Impairment of flow mediated vasodilatation of brachial artery in patients with primary hyperparathyroidism

Baykan, Merih; Erem, Cihangir; Erdoğan, Turan; Hacıhasanoğlu, Arif; Gedikli, Ömer; Kırış, Abdülkadir; Küçükosmanoğlu, Mehmet; Ersöz, Halil Önder; Çelık, Şükrü

doi:10.1007/s10554-006-9166-8

Cited by 45 publications

(30 citation statements)

References 44 publications

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“…Flow-mediated dilatation (FMD) of brachial artery, a 'gold standard' of endothelial dysfunction also considered a surrogate marker of atherosclerosis, has been reported to be impaired in PHPT patients improving after PTx (24, 25). FMD has been shown to be negatively correlated with serum calcium levels (64). In contrast, some authors found no improvement in the FMD 3 years after PTx (26).…”

Section: Atherosclerosismentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

122

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Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

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Section: Atherosclerosismentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

122

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“…3,5,6 Few data are available with regard to large-artery properties in PH. Several studies have investigated endothelial dysfunction, 7,8 augmentation of peripheral pulse waveform 9,10 or the aortic stiffness index 11 in PH. So far, only one study has examined pulse wave velocity (PWV) as a measure of arterial stiffness in normotensive patients with PH.…”

Section: Introductionmentioning

confidence: 99%

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

et al. 2010

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The study was aimed at investigating the arterial stiffness assessed by aortic pulse wave velocity (PWV) in the presence of primary hyperparathyroidism (PH), with and without concomitant hypertension. Subsequently, we examined the effect of parathyroidectomy (PTX) on arterial stiffness. A total of 28 patients with PH and concomitant hypertension, and 16 with PH without hypertension were investigated in comparison with 28 essential hypertensive patients and 18 healthy controls, respectively. Patients were matched for age, blood pressure (BP), body mass index, lipid profile and fasting glucose. Six months after PTX, 15 patients were examined again (hypertensive as well as normotensive). PWV was obtained using the SphygmoCor applanation tonometer (AtCor Medical, West Ryde, Australia). PWV was significantly higher in patients with PH and hypertension when compared with patients with essential hypertension (10.1 vs. 8.5 m s À1 , P¼0.013). PWV remained significant even after adjustment for age and BP (P¼0.02). Similarly, PWV was significantly higher in PH patients without hypertension in comparison with healthy controls (7.6 vs. 5.8 m s À1 , Po0.001). Six months after surgery, in addition to a normalization of calcium metabolism, a significant decrease in systolic BP (131 vs. 123 mm Hg, P¼0.004) and PWV (9.1 vs. 8.5 m s À1 , P¼0.024) was observed. After adjusting for BP reduction, the decrease in PWV appeared non-significant. Our data indicate that PH increases PWV as a marker of arterial stiffness, in both hypertensive and non-hypertensive patients. However, neither the calcium serum level nor the parathyroid hormone level has been associated with PWV. Specific treatment by PTX significantly decreases PWV, which may be determined primarily by improved BP control after surgery.

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“…This condition is mainly due to cardiovascular death (2,3). PHPT is associated with hypertension, coronary heart disease, and other CVDs (7,15,17). There are only two studies to evaluate the hemostatic parameters in patients with PHPT (12,15).…”

Section: Discussionmentioning

confidence: 99%

“…The causes of increased cardiovascular risk associated with PHPT are systemic arterial hypertension (4), left ventricular hypertrophy (5), valvular and myocardial calcification (6), dysfunction in vascular reactivity (7,8), vascular structural changes (9), arrhythmias (10), impaired glucose metabolism (11,12), dyslipidemia (13), and increased body mass index (14). Very recently, changes in coagulation and fibrinolytic systems have been reported in patients PHPT, which might also have a role in the pathogenesis of cardiovascular disease (CVD) in this disease (12,15).…”

Section: Introductionmentioning

confidence: 99%

Increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels in patients with primary hyperparathyroidism

Erem

Koçak²,

Nuhoğlu³

et al. 2009

European Journal of Endocrinology

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Background and objectives: Primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality and morbidity. Little is known about hemostatic features of patients with PHPT. To our knowledge, plasma tissue factor pathway inhibitor (TFPI) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels in these patints have not been investigated. Therefore, the main purpose of this study was to evaluate the markers of endogenous coagulation/fibrinolysis, including TFPI and TAFI, and to investigate the relationships between serum calcium and PTH and these hemostatic parameters in patients with PHPT. Design and methods: Twenty-four patients with PHPT and 20 age-, sex-, and-weight-matched healthy controls were included in the study. Tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor-1 (PAI-1), TFPI, and TAFI were measured. The relationships between serum calcium, phosphorus, and PTH and these hemostatic parameters were examinated. Results: Compared with the control subjects, t-PA, PAI-1, and PAI-1/t-PA ratios were significantly increased in patients with PHPT (P!0.0001), whereas TFPI levels were significantly decreased (P!0.0001). Plasma TAFI Ag levels did not significantly change in patients with PHPT compared with the controls. In patients with PHPT, serum phosphorus was negatively correlated with plasma PAI-1 Ag levels and PAI-1/t-PA ratio (r: K0.453, P!0.05; r: K0.580, P!0.01 respectively). There was a positive correlation between Cl/P ratio and plasma PAI-1 levels and PAI-1/t-PA ratio (r: 0.434, P!0.05; r: 0.528, P!0.05 respectively). iPTH was positively correlated with plasma PAI-1/t-PA ratio (r: 0.429, P!0.05). Interpretation and conclusions: In conclusion, we found some important differences in the hemostatic parameters between the patients with PHPT and healthy controls. Increased PAI-1, PAI-1/t-PA ratios and decreased TFPI levels in these patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess mortality due to cardiovascular disease seen in patients with PHPT.

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Impairment of flow mediated vasodilatation of brachial artery in patients with primary hyperparathyroidism

Cited by 45 publications

References 44 publications

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pulse wave velocity in primary hyperparathyroidism and effect of surgical therapy

Increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels in patients with primary hyperparathyroidism

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