Carotid vascular abnormalities in primary hyperparathyroidism

M. D. Walker, J. Fleischer, Tatjana Rundek, D. J. McMahon, S. Homma, Ralph L Sacco, Shonni J. Silverberg

Research output: Contribution to journalArticle

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Abstract

Context: Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting. Objective: This study evaluated carotid structure and function in PHPT patients compared with population-based controls. Design: This is a case-control study. Setting: The study was conducted in a university hospital metabolic bone disease unit. Participants: Forty-nine men and women with PHPT and 991 controls without PHPT were studied. Outcome Measures: We measured carotid intima-media thickness (IMT), carotid plaque presence and thickness, and carotid stiffness, strain, and distensibility. Results: IMT, carotid plaque thickness, carotid stiffness, and distensibility were abnormal in PHPT patients, and IMT was higher in patients than controls (0.959 vs. 0.907 mm, P = 0.0001). In PHPT, PTH levels, but not calcium concentration, predicted carotid stiffness (P = 0.04), strain (P = 0.06), and distensibility (P = 0.07). Patients with increased carotid stiffness had significantly higher PTH levels than did those with normal stiffness (141 ± 48 vs. 94.9 ± 44 pg/ml, P = 0.002), and odds of abnormal stiffness increased 1.91 (confidence interval = 1.09-3.35; P = 0.024) for every 10 pg/ml increase in PTH, adjusted for age, creatinine, and albumin-corrected calcium. Conclusions: Mild PHPT is associated with subclinical carotid vascular manifestations. IMT, a predictor of cardiovascular outcomes, is increased. Measures of carotid stiffness are associated with extent of PTH elevation, suggesting that those with more severe PHPT may have impaired vascular compliance and that PTH, rather than calcium, is the mediator.

Original languageEnglish
Pages (from-to)3849-3856
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume94
Issue number10
DOIs
StatePublished - Oct 19 2009

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Primary Hyperparathyroidism
Blood Vessels
Stiffness
Carotid Intima-Media Thickness
Calcium
Population Control
Metabolic Bone Diseases
Albumins
Creatinine
Bone
Compliance
Case-Control Studies
Cardiovascular Diseases
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Carotid vascular abnormalities in primary hyperparathyroidism. / Walker, M. D.; Fleischer, J.; Rundek, Tatjana; McMahon, D. J.; Homma, S.; Sacco, Ralph L; Silverberg, Shonni J.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 94, No. 10, 19.10.2009, p. 3849-3856.

Research output: Contribution to journalArticle

Walker, M. D. ; Fleischer, J. ; Rundek, Tatjana ; McMahon, D. J. ; Homma, S. ; Sacco, Ralph L ; Silverberg, Shonni J. / Carotid vascular abnormalities in primary hyperparathyroidism. In: Journal of Clinical Endocrinology and Metabolism. 2009 ; Vol. 94, No. 10. pp. 3849-3856.
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AU - Fleischer, J.

AU - Rundek, Tatjana

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AU - Homma, S.

AU - Sacco, Ralph L

AU - Silverberg, Shonni J.

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N2 - Context: Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting. Objective: This study evaluated carotid structure and function in PHPT patients compared with population-based controls. Design: This is a case-control study. Setting: The study was conducted in a university hospital metabolic bone disease unit. Participants: Forty-nine men and women with PHPT and 991 controls without PHPT were studied. Outcome Measures: We measured carotid intima-media thickness (IMT), carotid plaque presence and thickness, and carotid stiffness, strain, and distensibility. Results: IMT, carotid plaque thickness, carotid stiffness, and distensibility were abnormal in PHPT patients, and IMT was higher in patients than controls (0.959 vs. 0.907 mm, P = 0.0001). In PHPT, PTH levels, but not calcium concentration, predicted carotid stiffness (P = 0.04), strain (P = 0.06), and distensibility (P = 0.07). Patients with increased carotid stiffness had significantly higher PTH levels than did those with normal stiffness (141 ± 48 vs. 94.9 ± 44 pg/ml, P = 0.002), and odds of abnormal stiffness increased 1.91 (confidence interval = 1.09-3.35; P = 0.024) for every 10 pg/ml increase in PTH, adjusted for age, creatinine, and albumin-corrected calcium. Conclusions: Mild PHPT is associated with subclinical carotid vascular manifestations. IMT, a predictor of cardiovascular outcomes, is increased. Measures of carotid stiffness are associated with extent of PTH elevation, suggesting that those with more severe PHPT may have impaired vascular compliance and that PTH, rather than calcium, is the mediator.

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