Cardiovascular Events before and after Surgery for Primary Hyperparathyroidism

Abstract

Cardiovascular disease [atherosclerosis and subsequent myocardial infarction (MI)] has been associated with primary hyperparathyroidism. We aimed at studying cardiovascular events before and after surgery and mortality after surgery for primary hyperparathyroidism using a historical follow-up design. A total of 674 patients who underwent surgery at three Danish centers between January 1, 1979 and December 31, 1997 were compared with 2021 age-and gender-matched controls. There was an increased incidence of acute MI up to 10 years prior to surgery [relative risk (RR) 2.5, 95% confidence interval (95% CI) 1.5-4.2] and within the first year following surgery (RR 3.6, 95% CI 1.7-7.6). The risk of MI subsequently declined to a normal level more than 1 year after surgery. Patients with MI prior to diagnosis also had a higher postoperative risk of new infarction than did patients without [odds ratio (OR) 6.0, 95% CI 1.2-30.0]. The risk of hypertension, stroke, congestive heart failure, and diabetes was increased before surgery. More than 1 year after surgery only hypertension and congestive heart failure were more frequent in patients than controls. Preoperative cardiovascular disease was associated with an increased risk of death (RR 1.8, 95% CI 1.1-2.8). Mortality following surgery was higher than in the general population between 1979 and 1990 but not between 1991 and 1997. We concluded that there was an increase in acute MI up to 10 years prior to surgery. The risk of MI decreased to a normal level after surgery, which may be important for preventing cardiovascular disease in patients with primary hyperparathyroidism.

Interactions between adrenal-regulatory and calcium-regulatory hormones in human health

“…PHPT has been associated with hypertension [42, 43], coronary artery disease [44, 45], left ventricular hypertrophy [46, 47], and mortality [48–50]. Given the challenge of demonstrating a reversible effect on cardiovascular mortality, controlled interventional studies have assessed several intermediate cardiovascular phenotypes, including hypertension [51, 52] and arterial stiffness, and demonstrated improvement following parathyroidectomy [53, 54].…”

Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications

“…The authors postulated that calcium supplements may acutely elevate serum calcium levels [29] and, as a result, may enhance vascular calcification [28]. In fact, in a number of observational studies, high serum calcium levels have been associated with vascular calcification and an increased risk of vascular events, including myocardial infarction, stroke and death [30, 31]. Further support for a potentially deleterious effect of an acute increase in serum calcium comes from the observation that, in the meta-analysis, dietary intake was not associated with myocardial infarction, in line with observations that calcium from dairy products hardly affects serum calcium levels [27].…”

Parathyroid Surgery in the Elderly

“…Several European studies have reported an increased mortality risk in patients with untreated PHPT related to cardiovascular conditions including MI, angina, hypertension, congestive heart failure, and arrhythmias [38, 39]. Hedback and Oden studied 4,461 patients operated on for PHPT in Sweden over an 8-year period, control matched with the whole population of Sweden for age, sex, and calendar year.…”

“…A follow-up study to determine the influence of BMD on fracture risk post-PTx found that compared with observation, PTx decreased the risk of fracture in patients with normal, osteopenic, and osteoporotic BMD values, with the largest impact being in patients with osteoporosis [58]. A large, Danish observational study that followed 1,200 PHPT patients, each compared with three age- and gender-matched controls, failed to demonstrate an effect of surgery on fracture risk [39]. However, in a similar nationwide Danish cohort study, patients with PHPT who underwent surgery had a lower fracture risk than those treated conservatively [58].…”

“…They identified an increased risk of acute MI starting a decade prior to surgery, declining to a normal level 1 year following surgery (preoperative RR 1.9, 95% CI 1.2–3.0; 1 year postoperative RR 0.9, 95% CI 0.5–1.5). Patients with cardiovascular disease experienced an increased mortality, with hypertension being the main factor in the excess mortality (RR 2.29, 95% CI 1.09–4.82) [39]. The findings have not been replicated outside of Scandinavia.…”