Mild Primary Hyperparathyroidism: Vitamin D Deficiency and Cardiovascular Risk Markers

Farahnak, Parastou; Lärfars, Gerd; Sten-Linder, Margareta; Nilsson, Inga-Lena

doi:10.1210/jc.2011-0238

Cited by 60 publications

(59 citation statements)

References 47 publications

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“…Considering mild PHPT patients, an increased insulin resistance (HOMA IR) and lower quantitative insulin sensitivity check index (QUICKI) compared to controls, has been reported by some investigators (54); however, these findings were not confirmed by Gianotti et al (56). PTx in patients with mild PHPT showed no improvement in insulin sensitivity after one year (57,58,59) or 2 years (41). In patients with asymptomatic PHPT, a conservative follow-up of 18 months showed no progression of calcium and glucose metabolism abnormalities (60).…”

Section: Glucose Metabolismmentioning

confidence: 96%

“…Limited data exist on the effect of PTx on blood pressure in patients with mild PHPT; blood pressure was reduced one year after surgical intervention in one study (38) while it remained stable after 6 months in another investigation (39,40). It should be noted that the only randomized two-year duration study in mild PHPT patients showed neither benefit after PTx nor a deleterious effect on blood pressure with conservative management (41).…”

Section: Hypertensionmentioning

confidence: 99%

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Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

120

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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: Glucose Metabolismmentioning

confidence: 96%

Section: Hypertensionmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

120

View full text Add to dashboard Cite

show abstract

“…Also, we used an echo machine HP 5500, which has a better resolution. In a recent study by Farahnak et al, 21,22 they concluded that mild HPT patients did not differ from healthy controls for cardiovascular risk and observed no differences in systolic or diastolic functions or in cardiac morphology between the PHPT patients and the age-matched healthy controls. At baseline, the level of 25-OHD was significantly lower in patients in comparison with controls (40.1 ± 16.5), but still very high from our patients.…”

Section: Discussionmentioning

confidence: 94%

Assessment of Cardiovascular System Abnormalities in Patients with Advanced Primary Hyperparathyroidism by Detailed Echocardiographic Analysis: A Prospective Study

Mishra¹,

Agarwal²,

Mishra³

et al. 2017

World Journal of Endocrine Surgery

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Aim: Recognizing the paucity of data regarding the incidence of cardiovascular abnormalities in severe primary hyperparathyroidism (PHPT), a prospective study was done for left ventricular (LV) systolic and diastolic function by echocardiography in patients with hyperparathyroidism (HPT) before surgery. Materials and methods:A total of 18 consecutive patients with HPT and an equal number of age-and sex-matched controls were studied by two-dimensional and Doppler echocardiography.Results: Patients with HPT had higher systolic and diastolic blood pressures (BPs). Despite severe bone disease, nephropathy, and vitamin D deficiency, none had metastatic calcification in myocardium. There was no significant increase in LV systolic dimensions and volume, but decreased ejection fraction (EF) and significant diastolic dysfunction were observed. Conclusion:Despite an asymptomatic cardiac status, there were decreased EF and significant diastolic dysfunction. The HPT patients despite having severe disease, did not have metastatic calcification.

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“…Higher serum 25(OH)D concentrations increase the absorption of intestinal calcium, which may bind to fatty and bile acids and form insoluble lipid-calcium complexes, thereby inhibiting the absorption of cholesterol and increasing fecal excretion [36]. Elevated PTH levels associated with low serum 25(OH)D concentrations may also account for this association, because higher triglycerides levels has also been observed in states of hyperparathyroidism [37].…”

Section: Discussionmentioning

confidence: 99%

Independent factors associated with serum levels of 25- Hydroxyvitamin D in very elderly Chinese males

Bian¹,

Shou²,

Wang³

et al. 2017

Rheumatol Orthop Med

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Background: Vitamin D deficiency has been associated with a wide variety of chronic diseases and even all-cause mortality. Data on serum 25-hydroxyvitamin D [25(OH)D] and its independent factors in very elderly (aged 80 years or more) males remain to be fully explored. This study was designed to identify independent factors associated with the serum levels of 25(OH)D in very elderly Chinese males.

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Mild Primary Hyperparathyroidism: Vitamin D Deficiency and Cardiovascular Risk Markers

Abstract: Except for a lower 25-OH-D level and slightly higher systolic BP and TG levels, patients with mild PHPT without other CV risk factors did not differ from healthy controls as regards biomarkers predicting CV diseases. PTX had an overall positive effect on TG level, BP, and vitamin D status.

Cited by 60 publications

References 47 publications

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Assessment of Cardiovascular System Abnormalities in Patients with Advanced Primary Hyperparathyroidism by Detailed Echocardiographic Analysis: A Prospective Study

Independent factors associated with serum levels of 25- Hydroxyvitamin D in very elderly Chinese males

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