Increased Prevalence of Coronary Artery Calcification in Patients with Post-Surgical Hypoparathyroidism

Hypoparathyroidism is a rare disease characterized by hypocalcemia and deficient parathyroid hormone secretion. Cohort studies suggest a higher risk of cardiovascular disease. However, imaging-based assessment of coronary artery disease is limited. We aimed to characterize cardiovascular risk factors and coronary artery disease in 50 patients with chronic post-surgical hypoparathyroidism and 50 age- and sex-matched individuals from the general population, using coronary computed tomography angiography. The mean age of patients was 60 (range 31-84) years, 86% were female, and the median duration of hypoparathyroidism was 12 (range 5-49) years. Compared with controls, patients had a lower estimated glomerular filtration rate (78 vs. 83 mL/min, p = 0.04) and were more frequently treated with antihypertensive medication (56% vs. 36%, p = 0.05). Use of lipid-lowering therapy was more frequent (34% vs. 18%, p = 0.07). Prevalence of diabetes, smoking status, and arterial stiffness assessed by carotid-femoral wave velocity did not differ between groups. Angiography revealed coronary atherosclerotic plaques in 68% of patients, compared with 42% in controls (p < 0.01). This association remained significant after adjustment for sex, age, and presence of any cardiovascular risk factor, corresponding to a 24-percentage point higher prevalence of coronary atherosclerosis. Severe coronary artery disease (coronary artery calcium score ≥400) was present in 18% of patients versus 2% of controls (p = 0.02). Hypoparathyroidism was associated with increased odds of coronary calcification (coronary artery calcium score >0; OR 3.19, 95% CI 1.40-7.24, p < 0.01), independent of renal function. Compared with controls, patients had aortic valve calcification more often (29% vs. 8%, p<0.01) and calcifications of the ascending and descending aorta (34% vs. 8%, p<0.01). In conclusion, chronic post-surgical hypoparathyroidism is associated with an increased burden of atherosclerosis, which may explain the increased cardiovascular risk. Enhanced cardiovascular risk stratification and preventive strategies are warranted.