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Cardiovascular Involvement in Primary Hyperparathyroidism
Jessica Pepe1, Salvatore Minisola1, Evaristo Ettorre1
1Department of Medical and Cardiovascular Sciences, "Sapienza" University, Rome 00161, Italy.
Insights
Primary hyperparathyroidism (PHPT) involves high calcium and parathyroid hormone (PTH) levels, potentially impacting cardiovascular health. More research is needed to confirm cardiovascular risks and benefits of parathyroidectomy in PHPT patients.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Nephrology
Background:
- Primary hyperparathyroidism (PHPT) is characterized by elevated serum calcium and parathyroid hormone (PTH) levels.
- Existing evidence links hypercalcemia and high PTH to cardiovascular diseases, affecting various cell types.
- Epidemiological data on cardiovascular complications in PHPT patients are conflicting due to diverse risk factors and study populations.
Purpose of the Study:
- To review the association between primary hyperparathyroidism and cardiovascular diseases.
- To evaluate the impact of parathyroidectomy on cardiovascular parameters and outcomes in PHPT patients.
- To identify the need for further robust studies to clarify cardiovascular risks and surgical indications.
Main Methods:
- Systematic review and meta-analysis of existing epidemiological studies and clinical trials.
- Analysis of cardiovascular risk factors, including hypertension, arrhythmias, dyslipidemia, and vascular impairments.
- Assessment of cardiac structural and functional changes (e.g., left ventricular mass index, global longitudinal strain) before and after parathyroidectomy.
Main Results:
- Conflicting data exist regarding the prevalence of cardiovascular diseases in PHPT patients compared to controls.
- Some studies suggest parathyroidectomy may improve glucose metabolism and reduce blood pressure.
- Evidence on the improvement of cardiac structural changes and reduction in major cardiovascular events post-parathyroidectomy is inconsistent.
Conclusions:
- The relationship between PHPT and cardiovascular disease requires further investigation with robust randomized controlled trials.
- It remains unclear whether cardiovascular disease in PHPT is primarily dependent on serum calcium levels, PTH, or both.
- Further research will help establish definitive criteria for surgical intervention in PHPT patients based on cardiovascular health.
Abstract:
Increased serum calcium with elevated or nonsuppressed PTH levels is the biochemical hallmark of primary hyperparathyroidism (PHPT). A large body of evidence linked both hypercalcemia and high serum levels of PTH with cardiovascular diseases, due to their actions on cardiomyocytes, endothelial, pancreatic β, and fat cells. However, controversial epidemiological data exist regarding the higher prevalence of hypertension, arrhythmias, dyslipidemia, echocardiographic, and vascular parameter impairments in PHPT patients compared to controls. Different cardiovascular risk factors related to sex, age groups, serum calcium levels, and different countries included in these studies cause conflicting results. Although current guidelines on hypercalcemic PHPT management do not suggest parathyroidectomy based on cardiovascular diseases, one meta-analysis showed improvement following parathyroidectomy for glucose metabolism and reduction of blood pressure. While structural cardiac changes such as left ventricular mass index was improved following parathyroidectomy in one but not in another meta-analysis, a more modern method that included global longitudinal strain measurement of left ventricular mass showed improvement following parathyroidectomy. An increased risk of major cerebrovascular or cardiovascular events in PHPT patients compared to controls has been reported in some but not all studies. Furthermore, meta-analyses are not always consistent in showing a higher risk of total and cardiovascular death in PHPT patients compared to the general population, as well as their reduction following parathyroidectomy. Robust randomized controlled studies are needed to definitively answer whether in patients with PHPT cardiovascular disease depend on serum calcium levels, PTH, or both, thus representing another new criterion to submit patients to surgery.
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