Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Wetzel, J.
Cardiovascular Risk in Patients with Primary Hyperparathyroidism
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pilz Stefan
- Tomaschitz Andreas
- Verheyen Nicolas Dominik
- Altmetrics:
- Abstract:
- Introduction: Accumulating evidence indicates that high parathyroid hormone (PTH) is associated with increased cardiovascular risk. The underlying causes of cardiovascular impairment frequently seen in patients with primary hyperparathyroidism (pHPT) are however still unclear. This investigation is conducted to add information to the controversially discussed issue of cardiovascular risk associated with PTH excess. Thus, we analyzed the associations between PTH concentration and cardiovascular surrogate parameters in patients with pHPT. Methods and Results: We used baseline data of the randomized, double-blind, placebo-controlled “Effect of Eplerenone on Parathyroid Hormone Levels in Patients with Primary Hyperparathyroidism” (EPATH) Trial. Inclusion criteria were age of at least 18 years and a diagnosis of pHPT according to international guidelines. Standardized blood sampling was performed after an overnight fast and 24h ambulatory blood pressure measurement (ABPM) was performed by a validated non-invasive device for ambulatory hemodynamic monitoring (Mobil O Graph, I.E.M., Stolberg, Germany). Our analysis comprised 155 pHPT patients (78.7% females, 21.3% male; Group 1) with a mean age of 67.4 years (+/- 10.3 years) and a median PTH of 99 (IQR 82-125) pg/ml. For a second (subgroup) analysis we excluded patients with a continuous intake of cinacalcet (Group 2). Further exclusion of patients taking ACEI, ARB, MRB, thiazide or loop diuretics on a regular basis led to a third group. In multivariate linear regression analyses adjusted for age, sex, antihypertensive medication, body mass index (BMI), hemoglobin A1c (HbA1c), 25-hydroxyvitamin D, serum calcium, glomerular filtration rate and systolic blood pressure PTH emerged as a strong predictor of mean 24h PWV, nighttime PWV and nighttime SBP in Group 3. In Group 1 and 2 there was no significant association. Conclusion: In a selective cohort of patients with pHPT plasma PTH was related to mean 24h PWV, nighttime PWV and nighttime SBP. Our data strengthen the notion that PTH may impact on vascular function. Interventional and mechanistic trials are needed to evaluate modulatory effects on vasculature in patients with high PTH.