title: Arterial structure and function in mild primary hyperparathyroidism is not directly related to parathyroid hormone, calcium, or vitamin D.
abstract: OBJECTIVE
  Elevated levels of calcium and parathyroid hormone (PTH), characteristics of primary hyperparathyroidism (PHPT), may be associated with cardiovascular morbidity and mortality in the general population. We evaluated the possible vascular effects of these risk factors in patients with mild PHPT by using standard methods and new imaging techniques.
  
  
  METHODS
  A prospective case-control study.
  
  
  METHODS
  Forty-eight patients with mild PHPT without any known cardiovascular risk factors were studied at baseline and at one year after parathyroidectomy (PTX) in comparison with 48 healthy age- and gender-matched controls. We measured biochemical variables, augmentation index (AIx), aortic pulse wave velocity (PWV(ao)), radial (IMT(rad)) and common carotid artery (IMT(cca)) intima media thicknesses, and the grayscale median (IM-GSM) of the latter.
  
  
  RESULTS
  No significant differences were observed between PHPT patients and controls at baseline for AIx (28.6±12.2 vs. 27.7±12.8%), IMT(rad) (0.271±0.060 vs. 0.255±0.053 mm), IMT(cca) (0.688±0.113 vs. 0.680±0.135 mm), or IM-GSM (82.3±17.2 vs. 86.5±15.3), while PWV(ao) was slightly higher in patients (8.68±1.50 vs. 8.13±1.55, p<0.05). Systolic blood pressure (SBP), calcium, and PTH were higher in patients compared with controls, and decreased after PTX, while vitamin D was lower in patients and increased after PTX. While AIx, PWV(ao), IMT(rad), and IMT(cca) were related to SBP, neither correlated to vitamin D levels. Only PWV(ao) correlated weakly to plasma PTH (r = 0.29, p<0.01) and ionized calcium (r = 0.22, p<0.05) but showed no relation when age and SBP were adjusted for.
  
  
  CONCLUSIONS
  We found normal arterial function despite high calcium, PTH, and low vitamin D levels, in patients with mild PHPT without cardiovascular risk factors. The cardiovascular risk associated with low vitamin D and/or high PTH and calcium levels may be explained by their coupling to blood pressure and other risk factors rather than direct effects on arterial structure.
authors: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. margareta.ring@ki.se
authors: Margareta
authors: M
authors: Ring
authors: Parastou
authors: P
authors: Farahnak
authors: Tomas
authors: T
authors: Gustavsson
authors: Inga-Lena
authors: IL
authors: Nilsson
authors: Maria J
authors: MJ
authors: Eriksson
authors: Kenneth
authors: K
authors: Caidahl
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000473:pathology* / Q000503:physiopathology*; D002118:Calcium / Q000378:metabolism; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D016105:Parathyroidectomy; D017534:Radial Artery / Q000473:pathology / Q000503:physiopathology; D012044:Regression Analysis; D017539:Tunica Intima / Q000473:pathology / Q000503:physiopathology; D014807:Vitamin D / Q000378:metabolism; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium