Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

Abstract

Cardiometabolic disorders have been associated with primary hyperparathyroidism (PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic syndrome (MS) with different clinical presentation of PHPT remains undefined. Our aim was to evaluate CRS, MS and its components in PHPT looking for their correlation to different clinical forms. In 68 consecutive PHPT patients and 68 matched controls, CRS, MS and its components were assessed to perform an observational case-control study at an ambulatory referral center for Bone Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic PHPT; these latter were divided in high-risk and low-risk subgroups for end-organ damage. An increased proportion of PHPT patients had intermediate-high CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and controls without cardiometabolic risk factors, HOMA-IR index was significantly increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted MS after adjusting for age, sex, and BMI. Our data show an increased frequency of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT while MS prevails in low-risk asymptomatic PHPT, supporting the potential for cardiovascular morbidity and mortality also in this form.

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…Moreover, both BMI and the presence of a low-risk asymptomatic PHPT disease predicted MS after adjusting for age and sex (50). In PHPT patients with MS, Delfini et al showed higher mean values of leptin and lower adiponectin serum level compared to controls (78); these findings are interesting because an interaction between adipokines and bone metabolism has been recently suggested in the general population (79).…”

“…The high prevalence of type 2 diabetes mellitus in patients with PHPT was not confirmed in a large cohort of patients, even though the prevalence was still high in a subgroup of older patients and in men (47); differences are probably due to the retrospective nature of the investigation and the lack of appropriate controls (47). More subtle alterations of glucose metabolism, such as glucose intolerance and insulin resistance, have also been described in PHPT patient compared to controls by some (48,49,50), but not by all authors (35). The exact mechanism underlying this association is still unclear.…”

“…In mild PHPT, Luboshitzky et al showed that the prevalence of MS was lower (34.3%) compared to symptomatic PHPT (37.5%) (77); however, Procopio et al reported a significantly higher prevalence (47.6%) in asymptomatic PHPT patients, with low-risk of end-organ damage, compared to symptomatic PHPT (8.7%) (50). Moreover, both BMI and the presence of a low-risk asymptomatic PHPT disease predicted MS after adjusting for age and sex (50).…”

Prevalence of Metabolic Syndrome in Primary Hyperparathyroidism

“…However, Tassone et al (1) suggested that this was caused by significantly higher age of the patients with asymptomatic PHPT included in their study group when compared to symptomatic group (p<0.008). In a study by Procopio et al (8), 68 patients with PHPT and a control group were evaluated in 2013 with regard to the NCEP-ATP III MetS criteria and the prevalence of MetS was detected to be significantly higher in patients with PHPT than in controls (p<0.02). This higher prevalence was more prominent among patients with asymptomatic PHPT.…”

Primary hyperparathyroidism and cardiovascular risk. Is there a connection?

“…Increased PTH seemed to produce smaller ejection fraction and distension of the left ventricle. Smaller studies had the same results [24][25][26][27][28].…”