Plasma parathyroid hormone and cardiovascular disease in treatment-naive patients with primary hyperparathyroidism: The EPATH trial (original) (raw)
Related papers
The Journal of Clinical Endocrinology and Metabolism, 2000
The aim of the study was to evaluate: 1) the cardiovascular function and the autonomic drive to the heart in patients affected by primary hyperparathyroidism (pHPT) with no evidence of renal and cardiovascular complications; 2) the cardiovascular effects of acute administration of PTH in normal subjects. In 14 patients affected by mild asymptomatic pHPT echocardiographic assessment of cardiovascular function and of the mechanic properties of the brachial and carotid artery, heart rate variability and the dispersion of QT interval were performed before and 6 months after successful surgery. Twenty ageand sex-matched healthy subjects were included in the study. Five healthy volunteers underwent a single blind, placebo-controlled, random order, cross-over study with infusion of PTH (hPTH 1-34, 200 U in saline over 5 min) or placebo. Ecocardiographic assessment of cardiovascular function, heart rate variability, and QT interval were performed between 20 and 25 min after the start of the infusion and repeated after 15 min of tilting at 60 degrees. In pHPT patients the echocardiographic parameters were normal;
The Journal of Clinical Endocrinology & Metabolism, 2000
The aim of the study was to evaluate: 1) the cardiovascular function and the autonomic drive to the heart in patients affected by primary hyperparathyroidism (pHPT) with no evidence of renal and cardiovascular complications; 2) the cardiovascular effects of acute administration of PTH in normal subjects. In 14 patients affected by mild asymptomatic pHPT echocardiographic assessment of cardiovascular function and of the mechanic properties of the brachial and carotid artery, heart rate variability and the dispersion of QT interval were performed before and 6 months after successful surgery. Twenty ageand sex-matched healthy subjects were included in the study. Five healthy volunteers underwent a single blind, placebo-controlled, random order, cross-over study with infusion of PTH (hPTH 1-34, 200 U in saline over 5 min) or placebo. Ecocardiographic assessment of cardiovascular function, heart rate variability, and QT interval were performed between 20 and 25 min after the start of the infusion and repeated after 15 min of tilting at 60 degrees.
2010
The aim of the study was to evaluate: 1) the cardiovascular function and the autonomic drive to the heart in patients affected by primary hyperparathyroidism (pHPT) with no evidence of renal and cardiovascular complications; 2) the cardiovascular effects of acute administration of PTH in normal subjects. In 14 patients affected by mild asymptomatic pHPT echocardiographic assessment of cardiovascular function and of the mechanic properties of the brachial and carotid artery, heart rate variability and the dispersion of QT interval were performed before and 6 months after successful surgery. Twenty ageand sex-matched healthy subjects were included in the study. Five healthy volunteers underwent a single blind, placebo-controlled, random order, cross-over study with infusion of PTH (hPTH 1-34, 200 U in saline over 5 min) or placebo. Ecocardiographic assessment of cardiovascular function, heart rate variability, and QT interval were performed between 20 and 25 min after the start of the infusion and repeated after 15 min of tilting at 60 degrees. In pHPT patients the echocardiographic parameters were normal;
Relationship of Parathyroid Hormone and Hypertension
2020
Introduction: Numerous studies in humans and experimental models have shown that alterations in calcium homeostasis are associated with an increased risk of cardiovascular complication. In particular, changes in systemic calcium metabolism are thought to play an important role in the regulation of blood pressure. Aims and objectives: The basic aim of the study is to find the relationship between parathyroid hormone and hypertension in local population of Pakistan. Material and methods: This cross-sectional study was conducted at Bahawal Victoria Hospital, Bahawalpur during March 2019 to January 2020. This study was conducted on 100 patients which was suffering from hypertension and visit the hospital regularly. In all patients, 5 mL of fasting blood sample was taken before hemodialysis and was analyzed for serum calcium, phosphorous, albumin, PTH, and hemoglobin. Serum calcium, phosphorous, and albumin were measured. BP was obtained using an automatic BP monitor. Results: Calcium and PTH levels significantly decreased in all hypertensive patients with a cure rate of 99.1%. The mean systolic and diastolic BP decreased in the total population of hypertensive patients and hypertensive patients on antihypertensive therapy. Patients with PHPT experienced a significant decrease in both systolic BP (P < .001) and diastolic BP. Conclusion: It is concluded that the association between PTH and BP observed in this study contributes to the understanding of calcemic hormones and BP regulation.
Primary Hyperparathyroidism and Increased Cardiovascular Risk—A Review Article
World journal of research and review, 2023
Primary hyperparathyroidism (pHPT) is a common endocrine disease of the parathyroid gland tissues which leads to inappropriate overproduction of the Parathyroid Hormone (PTH). The symptoms of pHPT vary and they include renal stones, osteoporosis, constipation, and weakness secondary to hypercalcemia and hypophosphatemia. Moreover, it has been reported that patients with pHPT are at increased risk of death due to cardiovascular disease. Many research papers have shown that there is an increased mortality rate in patients with pHPT due to the effect of PTH on the heart. This review article is discussing the effect of pHPT on the cardiovascular system as it is a common cause of mortality.
