Aortic Valve Calcification in Mild Primary Hyperparathyroidism

Iwata, Shinichi; Walker, Marcella D.; Tullio, Marco R. Di; Hyodo, Eiichi; Jin, Zhezhen; Li, Rui; Sacco, Ralph L.; Homma, Shunichi; Silverberg, Shonni J.

doi:10.1210/jc.2011-2107

Cited by 70 publications

(40 citation statements)

References 31 publications

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“…Indeed, valvular and annular calcification exhibit histopathologic features of bone formation and remodeling. (7–9) and have been linked to Vitamin D receptor polymorphisms,(36) parathyroid gene variants,(37) hyperparathyroidism,(38) and serum phosphate levels. (39) Furthermore, inflammation may link the pathophysiology of the skeletal and cardiovascular systems, as pro-inflammatory cytokines acting to promote bone resorption instead act to activate osteogenic programs in vascular and valvular smooth muscle cells and myofibroblasts.…”

Section: Discussionmentioning

confidence: 99%

Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

Massera

Bartz

et al. 2017

Arch Osteoporos

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Introduction The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. Methods: We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1,497 older adults from the Cardiovascular Health Study. The adjusted association of BMD with aortic valve calcification (AVC), aortic annular calcification (AAC) and mitral annular calcification (MAC) was assessed with relative risk (RR) regression. Results Mean (SD) age was 76.2 (4.8) years; 58% were women. Cardiac calcification was highly prevalent in women and men: AVC, 59.5% and 71.0%; AAC 45.1% and 46.7%; MAC 42.8% and 39.5%, respectively. After limited and full adjustment for potential confounders, no statistically significant associations were detected between continuous BMD at either site and the three measures of calcification. Assessment of WHO BMD categories revealed a significant association between osteoporosis at the total hip and AVC in men (adjusted RR compared with normal BMD=1.24 [1.01–1.53]). In graded sensitivity analyses, there were apparent inverse associations between femoral neck BMD and AVC with stenosis in men, and femoral neck BMD and moderate/severe MAC in women, but these were not significant. Conclusion These findings support further investigation of the sex-specific relationships between low BMD and cardiac calcification, and whether processes linking the two could be targeted for therapeutic ends.

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Section: Discussionmentioning

confidence: 99%

Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

Massera

Bartz

et al. 2017

Arch Osteoporos

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“…PHPT appears to be associated with an increased risk of developing left ventricular hypertrophy, impaired diastolic filling, and myocardial calcification [42–44]. Yu et al [45] observed in a retrospective population-based study in Tayside, Scotland, that mild PHPT (calcium <2.9 mmol/L) also was associated with an increased risk of cardiovascular and cerebrovascular disease in comparison to the age- and sex-matched general population and that this increase in mortality was similar to those with symptomatic or severe disease.…”

Section: Presentationmentioning

confidence: 99%

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

et al. 2016

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The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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“…Interestingly, the only paper published after 2008 on this topic showed that in mild PHPT, aortic calcification was predicted by PTH and not by calcium levels, after corrections for well-known cardiovascular risk factors (88). So far, there are no studies in NC-PHPT regarding structural heart involvement.…”

Section: Structural Heart Involvementmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

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Aortic Valve Calcification in Mild Primary Hyperparathyroidism

Abstract: Mild PHPT is associated with subclinical aortic valve calcification. PTH, but not serum calcium concentration, predicted aortic valve calcification. PTH was a more important predictor of aortic valve calcification than well-accepted cardiovascular risk factors.

Cited by 70 publications

References 31 publications

Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

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