Parathyroidectomy and Cardiometabolic Risks in Patients With Primary Hyperparathyroidism.

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.