Cardiovascular Morbidity and Mortality in Chronic Hypoparathyroidism: A Systematic Review and Meta-Analysis

Chronic hypoparathyroidism (HypoPT) may increase cardiovascular risk, yet current care rarely includes structured cardiovascular assessment. This systematic review and meta‑analysis aimed to quantify the association of chronic HypoPT with major cardiovascular events. Electronic databases and registries were searched from their inception through 10 June 2026 to identify controlled cohort studies of adults with chronic HypoPT and non-HypoPT comparators that reported cardiovascular outcomes. Random‑effects meta‑analyses (for hazard ratios [HRs]) were conducted for the primary and secondary outcomes using R. Data from nine cohort studies (N=134, 598; HypoPT: 28, 625; controls: 105, 973) were analyzed. HypoPT was associated with higher risk of myocardial infarction (MI) (HR1.19, 95%CI1.06, 1.35; I²=0%). HypoPT was associated with higher occurrence of heart failure (HF) [HR 1.46(95%CI: 1.08, 1.96); I²=83.5%; P=0.012] which lost its significance on prediction-interval analysis (PIA) (95%CI: 0.62, 3.42). HypoPT had higher occurrence of arrhythmias [HR1.45(95%CI: 1.19, 1.76); I²=64.9%; P=0.0002] which lost its significance on PIA (95%CI: 0.87, 2.43). HypoPT had higher occurrence of stroke [HR 1.24(95% CI: 1.05, 1.46); I²=46.9%; P =0.009] which lost its significance on PIA (95%CI: 0.85, 1.81). HypoPT had higher all-cause mortality [HR1.40(95%CI: 1.07, 1.84); I²=80.9%; P = 0.015] which lost its significance on PIA (95% CI: 0.62, 3.15). Chronic HypoPT was associated with a higher pooled hazard of MI. Pooled associations with HF, arrhythmias, stroke, composite cardiovascular disease, CKD, and all-cause mortality were imprecise and heterogeneous, with prediction-intervals that included the null.