JAMA network open · 2025
Parathyroidectomy and Cardiometabolic Risks in Patients With Primary Hyperparathyroidism.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Tsur Nir, Edri Nofar, Kerman Tomer, Talmor-Barkan Yeela, Kushnir Shir, Bachar Gideon
Аннотация
IMPORTANCE: Primary hyperparathyroidism (pHPT) is a common endocrine disorder linked to elevated parathyroid hormone and calcium levels, which may contribute to increased cardiometabolic risk.
OBJECTIVE: To evaluate the long-term cardiometabolic risks associated with pHPT and to assess whether parathyroidectomy is associated with reduced incidence of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from Clalit Health Services, Israel's largest health care organization. A total of 50 199 patients diagnosed with pHPT between January 1, 2000, and November 29, 2023, and 150 265 matched controls (matched 1:3 by age, sex, and socioeconomic status) were included. Patients with secondary hyperparathyroidism were excluded. Among patients with pHPT, 6654 underwent parathyroidectomy. Duration of follow-up was as long as 15 years. Data were analyzed from November 1, 2024, to April 1, 2025.
EXPOSURES: Diagnosis of pHPT and parathyroidectomy.
MAIN OUTCOMES AND MEASURES: Incidence of hypertension, type 2 diabetes (T2D), cardiovascular disease (CVD), and cerebrovascular accidents (CVA). Events were analyzed using Kaplan-Meier curves and multivariable-stratified Cox proportional hazards regression models adjusted for Charlson Comorbidity Index, body mass index, and ethnicity.
RESULTS: A total of 200 464 individuals were included (median age, 66 [IQR, 55-75] years; 136 884 [68.3%] female), comprising 50 199 patients with pHPT and 150 265 matched control individuals. Patients with pHPT exhibited an elevated long-term risk of hypertension (adjusted hazard ratio [AHR], 1.22; 95% CI, 1.17-1.33; P < .001), T2D (AHR, 1.07; 95% CI, 1.01-1.16; P = .02), CVD (AHR, 1.28; 95% CI, 1.21-1.42; P < .001), and CVA (AHR, 1.22; 95% CI, 1.17-1.33; P < .001) compared with controls. Between patients who underwent parathyroidectomy and those who underwent nonsurgical management, parathyroidectomy was associated with a reduced risk of T2D only, with the incidence decreasing from 15.18 (95% CI, 14.58-15.81) to 10.77 (95% CI, 9.80-11.83) per 1000 person-years (AHR, 0.56; 95% CI, 0.30-0.89; P = .002).
CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that pHPT is associated with increased long-term cardiometabolic risks. Parathyroidectomy may be associated with reduced incidence of T2D, supporting consideration of surgical intervention in appropriate patients.
OBJECTIVE: To evaluate the long-term cardiometabolic risks associated with pHPT and to assess whether parathyroidectomy is associated with reduced incidence of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from Clalit Health Services, Israel's largest health care organization. A total of 50 199 patients diagnosed with pHPT between January 1, 2000, and November 29, 2023, and 150 265 matched controls (matched 1:3 by age, sex, and socioeconomic status) were included. Patients with secondary hyperparathyroidism were excluded. Among patients with pHPT, 6654 underwent parathyroidectomy. Duration of follow-up was as long as 15 years. Data were analyzed from November 1, 2024, to April 1, 2025.
EXPOSURES: Diagnosis of pHPT and parathyroidectomy.
MAIN OUTCOMES AND MEASURES: Incidence of hypertension, type 2 diabetes (T2D), cardiovascular disease (CVD), and cerebrovascular accidents (CVA). Events were analyzed using Kaplan-Meier curves and multivariable-stratified Cox proportional hazards regression models adjusted for Charlson Comorbidity Index, body mass index, and ethnicity.
RESULTS: A total of 200 464 individuals were included (median age, 66 [IQR, 55-75] years; 136 884 [68.3%] female), comprising 50 199 patients with pHPT and 150 265 matched control individuals. Patients with pHPT exhibited an elevated long-term risk of hypertension (adjusted hazard ratio [AHR], 1.22; 95% CI, 1.17-1.33; P < .001), T2D (AHR, 1.07; 95% CI, 1.01-1.16; P = .02), CVD (AHR, 1.28; 95% CI, 1.21-1.42; P < .001), and CVA (AHR, 1.22; 95% CI, 1.17-1.33; P < .001) compared with controls. Between patients who underwent parathyroidectomy and those who underwent nonsurgical management, parathyroidectomy was associated with a reduced risk of T2D only, with the incidence decreasing from 15.18 (95% CI, 14.58-15.81) to 10.77 (95% CI, 9.80-11.83) per 1000 person-years (AHR, 0.56; 95% CI, 0.30-0.89; P = .002).
CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that pHPT is associated with increased long-term cardiometabolic risks. Parathyroidectomy may be associated with reduced incidence of T2D, supporting consideration of surgical intervention in appropriate patients.