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Cardiovascular Morbidity in Patients Undergoing Successful Surgery for Primary Hyperparathyroidism

Nilsson, Martin LU orcid ; Smith, Gustav LU orcid ; Thier, Mark LU ; Nordenström, Erik LU ; Bergenfelz, Anders LU and Almquist, Martin LU (2025) In Clinical Endocrinology 103(5). p.669-681
Abstract

Objective: Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT). Design: The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls. Methods: Data was linked with the National Patient and Death... (More)

Objective: Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT). Design: The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls. Methods: Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors. Results: TIA was increased in patients pre-and postoperatively with a peak 1–4 years before PTX (IRR: 2.06, CI 95%: 1.31–3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51–6.85), and heart failure (IRR: 1.37, 1.11–1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively. Conclusions: The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
calcium, cardiovascular diseases/epidemiology, cerebrovascular disorders/epidemiology, hyperparathyroidism, primary/complications, hyperparathyroidism, primary/surgery
in
Clinical Endocrinology
volume
103
issue
5
pages
13 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:40793872
  • scopus:105012930733
ISSN
0300-0664
DOI
10.1111/cen.70015
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd.
id
f1014f0a-74de-4aae-a3ae-cc0193fc2ce5
date added to LUP
2026-01-07 13:49:14
date last changed
2026-01-08 03:00:03
@article{f1014f0a-74de-4aae-a3ae-cc0193fc2ce5,
  abstract     = {{<p>Objective: Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT). Design: The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls. Methods: Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors. Results: TIA was increased in patients pre-and postoperatively with a peak 1–4 years before PTX (IRR: 2.06, CI 95%: 1.31–3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51–6.85), and heart failure (IRR: 1.37, 1.11–1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively. Conclusions: The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.</p>}},
  author       = {{Nilsson, Martin and Smith, Gustav and Thier, Mark and Nordenström, Erik and Bergenfelz, Anders and Almquist, Martin}},
  issn         = {{0300-0664}},
  keywords     = {{calcium; cardiovascular diseases/epidemiology; cerebrovascular disorders/epidemiology; hyperparathyroidism, primary/complications; hyperparathyroidism, primary/surgery}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{669--681}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Endocrinology}},
  title        = {{Cardiovascular Morbidity in Patients Undergoing Successful Surgery for Primary Hyperparathyroidism}},
  url          = {{http://dx.doi.org/10.1111/cen.70015}},
  doi          = {{10.1111/cen.70015}},
  volume       = {{103}},
  year         = {{2025}},
}