Primary Hyperparathyroidism Associated With Elevated Coronary Artery Calcium Scores and Increased Cardiovascular Risk

Coronary artery calcium (CAC) scoring measures calcific plaque burden to assess cardiovascular risk. The relationship between CAC and primary hyperparathyroidism (PHPT), a disease linked to increased cardiovascular risk, is yet to be defined. We thus evaluated the relationship between PHPT and CAC scores.

Patients who underwent CAC scoring from January 1, 2015, to December 31, 2024, were retrospectively identified via electronic records. Patients with concurrent serum calcium and parathyroid hormone levels within 1 year of CAC testing were included. Cardiovascular risk was stratified by CAC scores (low-intermediate: 0-99, high: ≥100) and compared between PHPT and non-PHPT groups. CAC scores were then sub-analyzed in the PHPT cohort stratified by cardiovascular risk and PHPT subtype.

Four hundred fifteen patients (75 PHPT and 340 non-PHPT) were included. The PHPT group was more likely to have greater coronary calcific burden (67 vs 50% with CAC scores ≥100, P = .04). PHPT also independently predicted CAC scores ≥100 [odds ratio 1.5 (95% CI: 1.1-2.7), P = .03]. Subgroup analysis revealed higher CAC scores in male versus female patients with PHPT [495 (IQR: 51-634) vs 6 (IQR: 0-190), P < .01]. Longer periods of untreated PHPT disease were associated with moderate-to-severe coronary calcific burden [odds ratio 1.2 (95% CI: 1.1-1.3), P < .01].

Patients with PHPT had higher proportions of CAC scores ≥100, suggesting greater cardiovascular event risk. Men with PHPT had significantly higher CAC scores compared to women, and untreated parathyroid disease was associated with moderate-to-severe coronary calcific burden. Therefore, routine screening may be considered in PHPT populations to evaluate for cardiovascular risk.