Endocrine Abstracts

Objective: Primary hyperparathyroidism (PHPT) is associated with a higher incidence of different cardiovascular diseases (CVD), but the prevalence of CVD in PHPT remains unclear.

Aim: To evaluate the prevalence of CVD in PHPT according to the RussianPHPT Registry.

Materials and Methods: The Registry includes a database of patients with PHPT available at the Endocrinology Research Centre (Moscow) since 2007, which was transferred to the online platform in 2017. New cases of the disease, as well as dynamic monitoring, are recorded through an electronic form by medical professionals. The data of the included patients were entered into the register by 247 endocrinologists from 81 regions of the Russia. Data are given as medians, unless otherwise noted.

Results: Data from the Registry was uploaded on September 1, 2022. The study included 4892 patients with PHPT. 2308 (47.2%) of them had their cardiovascular history filled in. Among them the most frequent cardiovascular complication was arterial hypertension (AH) (up to 96%), while left ventricular hypertrophy was present in 5.8% of patients. A history of coronary artery disease (CAD) was diagnosed in 20.1%, calcification of the structures of the heart and/or blood vessels was observed in 2.7% of patients. Patients with a mild course of PHPT were significantly younger (62 vs 68 years, P<0.001) and had lower concentrations of parathyroid hormone (PTH) (118 vs 141 pg/ml, P<0.001), total calcium, (2.67 vs 2.75 mmol/l, P<0.001) and higher GFR (84 vs 76 ml/min/1.73 m²) than patients with symptomatic PHPT. In patients with mild PHPT, the frequency of CVD was significantly lower than in the patients with symptomatict PHPT: for all CVD 37.9 vs 46%, P<0.001, for AH 36.5 vs 51.6%, P<0.001 and for ischemic heart disease 4.4 vs 11.9%, P<0.001, respectively. Patients with AH were statistically significantly older, had higher serum PTH levels (149 vs 138 pg/ml), and lower GFR compared with normotonic patients. Patients with CAD were also older than those without CAD and had higher ionized calcium levels(1.4 vs 1.37 mmol/l, P=0.006), and lower GFR.

Conclusion: There is a high incidence of CVD in PHPT. The severity of PHPT is associated with higher incidence of all CVDs but most often with AH and ischemic heart disease in particular.