Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism

Abstract

Objective We recently demonstrated that mild primary hyperparathyroidism (PHPT) is associated with increased carotid intima-media thickness (IMT) and stiffness, and increased aortic valve calcification. It is unclear whether parathyroidectomy (PTX) improves these abnormalities. The purpose of this study was to determine whether cardiovascular abnormalities in PHPT improve with PTX. Design Forty-four patients with PHPT were studied using carotid ultrasound and transthoracic echocardiography before and after PTX. Carotid IMT, carotid plaque and stiffness, left ventricular mass index (LVMI), myocardial and valvular calcification, and diastolic function were measured before, 1- and 2-year post-PTX. Results Two years after PTX, increased carotid stiffness tended to decline to the normal range (17%, P =0.056) while elevated carotid IMT did not improve. Carotid plaque number and thickness, LVMI and cardiac calcifications did not change after PTX, while some measures of diastolic function (isovolumic relaxation time (IVRT) and tissue Doppler peak early diastolic velocity) worsened within the normal range. Indices did improve in patients with cardiovascular abnormalities at baseline. Increased carotid stiffness improved by 28% (P=0.004), a decline likely to be of clinical significance. More limited improvements also occurred in elevated IMT (3%, P=0.017) and abnormal IVRT (13%, P<0.05), a measure of diastolic dysfunction. Conclusions In mild PHPT, PTX led to modest changes in some cardiovascular indices. Improvements were mainly evident in those with preexisting cardiovascular abnormalities, particularly elevated carotid stiffness. These findings are reassuring with regard to current international guidelines that do not include cardiovascular disease as a criterion for PTX.

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…Mean carotid intima-media thickness (IMT) values, considered a strong predictor of systemic atherosclerosis and cerebrovascular events, have been shown to be elevated by some authors in patients with PHPT (65,99,100,101 (106). In NC-PHPT, mean carotid IMT values were significantly higher (regardless of serum calcium values) compared to controls; PTx led to an improvement in IMT only in hypercalcemic patients and not in NC-PHPT (72).…”

Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test

“…Several studies reported a substantial improvement after PTx in the metabolic and the cardiovascular risk factors, also measured by echocardiogram, while other studies do not support this finding (11,12,13,14,15,16,17,18,19,20,21). Interestingly, there are no studies regarding the effects of PTx on arrhythmic risk, in PHPT patients, evaluated during bicycle ergometry ET.…”

Asymptomatic Primary Hyperparathyroidism

“…Recent observational data in very mild PHPT (mean serum calcium: 10.6 mg/dL) have demonstrated increased aortic valve calcification area, increased aortic and carotid stiffness, as well as increased carotid intima-medial thickness, all preclinical predictors of deleterious cardiovascular outcomes (52-55). There was no evidence of left ventricular hypertrophy or diastolic dysfunction in these patients, and parathyroidectomy did not lead to improvement in the abnormalities in these uncontrolled studies (56).…”