Primary Hyperparathyroidism and Hypertension
Endocrine Hypertension, 2012
Although untreated primary hyperparathyroidism is associated with increased cardiovascular mortality, controversy exists regarding the therapeutic effects of parathyroidectomy on cardiovascular health. This review will examine the evidence linking primary hyperparathyroidism (PHPT) and cardiovascular disease, specifically hypertension, and evaluate the available literature regarding the natural history of hypertension after successful parathyroidectomy.
Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample
International Journal of Cardiology, 2017
Introduction: Primary hyperparathyroidism (pHPT), most commonly caused by solitary parathyroid adenomas, leads to mobilization of calcium and is known to result in nephrolithiasis and osteoporosis. To date, studies of pHPT and cardiovascular risk factors and events have produced discrepant findings, likely due to small sample sizes and enrolling populations with varying disease severity. Hypothesis: We utilized a national registry, hypothesizing an association between pHPT and cardiovascular risk factors and events. Methods: Patients N 18 years with a diagnosis of pHPT were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Diseases code 252.01. Demographics, risk factors, and cardiovascular event rates were collected and compared to general population data. Results: pHPT was present in 0.1% (n = 37,922) of hospital admissions. There was a significant increase in the prevalence of most cardiac risk factors including hypertension (HTN), diabetes mellitus, hyperlipidemia, obesity, and chronic kidney disease. The rates of heart failure (HF) and coronary artery disease (CAD) were higher in the pHPT population. However, after performing multivariate regression for age and cardiac risk factors, pHPT did not independently predict HF or CAD. The risk of HTN, however, was independently predicted by pHPT (OR 1.3; p b 0.001). Conclusions: Primary hyperparathyroidism independently predicted the risk of hypertension in a patient population from a large national database. Despite significant differences in univariate analysis of cardiac risk factors and events, pHPT did not independently predict risk of HF or CAD after multivariate regression analysis. Future studies should explore potential mechanisms relating hypertension to pHPT.
Plasma Parathyroid Hormone and the Risk of Cardiovascular Mortality in the Community
Circulation, 2009
Background— Diseases with elevated levels of parathyroid hormone (PTH) such as primary and secondary hyperparathyroidism are associated with increased incidence of cardiovascular disease and death. However, data on the prospective association between circulating PTH levels and cardiovascular mortality in the community are lacking. Methods and Results— The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n=958), was used to investigate the association between plasma PTH and cardiovascular mortality. During follow-up (median, 9.7 years), 117 participants died of cardiovascular causes. In Cox proportional-hazards models adjusted for established cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, total cholesterol, high-density lipoprotein cholesterol, antihypertensive treatment, lipid-lowering treatment, and history of cardiovascular disease), higher plasma PTH was associated with hi...
Surgery, 2013
Background. Cardiovascular mortality in primary hyperparathyroidism (PHPT) is attributed to myocardial and endothelial dysfunction. In this prospective, case-control study we assessed cardiovascular dysfunction in patients with symptomatic PHPT and its reversal after successful parathyroidectomy. Methods. Fifty-six patients with symptomatic PHPT underwent two-dimensional echocardiography, tissue Doppler (diastolic function assessment), serum N-terminal pro-brain natriuretic peptide (s-NTproBNP, a myocardial damage marker), and endothelial-and smooth muscleÀdependent vasodilatory response (vascular dysfunction) studies before, 3, and 6 months after parathyroidectomy; 25 age-matched controls were studied similarly. Results. Patients had greater left ventricular mass (192 ± 70 vs 149 ± 44 g; P = .006), interventricular septal thickness (10.8 ± 2.5 vs 9.0 ± 1.6 mm; P = .001), posterior wall thickness (9.9 ± 2.0 vs 8.6 ± 2.2 mm; P = .004), and diastolic dysfunction (lower E/A trans-mitral flow velocity ratio [1.0 ± 0.4 vs 1.3 ± 0.4; P = .01). Patients had greater s-NTproBNP (4,625 ± 1,130 vs 58 ± 49 pg/mL; P = .002) and lower endothelial-mediated vasodilation (9.3 ± 8.6 vs 11.7 ± 6.3%; P = .03) and smooth mu-scleÀmediated vasodilation (20.1 ± 17.9 vs 23.8 ± 11.2%; P = .01). Improvements in left ventricular mass, systolic and diastolic function, and smooth muscleÀmediated vasodilation were noted from 3 to 6 months after parathyroidectomy. Endothelial-mediated vasodilation did not improve significantly. S-NTproBNP levels mirrored echocardiographic changes with a substantial, sustained decrease. Results were similar in hypertensive and normotensive patients. Conclusion. Symptomatic PHPT patients have substantial cardiac and vascular dysfunction, which improve by 6 months after parathyroidectomy. Objective cardiovascular evaluation may improve outcomes in symptomatic PHPT patients.