Evaluation of coronary calcium score in patients with normocalcemic primary hyperparathyroidism

Abstract

RationaleGiven that the diagnosis of primary hyperparathyroidism (PHPT) is given at an increasingly less-symptomatic phase, and the literature data on the cardiovascular risk of patients with normocalcemic primary hyperparathyroidism (NPHPT) are controversial, the coronary calcium score (CCS), which is correlated with coronary artery disease, may be useful for clarifying the association between cardiovascular risk and NPHPT.ObjectiveThis research aims to describe the CCS and the clinical and laboratory variables of patients with NPHPT compared with a control group and to verify the presence of an association between NPHPT and CCS.Study population and methodsA questionnaire on anthropometric data (weight, height, waist circumference, and blood pressure) was used, laboratory examinations (estimations of glucose, glycated hemoglobin [HbA1c], total cholesterol [TC] and its fractions, triglycerides, creatinine, calcium, parathyroid hormone, and 25-OH vitamin D) were conducted, and computerized tomography was carried out to measure the CCS in 13 patients diagnosed with NPHPT and 16 controls.ResultsThere was no association between NPHPT and altered CCS (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.05–1.26; p=0.095). Differences between the case and control groups were found in terms of body mass index (BMI) (26.97 kg/m2 vs 31.53 kg/m2, respectively; p=0.044), HbA1c (5.59% vs 6.62%; p=0.000), and TC (188.07 mg/dL vs 220.64 mg/dL; p=0.088). After adjustment for potential confounders, no statistical significance was observed for the association between changes in CCS and presence of NPHPT (adjusted OR: 1.64; 95% CI: 0.1–26.43; p=0.726).ConclusionNo association was found between the CCS and the presence of NPHPT.

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

“…( 49 ) NHPT does not appear to be associated with ischemic heart disease, as one study excluded an influence of NHPT on the coronary calcium score, which has been correlated with coronary artery disease. ( 50 ) Another recent study showed no improvement in cerebrovascular or neuropsychological function in patients with NHPT after parathyroidectomy. ( 51 )…”

Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

“…42 However, a recent study compared the two variants and found that a cohort of patients with normocalcaemic primary hyperparathyroidism had more prominent coronary artery calcification than those with the hypercalcaemic form of the disease, 43 although other data suggest the lack of an association. 44 Beysel et al conducted a small case-control study (n = 95) that challenges these findings: patients with normocalcaemic and age-and sex-matched hypercalcaemic PHPT were found to have similarly elevated blood pressure, glucose, insulin, HOMA-IR (homeostatic model assessment of insulin resistance), lipid profiles and cardiovascular risk scores (P > .05) when compared with controls (P < .05). 45 Because the normocalcaemic group was made up of only 35 patients, it is unclear how generalizable these findings are to all patients with normocalcaemic hyperparathyroidism.…”

Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach

“…One study [ 42 ] showed that blood pressure, serum cholesterol, and homeostatic model assessment-insulin resistance (HOMA-IR) improved after parathyroidectomy. In contrast, another study [ 43 ], which evaluated the coronary calcium score did not find an association between NHPT and coronary artery disease. A recent study [ 44 ] compared 17 postmenopausal women with NHPT to 20 women with traditional PHPT and 20 controls.…”