Hemodynamic Markers and Subclinical Atherosclerosis in Postmenopausal Women With Primary Hyperparathyroidism

Stamatelopoulos, Kimon; Athanasouli, Fani; Παππά, Θεοδώρα; Labrinoudaki, Irene; Papamichael, Christos; Polymeris, Antonis; Georgiopoulos, Georgios; Vemmou, Anastasia; Sarika, Leda; Terpos, Evangelos; Alevizaki, Maria

doi:10.1210/jc.2013-4273

Cited by 25 publications

(24 citation statements)

References 38 publications

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“…Their study group consisted of 53 patients with PHPT, FMD measurements were lower than the control group, and a significant improvement was detected postoperatively in 20 patients who had undergone surgery . In contrast to our study, studies by Neunteulf, Carrelli and Stamatelopoulos did not show FMD decrements in patients with PHPT . While the two former studies could be criticized concerning the appropriateness of their control groups, the latter study's results cannot be generalized to the entire population as all of the patients were women.…”

Section: Discussioncontrasting

confidence: 94%

Is primary hyperparathyroidism a cause of endothelial dysfunction?

Çolak

Aydoğan

Canpolat

et al. 2017

Clinical Endocrinology

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Section: Discussioncontrasting

confidence: 94%

Is primary hyperparathyroidism a cause of endothelial dysfunction?

Çolak

Aydoğan

Canpolat

et al. 2017

Clinical Endocrinology

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“…Their data are in line with several previous studies that reported an increased coronary artery and cerebrovascular morbidity in PHPT [7,8]. By means of a multivariate analysis, they also showed that, PHPT status predicts the presence of intermediate-high CRS and metabolic syndrome [9], while elevated calcium levels predict altered glucose tolerance among the components of metabolic syndrome.…”

supporting

confidence: 89%

Emerging data on cardiovascular risk in primary hyperparathyroidism

et al. 2014

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The cardiovascular risk profile of patients affected by primary hyperparathyroidism (PHPT) has been an issue of debate over the last years. Studies regarding the potential damages caused by increased serum levels of parathyroid hormone (PTH) and/or calcium, have yielded controversial results, suggesting either the presence or the absence of damage [1,2].It is interesting to note that the answer to this question is further complicated by the changing clinical presentation of PHPT over the last decade. Indeed, once considered a symptomatic disorder characterized by significant hypercalcemia with kidney stones and/or bone involvement [3][4][5], today PHPT is most commonly seen in asymptomatic individuals with milder hypercalcemia, due to the large availability of routine serum calcium measurements and developments in assay systems. A new presentation is now emerging, characterized by normocalcemia and elevated serum parathyroid hormone levels (the so-called ''normocalcemic primary hyperparathyroidism'').Recently in this Journal, Procopio et al. reported an increased prevalence of intermediate-high cardiovascular risk score (CRS), both in symptomatic and asymptomatic PHPT patients, as compared to healthy controls [6]. Their data are in line with several previous studies that reported an increased coronary artery and cerebrovascular morbidity in PHPT [7,8]. By means of a multivariate analysis, they also showed that, PHPT status predicts the presence of intermediate-high CRS and metabolic syndrome [9], while elevated calcium levels predict altered glucose tolerance among the components of metabolic syndrome.Procopio et al. added new information on an emerging aspect of patients with this glandular disorder; however, there are also some limitations that should be kept in mind when interpreting the results obtained. For example, the classification of patients is somewhat arbitrary. Asymptomatic patients with complications should no longer be considered as such; indeed, future classifications should be based on the presence or absence of complications. Just to make an example, patients may be asymptomatic, but can be incidentally discovered to have a kidney stone by ultrasound; in such a case she/he is asymptomatic but already has a complication of the disease. In essence, the term asymptomatic does not mean without complications; in this context, also a vertebral fracture may be asymptomatic but represents a complication. Secondly, the paper does not include any follow-up after surgery; this could have added meaningful information about the possible reversible effects of a restored biochemical calcium metabolism on cardiovascular risk factors. The current data conflict on this last issue [10,11], possibly due to the different timing of surgery. For example in the case of hypertensive patients, it is entirely possible that parathyroidectomy would be effective only if performed in an early phase of the disease, when structural abnormalities are not present. A similar situation can be observed in other endocrine disorders ...

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“…The Kauppila score provides a simple method to assess AAC without additional cost. This finding together with previous studies on cardiovascular risk factors in PHPT patients, including data on valve and cardiac calcifications, cardiomyopathy, and arrhythmia (5,10,28,34,35), suggests the need of a cardiovascular assessment in PHPT patients. Stratification according to CV risk category, as a result of AAC scoring, may improve patient care, with a more aggressive prevention strategy targeting patients with higher risk profiles.…”

Section: Discussionsupporting

confidence: 64%

“…Furthermore, hyperparathyroidism per se may have an indirect effect that accelerates atherogenesis due to its presumed positive relation with hypertension, endothelial dysfunction, and dyslipidemia, which are well-known contributors to the development of atherosclerosis (3,4,5). Accordingly, some studies demonstrate that patients with primary hyperparathyroidism (PHPT) have an increased mortality, mainly related to cardiovascular diseases (CVD) (6,7,8).…”

Section: Introductionmentioning

confidence: 99%

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

Pepe

Diacinti

Fratini

et al. 2016

European Journal of Endocrinology

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Objective: The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. Methods: In this study 70 PHPT postmenopausal women and 70 age-and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. Results: There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P = 0.0008) and lower radial BMD values (0.558 ± 0.071 vs 0.588 ± 0.082 g/cm 2 , P < 0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P = 0.03), with more severe calcifications (Kauppila score 7.35 ± 6.1 vs 5.05 ± 3.5, P = 0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. Conclusion: We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.

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Hemodynamic Markers and Subclinical Atherosclerosis in Postmenopausal Women With Primary Hyperparathyroidism

Abstract: These results suggest that pHPT may increase peripheral and aortic BP through PTH and inflammatory-mediated mechanisms. A direct impact of the disease on the arterial wall cannot be implicated despite the large number of markers of subclinical atherosclerosis measured in this study.

Cited by 25 publications

References 38 publications

Is primary hyperparathyroidism a cause of endothelial dysfunction?

Is primary hyperparathyroidism a cause of endothelial dysfunction?

Emerging data on cardiovascular risk in primary hyperparathyroidism

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

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