1.37, 1.11-1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively.

The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.