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Effect of chronic hypercalcemia on the heart. An analysis of 18 necropsy patients
Insights
Chronic hypercalcemia accelerates calcium deposition in heart valves and coronary arteries, increasing atherosclerosis risk, particularly with high cholesterol.
Area of Science:
- Cardiovascular Pathology
- Endocrinology
- Nephrology
Background:
- Chronic hypercalcemia, from primary or secondary hyperparathyroidism, affects multiple organ systems.
- Cardiac manifestations of chronic hypercalcemia are not fully understood.
- Dystrophic calcification is a known complication of prolonged high calcium levels.
Purpose of the Study:
- To investigate cardiac morphologic changes in patients with chronic hypercalcemia.
- To determine the association between chronic hypercalcemia and coronary artery calcification and stenosis.
- To identify potential risk factors for accelerated coronary atherosclerosis in hypercalcemic patients.
Main Methods:
- Necropsy examination of 18 patients with chronic hypercalcemia (mean duration 5 years).
- Analysis of cardiac valve anuli, coronary arteries, and myocardial fibers for calcific deposits.
- Comparison of cardiac findings between patients with significant coronary calcification (Group I) and those without (Group II).
- Correlation of cardiac findings with clinical data including serum calcium, cholesterol levels, and heart weight.
Main Results:
- 10 of 18 patients showed cardiac valve anular and coronary arterial calcific deposits.
- Four patients (Group I) had significant coronary artery narrowing, associated with higher serum cholesterol (216 vs 163 mg/dl) and heart weight (426 vs 320 g) compared to Group II.
- Calcium deposition occurred in the media and intima of coronary arteries and in myocardial fibers.
- Coronary intimal calcification was linked to luminal narrowing, especially in patients with cholesterol >200 mg/dl.
Conclusions:
- Chronic hypercalcemia promotes accelerated calcification in cardiac structures, including valves and coronary arteries.
- Coronary intimal calcification in hypercalcemic patients can lead to significant luminal narrowing.
- Chronic hypercalcemia, particularly with elevated cholesterol, acts as a risk factor for accelerated coronary atherosclerosis.
Abstract:
Certain clinical and morphologic cardiac observations are described in 18 necropsy patients, aged 33 to 58 years (mean 45 years) (14 women), with chronic hypercalcemia (11.6 to 34.4 mg/dl [19.4]) from one to nine years (mean five years). Primary hyperparathyroidism was present in nine patients and secondary hyperparathyroidism in the other nine (of renal origin in seven). Cardiac valve anular and coronary arterial calcific deposits were present in 10 patients (Group I) including four (mean age 51 years) with considerable narrowing of two or three of the four major epicardial coronary arteries. None of the other eight patients (Group II) had cardiac valve anular or cuspal calcific deposits; only two had coronary calcific deposits, small in each, and none had significant coronary luminal narrowing. Calcium was in the media ("medial calcinosis"), with or without intimal deposition, of the coronary arteries in five patients. Comparison of the patients in Group I to those in Group II disclosed similar mean ages, durations of hypercalcemia and serum calcium levels, but significantly (p less than 0.05) higher mean total serum cholesterol levels (216 versus 163 mg/dl) and heart weights (426 versus 320 g). This study demonstrates that chronic hypercalcemia is associated with accelerated deposition of calcium in the cardiac anuli and valvular cusps, in the media and intima of the coronary arteries and in individual myocardial fibers (dystrophic calcification), and that coronary intimal calcification may be associated with or produce luminal narrowing, especially in patients with serum total cholesterol levels over 200 mg/dl. Thus, chronic hypercalcemia may be viewed as a "risk factor" to accelerated coronary atherosclerosis.