Association between Hyperparathyroidism and the Risk of Cerebrovascular Disease in the General Population

Hyperparathyroidism has been associated with an increased risk of stroke in several previous studies; but the findings have not been consistent, which prompts further investigation. This study aimed to elucidate the association between high serum parathyroid hormone levels and stroke through a systematic review and meta-analysis. PubMed, Embase, Scopus and Google Scholar were systematically searched up to May 2025 for relevant and original observational studies. Pooled odds ratios and hazard ratios were calculated with corresponding 95% confidence intervals, along with heterogeneity and publication bias. The combined search yielded 2,063 unique articles, and 14 studies were included in statistical analysis. Two associations were analysed: nine studies focused on comparing the risk of stroke between populations with normal and high parathyroid hormone levels and the remaining five studies focused on comparing the rate of hyperparathyroidism between populations with stroke and normal population. In the first group, subgroup analyses of studies reported that both hazard ratios and odds ratios demonstrated stroke to be more likely in groups with hyperparathyroidism (odds ratio: 1.49 and 95% confidence interval: 1.38-1.61; hazard ratio: 1.38 and 95% confidence interval: 1.09-1.75). In the second group, analysis demonstrated that groups with stroke are more likely to have higher level of parathyroid hormone (mean difference of parathyroid hormone levels: 10.30 pg/mL and 95% confidence interval: 1.60-19.00). There were no significant publication biases in any of the analyses (p> 0.05). This review is supportive of the association between hyperparathyroidism and stroke but does not establish a conclusive causal relationship.