Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

Osto, Elena; Fallo, Francesco; Pelizzo, Maria Rosa; Maddalozzo, Anna; Sorgato, Nadia; Corbetti, Francesco; Montisci, Roberta; Famoso, Giulia; Bellù, Roberto; Lüscher, Thomas F.; Iliceto, Sabino; Tona, Francesco

doi:10.1161/circulationaha.111.081307

Cited by 72 publications

(44 citation statements)

References 51 publications

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“…Present results show that PHPT patients, independently of clinical presentation, bear an enhanced intermediate-high CRS in comparison to controls; these new data are in accord with previous studies reporting an increased coronary artery and cerebrovascular morbidity in PHPT [3,4,12].…”

Section: Discussionsupporting

confidence: 92%

“…Among cardiovascular alterations, increased arterial stiffness and carotid intima-media thickness, endothelial dysfunction, hypertension, left ventricular hypertrophy, and diastolic dysfunction have been reported [4,5]. Among metabolic disorders, impaired insulin sensitivity, high prevalence of type 2 diabetes mellitus (Type 2 DM), dyslipidemia, hyperuricemia, increased body weight, and metabolic syndrome (MS) have been shown [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Among metabolic disorders, impaired insulin sensitivity, high prevalence of type 2 diabetes mellitus (Type 2 DM), dyslipidemia, hyperuricemia, increased body weight, and metabolic syndrome (MS) have been shown [6][7][8][9][10][11][12]. So far, it remains to be fully elucidated the pathogenetic link between PHPT and cardiometabolic morbidity and mortality which might be ascribed potentially to the contributory role of hypercalcemia, high serum PTH levels and vitamin D deficiency [4,6,13,14] .…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

et al. 2013

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Cardiometabolic disorders have been associated with primary hyperparathyroidism (PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic syndrome (MS) with different clinical presentation of PHPT remains undefined. Our aim was to evaluate CRS, MS and its components in PHPT looking for their correlation to different clinical forms. In 68 consecutive PHPT patients and 68 matched controls, CRS, MS and its components were assessed to perform an observational case-control study at an ambulatory referral center for Bone Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic PHPT; these latter were divided in high-risk and low-risk subgroups for end-organ damage. An increased proportion of PHPT patients had intermediate-high CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and controls without cardiometabolic risk factors, HOMA-IR index was significantly increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted MS after adjusting for age, sex, and BMI. Our data show an increased frequency of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT while MS prevails in low-risk asymptomatic PHPT, supporting the potential for cardiovascular morbidity and mortality also in this form.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

et al. 2013

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“…Patients with abnormal CFR who consented underwent MSCT coronary angiography to exclude epicardial significant CAD, as previously described [14].…”

Section: Methodsmentioning

confidence: 99%

“…Coronary flow reserve (CFR) by transthoracic Doppler echocardiography (TDE) may provide functional assessment of the microvascular function [13]. As reported in other diseases [14,15], CFR may become of clinical relevance in the management, treatment, and risk assessment of MPN in its asymptomatic initial phase. Accordingly, the aim of the present study was to evaluate the coronary microvascular function, assessed by CFR by TDE, in healthy subjects and in patients with ET and PV without evidence of CAD.…”

Section: Introductionmentioning

confidence: 99%

Coronary microvascular dysfunction due to essential thrombocythemia and policythemia vera: The missing piece in the puzzle of their increased cardiovascular risk?

Vianello¹,

Cella

Osto³

et al. 2014

American J Hematol

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Myeloproliferative neoplasms are most commonly associated with venous thrombosis. Up to 60% of patients experience a thrombotic event in their lifetimes, including stroke or myocardial infarction. It is unclear whether pathogenetic factors linking essential thrombocythemia (ET) and polycythemia vera (PV) to thrombotic complications do play a role in the risk of coronary artery disease (CAD). We aimed to assess coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic patients with ET and PV. Fifty-two patients with ET (M/F 13/39, age 61 ± 7 years) and 22 patients with PV (M/F 13/9, age 60.4 ± 13 years) without clinical evidence of heart disease, and 50 controls matched for age and gender were studied. None had CAD. All control subjects were asymptomatic with no history of heart disease. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. In patients with ET and PV, CFR was lower than in controls (2.9 ± 0.94 and 2.2 ± 0.7 vs. 3.8 ± 0.7, P < 0.004 and P < 0.0001 respectively). The prevalence of CFR ≤ 2.5 was higher in patients with ET (20 cases, 38.5%) and PV (15 cases, 68.2%) compared with controls (4.1%) (P < 0.0001). Severe CFR (CFR < 2) impairment was found in eight patients with ET (15.4%), in nine patients with PV (40.9%), and in none of control subjects. The mutation of JAK2 gene was associated with abnormal CFR. Asymptomatic patients with ET and PV have coronary microvascular dysfunction in the absence of clinical conditions suggesting CAD

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PTH and Vitamin D

Khundmiri

Murray

Lederer

2016

Comprehensive Physiology

234

158

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PTH and Vitamin D are two major regulators of mineral metabolism. They play critical roles in the maintenance of calcium and phosphate homeostasis as well as the development and maintenance of bone health. PTH and Vitamin D form a tightly controlled feedback cycle, PTH being a major stimulator of vitamin D synthesis in the kidney while vitamin D exerts negative feedback on PTH secretion. The major function of PTH and major physiologic regulator is circulating ionized calcium. The effects of PTH on gut, kidney, and bone serve to maintain serum calcium within a tight range. PTH has a reciprocal effect on phosphate metabolism. In contrast, vitamin D has a stimulatory effect on both calcium and phosphate homeostasis, playing a key role in providing adequate mineral for normal bone formation. Both hormones act in concert with the more recently discovered FGF23 and klotho, hormones involved predominantly in phosphate metabolism, which also participate in this closely knit feedback circuit. Of great interest are recent studies demonstrating effects of both PTH and vitamin D on the cardiovascular system. Hyperparathyroidism and vitamin D deficiency have been implicated in a variety of cardiovascular disorders including hypertension, atherosclerosis, vascular calcification, and kidney failure. Both hormones have direct effects on the endothelium, heart, and other vascular structures. How these effects of PTH and vitamin D interface with the regulation of bone formation are the subject of intense investigation.

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Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

Cited by 72 publications

References 51 publications

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

Coronary microvascular dysfunction due to essential thrombocythemia and policythemia vera: The missing piece in the puzzle of their increased cardiovascular risk?

PTH and Vitamin D

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