Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Versus Conservative Management

Background: There is emerging evidence suggestive of endothelial and cardiovascular dysfunction in patients with mild or asymptomatic primary hyperparathyroidism (PHPT) although there is a lack of clear consensus regarding potential cardiovascular benefits post elective parathyroidectomy. Methods: We carried out a retrospective observational study on patients with a biochemically confirmed diagnosis of PHPT who were under follow-up at our district general hospital between 1995 and 2016. The primary objective of the study was to compare all-cause mortality in patients who underwent elective parathyroidectomy versus the patients who were managed conservatively. The secondary objective of our study was to compare the rate of development of atherosclerotic cardiovascular disease (ASCVD) in the two groups. Results: Our results showed no statistically significant difference in all-cause mortality rate in the patients managed conservatively as compared to the surgically treated group. However, the rate of ASCVD events, including coronary artery disease and hypertension, were lower in the latter group. Conclusions: The adverse impact of PHPT on the cardiovascular system remains underrecognized with most of the evidence being derived from observational studies supporting a correlation between parathyroid hormone (PTH) levels and ASCVD events. All patients with PHPT should undergo clinical evaluation for ASCVD risks during initial workup as well as during follow-up visits. As elective parathyroidectomy is a relatively safe procedure and ASCVD risk is known to increase with age, there is a rationale to consider surgery for the majority of asymptomatic PHPT patients aged < 60 years.