Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism

M. D. Walker, Tatjana Rundek, S. Homma, M. DiTullio, S. Iwata, J. A. Lee, J. Choi, R. Liu, C. Zhang, D. J. McMahon, Ralph L Sacco, S. J. Silverberg

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)277-285
Number of pages9
JournalEuropean Journal of Endocrinology
Volume167
Issue number2
DOIs
StatePublished - Aug 1 2012

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Parathyroidectomy
Primary Hyperparathyroidism
Cardiovascular Abnormalities
Carotid Intima-Media Thickness
Cardiovascular Diseases
Reference Values
Echocardiography
Guidelines

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

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Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. / Walker, M. D.; Rundek, Tatjana; Homma, S.; DiTullio, M.; Iwata, S.; Lee, J. A.; Choi, J.; Liu, R.; Zhang, C.; McMahon, D. J.; Sacco, Ralph L; Silverberg, S. J.

In: European Journal of Endocrinology, Vol. 167, No. 2, 01.08.2012, p. 277-285.

Research output: Contribution to journalArticle

Walker, MD, Rundek, T, Homma, S, DiTullio, M, Iwata, S, Lee, JA, Choi, J, Liu, R, Zhang, C, McMahon, DJ, Sacco, RL & Silverberg, SJ 2012, 'Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism', European Journal of Endocrinology, vol. 167, no. 2, pp. 277-285. https://doi.org/10.1530/EJE-12-0124
Walker, M. D. ; Rundek, Tatjana ; Homma, S. ; DiTullio, M. ; Iwata, S. ; Lee, J. A. ; Choi, J. ; Liu, R. ; Zhang, C. ; McMahon, D. J. ; Sacco, Ralph L ; Silverberg, S. J. / Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. In: European Journal of Endocrinology. 2012 ; Vol. 167, No. 2. pp. 277-285.
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AU - Walker, M. D.

AU - Rundek, Tatjana

AU - Homma, S.

AU - DiTullio, M.

AU - Iwata, S.

AU - Lee, J. A.

AU - Choi, J.

AU - Liu, R.

AU - Zhang, C.

AU - McMahon, D. J.

AU - Sacco, Ralph L

AU - Silverberg, S. J.

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N2 - 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.

AB - 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.

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