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Parathyroidectomy may decrease short-term CV risk markers in primary hyperparathyroidism
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Patients with mild to moderate hyperparathyroidism who underwent parathyroidectomy experienced a decrease in total cholesterol and reduced pulse wave velocity vs. controls who delayed surgery for 3 months, suggesting a possible benefit in short-term cardiovascular risk with surgery, according to findings from a randomized controlled trial.
Since the presentation of primary hyperparathyroidism has changed to become less symptomatic, more attention has been paid to subclinical CV abnormalities, such as increased arterial stiffness, in patients who undergo parathyroidectomy, Henriette Ejlsmark-Svensson, a doctoral student in the department of endocrinology and internal medicine at Aarhus University Hospital, Denmark, and colleagues wrote in the study background.
“A few prospective studies have reported increased arterial stiffness in patients with [primary hyperparathyroidism] compared to healthy controls and a decrease (better) arterial stiffness following parathyroidectomy, whereas no associations have been reported by other investigators,” Ejlsmark-Svensson and colleagues wrote. “However, effects of [parathyroidectomy] on arterial stiffness have not been associated in a randomized clinical trial.”
Researchers analyzed data from 79 patients with hyperparathyroidism who were eligible for parathyroidectomy and referred to Aarhus University Hospital between Feb. 1, 2017, and April 1, 2018 (median age, 64 years; 72% women). Researchers randomly assigned patients to a group in which parathyroidectomy was performed as soon as possible after randomization (surgery group) or to a group in which parathyroidectomy was performed 3 months after study enrollment (controls). Researchers measured levels of plasma calcium, magnesium, phosphate, triglycerides, lipid profile, intact parathyroid hormone and plasma 25-hydroxyvitamin D at baseline and 3 months, as well as ambulatory 24-hour blood pressure, carotid-to-femoral pulse wave velocity and bone mineral density at the lumbar spine, total hip and forearm via DXA.
At baseline, the mean level of ionized calcium for the cohort was 1.41 mmol/L, and mean level of parathyroid hormone was 10.4 pmol/L; 53% of patients had hypertension and 28% used cholesterol-lowering drugs. Among the 75 patients who underwent surgery, 36% had an ionized calcium level of at least 1.45 mmol/L. Mean baseline pulse wave velocity was 9.1 m/s.
Researchers did not observe any between-group differences in pulse wave velocity between baseline and end of study, with results persisting after adjustment for heart rate and mean arterial BP. However, among patients with an elevated plasma ionized calcium level, pulse wave velocity decreased 3 months after surgery when compared with controls (mean, –4.4% vs. 3%; P = .02), with results again persisting after adjustment for heart rate and mean arterial BP.
There were no between-group differences in measurements of systolic and diastolic BP; however, during the study, 24-hour diastolic BP decreased among controls when compared with changes in the surgery group (mean, –3.4% vs. 0.51%; P = .03), with results persisting after adjusting for age and use of antihypertensive medication. There were no between-group changes observed for 24-hour systolic BP or mean arterial BP.
After parathyroidectomy, researchers observed a decrease in total cholesterol among those in the surgery group vs. controls (mean, –0.24% vs. 5.25%; P = .04). There were no between-group differences for other lipid parameters, and results persisted after excluding patients who discontinued or initiated statin therapy, according to researchers.
In linear regression analyses, researchers found that heart rate and mean arterial BP were not associated with levels of pulse wave velocity, ionized calcium or parathyroid hormone after accounting for age.
The researchers noted that inclusion of participants for the study was difficult, as many refused to postpone parathyroidectomy surgery for 3 months, possibly making the study underpowered to detect changes in arterial stiffness and BP. Additionally, the conclusions are limited to patients with mild to moderate disease.
“Our findings suggest a potential beneficial effect of [parathyroidectomy] on plasma levels of total cholesterol, whereas ambulatory diastolic blood pressure may increase following [parathyroidectomy],” the researchers wrote. “[Primary hyperparathyroidism] patients with non-mild hypercalcemia may benefit from [parathyroidectomy] in terms of reduced [pulse wave velocity].” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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