This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rubin, M. R. Articles by Silverberg, S. J. Search for Related Content PubMed PubMed Citation Articles by Rubin, M. R. Articles by Silverberg, S. J. Related Collections Calcium and Bone Metabolism Cardiovascular Endocrinology

Arterial Stiffness in Mild Primary Hyperparathyroidism

Departments of Medicine (M.R.R., M.S.M., D.J.M., J.P.B., S.J.S.) and Pharmacology (J.P.B.), College of Physicians & Surgeons, Columbia University, New York, New York 10032

Address all correspondence and requests for reprints to: Shonni J. Silverberg, M.D., Columbia University, College of Physicians & Surgeons, Department of Medicine, PH8-864, 630 West 168th Street, New York, New York 10032. E-mail: sjs5{at}columbia.edu.

When primary hyperparathyroidism was a more symptomatic disease, it was often associated with increased cardiovascular risk. As the clinical manifestations of the disease have changed to a milder, more asymptomatic disorder, investigation is shifting to more subtle cardiovascular abnormalities. We measured arterial stiffness in 39 patients with mild primary hyperparathyroidism [serum calcium, 2.66 ± 0.2 mmol/liter (10.7 ± 0.6 mg/dl); PTH, 21.7 ± 9.5 pmol/liter (89 ± 39 pg/ml)] and in 134 controls. Arterial stiffness was measured mathematically at the radial artery with a noninvasive device as the "augmentation index" (AIx). The AIx measures the difference between the second and first systolic peaks in the pressure waveform and correlates with increased cardiovascular risk. When physiological variables affecting augmentation index and potentially confounding cardiovascular risk factors (age, gender, heart rate, height, blood pressure, diabetes mellitus, smoking, and hyperlipidemia) were adjusted for, primary hyperparathyroidism was an independent predictor of increased augmentation index (B = 3.37; P < 0.03). A matched-pair analysis showed that 15% of the variance in AIx was uniquely accounted for by the presence of primary hyperparathyroidism. The presence of primary hyperparathyroidism was a stronger predictor of elevated AIx than age, gender, smoking, hypertension, hyperlipidemia, or diabetes mellitus. AIx was also directly correlated with evidence of more active parathyroid disease, including higher PTH levels (r = +0.42; P < 0.05) and lower bone mineral density at the distal one-third radius (r = –0.33; P < 0.05). The diagnosis of primary hyperparathyroidism was therefore an independent predictor of increased AIx, an early measure of arterial stiffness, and the increase was associated with evidence of more active parathyroid disease.

This article has been cited by other articles:

				J. Bollerslev, T. Rosen, C. L. Mollerup, J. Nordenstrom, M. Baranowski, C. Franco, Y. Pernow, G. A. Isaksen, K. Godang, T. Ueland, et al. Effect of Surgery on Cardiovascular Risk Factors in Mild Primary Hyperparathyroidism J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2255 - 2261. [Abstract] [Full Text] [PDF]

				M. D. Walker, D. J. McMahon, W. B. Inabnet, R. M. Lazar, I. Brown, S. Vardy, F. Cosman, and S. J. Silverberg Neuropsychological Features in Primary Hyperparathyroidism: A Prospective Study J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 1951 - 1958. [Abstract] [Full Text] [PDF]

				S. J. Silverberg, E. M. Lewiecki, L. Mosekilde, M. Peacock, and M. R. Rubin Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 351 - 365. [Abstract] [Full Text] [PDF]

				J. Andrade, L. Er, A. Ignaszewski, and A. Levin Exploration of Association of 1,25-OH2D3 with Augmentation Index, a Composite Measure of Arterial Stiffness Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1800 - 1806. [Abstract] [Full Text] [PDF]

				E. Ambrogini, F. Cetani, L. Cianferotti, E. Vignali, C. Banti, G. Viccica, A. Oppo, P. Miccoli, P. Berti, J. P. Bilezikian, et al. Surgery or Surveillance for Mild Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized Clinical Trial J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3114 - 3121. [Abstract] [Full Text] [PDF]

				J. Bollerslev, S. Jansson, C. L. Mollerup, J. Nordenstrom, E. Lundgren, O. Torring, J.-E. Varhaug, M. Baranowski, S. Aanderud, C. Franco, et al. Medical Observation, Compared with Parathyroidectomy, for Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized Trial J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1687 - 1692. [Abstract] [Full Text] [PDF]