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Evaluation of subclinical coronary atherosclerosis in mild asymptomatic primary hyperparathyroidism patients

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Abstract

Objective Although there is sufficient data supporting the increased cardiovascular risk in patients with advanced stage of primary hyperparathyroidism (pHPT), it is not clear whether same is valid for patients with subclinical forms of this disease. In this study we aimed to evaluate coronary atherosclerosis burden of asymptomatic pHPT patients by using tomographic coronary calcification scoring. Patients and methods Thirty-one mild asymptomatic pHPT patients (28 female, 3 male; mean age: 54.4 ± 12.1 years) and 19 gender- and age-matched normotensive healthy controls (17 female, 2 male; mean age: 50.6 ± 5.8) constituted our study population. Asymptomatic pHPT patients were subdivided according to presence of hypertension (19 hypertensive and 12 non-hypertensive patients). All subjects in study population underwent tomographic coronary calcification scoring by using 16-multidetector computed tomography (16-MDCT). Results Median tomographic coronary calcification score was comparable between the whole group of pHPT patients [0.0 (Interquartile Range, IQR:18.70] and the controls [0.0 (IQR: 0.90). Median tomographic coronary calcification scores of pHPT patients with hypertension was 0.90 (IQR: 75.0) HU, whereas no calcification was noted in coronary arteries of normotensive pHPT patients. Calcification scores of hypertensive pHPT patients were significantly higher than both normotensive pHPT patients (P = 0.014) and controls (P = 0.046). There was no significant difference regarding calcification scores of normotensive pHPT patients versus controls. In the binary logistic regression model, only the presence of hyperlipidemia was found to be independently associated with presence of calcification on coronary arteries (relative risk 6.56, 95% CI 1.18–36.56, P = 0.032). Conclusion These results suggest that mild asymptomatic pHPT with serum calcium levels in the high-normal range does not constitute an independent risk factor for coronary atherosclerosis. The combined presence of classic cardiovascular risk factors determines the severity of coronary atherosclerosis in these patients.

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References

  1. Andersson P, Rydberg E, Willenheimer R (2004) Primary hyperparathyroidism and heart disease- a review. Eur Heart J 25:1776–1787

    Article  CAS  PubMed  Google Scholar 

  2. Hedback G, Tisell LE, Bengtsson BA, Hedman I, Oden A (1990) Premature death in patients operated on for primary hyperparathyroidism. World J Surg 14:829–835

    Article  CAS  PubMed  Google Scholar 

  3. Hedback G, Oden A (1998) Increased risk of death from primary hyperparathyroidism-an update. Eur J Clin Invest 28:271–276

    Article  CAS  PubMed  Google Scholar 

  4. Garcia de la Torre N, Wass JA, Turner HE (2003) Parathyroid adenomas and cardiovascular risk. Endocr Relat Cancer 10:309–322

    Article  CAS  PubMed  Google Scholar 

  5. Silverberg SJ (2000) Editorial: cardiovascular disease in primary hyperparathyroidism. Clin Endocrinol Metab 85:3513–3514

    Article  CAS  Google Scholar 

  6. Kamycheva E, Sundsfjord J, Jorde R (2004) Serum parathyroid hormone levels predict coronary heart disease: the Tromso Study. Eur J Cardiovasc Prev Rehabil 11:69–74

    Article  PubMed  Google Scholar 

  7. Nuzzo V, Tauchmanova L, Fonderico F et al (2002) Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol 147:453–459

    Article  CAS  PubMed  Google Scholar 

  8. Fallo F, Camporese G, Capitelli E, Andreozzi GM, Mantero F, Lumachi F (2003) Ultrasound evaluation of carotid artery in primary hyperparathyroidism. J Clin Endocrinol Metab 88:2096–2099

    Article  CAS  PubMed  Google Scholar 

  9. Rubin MR, Maurer MS, McMahon DJ, Bilezikian JP, Silverberg SJ (2005) Arterial stiffness in mild primary hyperparathyroidism. J Clin Endocrinol Metab 90:3326–3330

    Article  CAS  PubMed  Google Scholar 

  10. Kosch M, Hausberg M, Vormbrock K, Kisters K, Rahn KH, Barenbrock M (2000) Studies on flow-mediated vasodilation and intima-media thickness of the brachial artery in patients with primary hyperparathyroidism. Am J Hypertens 13:759–764

