Increased Mortality in Patients Hospitalized with Primary Hyperparathyroidism during the Period 1977–1993 in Denmark

Abstract

The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population. In a random sample of half of the Danish population, all patients with an incident hospital diagnosis of PHPT were identified in the National Hospital Patients Register. The mortality in the cohort was analyzed and compared with the background population. A cohort of 1578 patients was identified. Follow-up of 1179 women and 376 men, who did not die in the same month as the incident PHPT diagnosis, was made through 1993. Of these, 312 (20%) died within the follow-up period. The standard mortality ratio (SMR) for women was 1.7 (95% confidence interval [95% CI]: 1.5-1.9). SMR for men was 1.6 (95% CI: 1.3-2.0). In women an increased mortality from ischemic heart disease, cerebrovascular disease, and cancer was found. In men an increased mortality from cerebrovascular disease and cancer was found.

Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism

“…While not entirely supported by the American data, excess CV mortality has been consistently reported among Scandinavian patients with PHPT (3)(4)(5)(6). It has been argued that the excess mortality seen among patients with PHPT belongs to the era of severe symptomatic disease, whereas nowadays the disease is mostly recognized in a mild asymptomatic state characterized by lower serum calcium concentrations (2,7).…”

Non-traditional Manifestations of Primary Hyperparathyroidism

“…The increase in cardiovascular mortality in patients with severe and moderately severe PHPT has been well documented in studies from Scandinavia (31)(32)(33)(34)(35). The higher mortality rate declines with time from PTX, but persists long after surgical cure, suggesting that PHPT may cause enduring damage to the cardiovascular system (36).…”

Endocrine Disorders and the Heart

“…[381][382][383][384] Postulated mediators of this phenomenon 385,386 include hypertension, 387 disturbances in the renin-angiotensin system, 388 cardiac arrhythmias, 389,390 structural and functional abnormalities of the vascular wall [391][392][393][394][395] and cardiac muscle, 396-400 insulin resistance, 401 and hyperlipidemia. 402 Whether asymptomatic primary hyperparathyroidism confers increased mortality remains to be determined.…”