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Carotid Vascular Abnormalities in Primary Hyperparathyroidism

Department of Medicine (M.D.W., J.F., D.J.M., S.H., S.J.S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; and Department of Neurology (T.R., R.S.), University of Miami, Miami, Florida 33136

Address all correspondence and requests for reprints to: Shonni J. Silverberg, M.D., 630 West 168th Street, PH8 West 864, New York, New York 10032. E-mail: sjs5{at}columbia.edu.

Context: Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting.

Objective: This study evaluated carotid structure and function in PHPT patients compared with population-based controls.

Design: This is a case-control study.

Setting: The study was conducted in a university hospital metabolic bone disease unit.

Participants: Forty-nine men and women with PHPT and 991 controls without PHPT were studied.

Outcome Measures: We measured carotid intima-media thickness (IMT), carotid plaque presence and thickness, and carotid stiffness, strain, and distensibility.

Results: IMT, carotid plaque thickness, carotid stiffness, and distensibility were abnormal in PHPT patients, and IMT was higher in patients than controls (0.959 vs. 0.907 mm, P < 0.0001). In PHPT, PTH levels, but not calcium concentration, predicted carotid stiffness (P = 0.04), strain (P = 0.06), and distensibility (P = 0.07). Patients with increased carotid stiffness had significantly higher PTH levels than did those with normal stiffness (141 ± 48 vs. 94.9 ± 44 pg/ml, P = 0.002), and odds of abnormal stiffness increased 1.91 (confidence interval = 1.09–3.35; P = 0.024) for every 10 pg/ml increase in PTH, adjusted for age, creatinine, and albumin-corrected calcium.

Conclusions: Mild PHPT is associated with subclinical carotid vascular manifestations. IMT, a predictor of cardiovascular outcomes, is increased. Measures of carotid stiffness are associated with extent of PTH elevation, suggesting that those with more severe PHPT may have impaired vascular compliance and that PTH, rather than calcium, is the mediator.