Impact of parathyroidectomy on cardiometabolic events associated with primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is associated with numerous established clinical manifestations as well as subclinical impairments, including cardiometabolic complications (cardiovascular mortality, hypertension, prediabetes, diabetes, dyslipidemia, vascular abnormalities). These alterations appear to be linked to elevated parathyroid hormone and/or calcium levels, and could play a direct or indirect role in increasing cardiovascular risk in patients with PHPT. In the absence of robust data and given sometimes heterogeneous results, current French and international guidelines do not recognize cardiometabolic complications as an indication for parathyroidectomy in PHPT. Nevertheless, some data suggest a beneficial effect of surgery on these parameters, notably an improvement in blood pressure, lipid profile, or insulin sensitivity after parathyroidectomy. However, results remain variable depending on the studies, methodologies used, and evaluation criteria retained. This review aims to provide an overview of current knowledge on the impact of parathyroidectomy in PHPT regarding cardiovascular and metabolic risk, and to identify open questions to guide future research.