    Article  CAS  PubMed  Google Scholar 

  11. Barletta G, De Feo ML, Del Bene R et al (2000) Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. J Clin Endocrinol Metab 85:1815–1821

    Article  CAS  PubMed  Google Scholar 

  12. Nilsson IL, Aberg J, Rastad J, Lind L (1999) Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy. Surgery 126:1049–1055

    Article  CAS  PubMed  Google Scholar 

  13. Kosch M, Hausberg M, Barenbrock M, Posadzy-Malaczynska A, Kisters K (2001) Rahn KH Arterial distensibility and pulse wave velocity in patients with primary hyperparathyroidism before and after parathyroidectomy. Clin Nephrol 55:303–308

    CAS  PubMed  Google Scholar 

  14. Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114:1761–1791

    Article  PubMed  Google Scholar 

  15. Bilezikian JP, Potts JT, Fuleihan GE et al (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87(12):5353–5361

    Article  CAS  PubMed  Google Scholar 

  16. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  17. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT (2001) Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 87:1335–1339

    Article  CAS  PubMed  Google Scholar 

  18. Richards AM, Espiner EA, Nicholls MG, Ikram H, Hamilton EJ, Maslowski AH (1988) Hormone, calcium and blood pressure relationships in primary hyperparathyroidism. J Hypertens 6:747–752

    Article  CAS  PubMed  Google Scholar 

  19. Palmer M, Adami HO, Bergstrom R, Akerstrom G, Ljunghall S (1987) Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979. Surgery 102:1–7

    CAS  PubMed  Google Scholar 

  20. Soreide JA, van Heerden JA, Grant CS, Yau Lo C, Schleck C, Ilstrup DM (1997) Survival after surgical treatment for primary hyperparathyroidism. Surgery 6:1117–1123

    Article  Google Scholar 

  21. Lundgren E, Lind L, Palmer M, Jakobsson S, Ljunghall S, Rastad J (2001) Increased cardiovascular mortality and normalized serum calcium in patients with mild hypercalcemia followed up for 25 years. Surgery 130:978–985

    Article  CAS  PubMed  Google Scholar 

  22. Leiffson BG, Ahren B (1996) Serum calcium and survival in a large health screening program. J Clin Endocrinol Metab 81:2149–2153

    Article  Google Scholar 

  23. Roberts WA, Waller BF (1981) Effect of chronic hypercalcemia on the heart: an analysis of 18 necropsy patients. Am J Med 71:371–384

    Article  CAS  PubMed  Google Scholar 

  24. Ogard CG, Engelmann MD, Kistorp C, Nielsen SL, Vestergaard H (2005) Increased plasma N-terminal pro-B-type natriuretic peptide and markers of inflammation related to atherosclerosis in patients with primary hyperparathyroidism. Clin Endocrinol 63:493–498

    Article  CAS  Google Scholar 

  25. Watson KE, Abrolat ML, Malone LL et al (1997) Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation 96:1755–1760

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Bascavus Sok. 76/8 Kucukesat, Ankara, 06660, Turkey

    Alper Kepez

  2. Cardiology Clinic, Yunus Emre Public Hospital, Eskisehir, Turkey

    Alper Kepez

  3. Department of Internal Medicine, Division of Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Ayla Harmanci, Mehlika Isıldak & Alper Gürlek

  4. Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Tuncay Hazirolan

  5. Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Ugur Kocabas, Ahmet Ates, Orcun Ciftci & Lale Tokgozoglu

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  1. Alper Kepez
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  2. Ayla Harmanci
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  3. Tuncay Hazirolan
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  4. Mehlika Isıldak
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  9. Alper Gürlek
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Correspondence to Alper Kepez.

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Kepez, A., Harmanci, A., Hazirolan, T. et al. Evaluation of subclinical coronary atherosclerosis in mild asymptomatic primary hyperparathyroidism patients. Int J Cardiovasc Imaging 25, 187–193 (2009). https://doi.org/10.1007/s10554-008-9369-2

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  • DOI: https://doi.org/10.1007/s10554-008-9369-2

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