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SHR Neuro Cancer Cardio Lipid Metab Microb

Osto, E; Fallo, F; Pelizzo, MR; Maddalozzo, A; Sorgato, N; Corbetti, F; Montisci, R; Famoso, G; Bellu, R; Lüscher, TF; Iliceto, S; Tona, F.
Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy.
Circulation. 2012; 126(9):1031-9 Doi: 10.1161/CIRCULATIONAHA.111.081307
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Leading authors Med Uni Graz: Osto Elena
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Abstract:: BACKGROUND: Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality. However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset. METHODS AND RESULTS: We studied 100 PHPT patients (80 women; age, 58±12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0±0.8 versus 3.8±0.7; P<0.0001) and was abnormal (≤2.5) in 27 patients (27%) compared with control subjects (4%; P=0.0008). CFR was inversely related to parathyroid hormone (PTH) levels (r=-0.3, P<0.004). In patients with CFR ≤2.5, PTH was higher (26.4 pmol/L [quartiles 1 and 3, 16 and 37 pmol/L] versus 18 [13-25] pmol/L; P<0.007), whereas calcium levels were similar (2.9±0.1 versus 2.8±0.3 mmol/L; P=0.2). In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR (P=0.04, P=0.01, and P=0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR ≤2.5 (P=0.03). In all PHPT patients with CFR ≤2.5, parathyroidectomy normalized CFR (3.3±0.7 versus 2.1±0.5; P<0.0001). CONCLUSIONS: PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT.
Find related publications in this database (using NLM MeSH Indexing): Adenoma - complications, metabolism, surgery; Aged - administration & dosage; Comorbidity - administration & dosage; Coronary Angiography - administration & dosage; Coronary Circulation - physiology; Coronary Disease - etiology, physiopathology; Cross-Sectional Studies - administration & dosage; Dyslipidemias - epidemiology; Echocardiography - administration & dosage; Female - administration & dosage; Hemodynamics - administration & dosage; Humans - administration & dosage; Hyperparathyroidism, Primary - blood, physiopathology, surgery; Male - administration & dosage; Microcirculation - administration & dosage; Middle Aged - administration & dosage; Models, Cardiovascular - administration & dosage; Parathyroid Hormone - blood, metabolism; Parathyroid Neoplasms - complications, metabolism, surgery; Parathyroidectomy - administration & dosage; Recovery of Function - administration & dosage
Find related publications in this database (Keywords): coronary flow reserve; hyperparathyroidism; microvascular dysfunction; parathyroid hormone; risk factors

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