Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism.
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.


METHODS
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.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. mad2037@columbia.edu
M D
MD
Walker
T
T
Rundek
S
S
Homma
M
M
DiTullio
S
S
Iwata
J A
JA
Lee
J
J
Choi
R
R
Liu
C
C
Zhang
D J
DJ
McMahon
R L
RL
Sacco
S J
SJ
Silverberg
D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000534:rehabilitation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index