title: Large-artery stiffness: a reversible marker of cardiovascular risk in primary hyperparathyroidism.
abstract: OBJECTIVE
  Patients with primary hyperparathyroidism (pHPT) are at increased risk of cardiovascular mortality. We investigated whether aortic stiffness, an early marker of arteriosclerosis and a strong predictor of cardiovascular risk, is increased in pHPT, and whether it improves after parathyroidectomy.
  
  
  METHODS
  Twenty-four patients with mild pHPT (age 56 ± 10 years, blood pressure 136/85 mmHg, serum calcium 2.55-3.00 mmol/L) and 48 control subjects individually matched with cases by age, sex and blood pressure underwent aortic (carotid-femoral) and upper-limb (carotid-radial) pulse wave velocity (PWV) determination by applanation tonometry in a case-control study. Subjects with renal disease, diabetes, treated hypertension or overt cardiovascular disease were excluded from the study. Seventeen of the patients with pHPT were re-examined 4 weeks after surgical parathyroidectomy.
  
  
  RESULTS
  Aortic PWV was significantly higher among pHTP patients (11.4 ± 2 vs 9.6 ± 2 m/s, p<0.001). In a conditional logistic regression analysis, pHPT was independently associated with an increased risk of having an aortic PWV >12 m/s (odds ratio 3.28, 95% confidence interval 1.21-8.93). As expected, surgery was accompanied by a reduction in serum calcium (from 2.77 ± 0.2 to 2.25 ± 0.1 mmol/L, p<0.001) and parathyroid hormone (from 29.6 ± 10 to 3.3 ± 2 pmol/L, p<0.001). Aortic PWV decreased after surgery (from 10.9 ± 2 to 9.8 ± 2 m/s, p=0.003). The change in aortic PWV remained significant also after adjustment for changes in blood pressure (p<0.01). Changes in upper-limb PWV generally paralleled those in aortic PWV.
  
  
  CONCLUSIONS
  pHPT is associated with increased aortic stiffness, which improves after parathyroidectomy. Our data demonstrate that aortic stiffness may improve upon removal of hyperparathyroid stimuli.
authors.affiliation: Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pucci
authors.forename: Matteo
authors.initials: M
authors.lastname: Pirro
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Scarponi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Manfredelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Rondelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology; D001161:Arteriosclerosis / Q000473:pathology; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D012044:Regression Analysis; D012306:Risk; D018401:Sample Size; D016896:Treatment Outcome; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers