Effects of Successful Parathyroidectomy on Metabolic Cardiovascular Risk Factors In Patients With Severe Primary Hyperparathyroidism |
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| Institution: | 1. Endocrine Institute, Haemek Medical Center, Afula, Israel,;2. B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;1. Divisâo de Endocrinologia e Diabetes, Hospital Agamenon Magalhâes - SUS, Universidade de Pernambuco;1. Laboratório de Eletrofisiologia do Hospital das Clínicas de Pernambuco, Universidade Federal de Pernambuco;1. Instituto de Medicina Integral Prof Fernando Figueira, Recife;1. Departamento of Neurosurgery, Hospital da Restauração, SUS/Universidade de Pernambuco, Recife;1. Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria;2. Department of Cardiology, Medical University of Graz, Graz, Austria;3. Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin Germany;4. Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria;5. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands;6. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria;7. Department of Cardiology, University Hospital of the RWTH, Aachen, Germany;8. Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany;9. University Hospital Heidelberg, Department of Medicine, Division of Nephrology, Heidelberg, Germany;10. Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria;11. Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, USA;12. Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA;13. Department of Internal Medicine, Diabetes and Metabolism, Medical University of Graz, Austria;14. Synlab Academy, Synlab Services LLC, Mannheim, Germany |
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| Abstract: | ObjectiveTo evaluate the effect of parathyroidectomy on metabolic abnormalities associated with cardiovascular disease in patients with primary hyperparathyroidism (PHPT).MethodsThirty-four patients with PHPT (aged 51.0 ± 11.8 years, mean ± standard deviation) underwent assessment before and 1 year after successful parathyroidectomy. A control group of 42 normocalcemic healthy subjects, matched for age and body mass index, was also examined at baseline. We measured serum lipids, glucose, insulin, uric acid, calcium, parathyroid hormone, C-reactive protein, and bone density. Insulin resistance index was evaluated by homeostasis model assessment, and the presence of metabolic syndrome was determined. Because of multiple tests, the level of statistical significance was set at .01.ResultsAfter parathyroidectomy, there was a decrease in diastolic blood pressure (P < .02) and in serum concentrations of uric acid (P < .04) and insulin (P < .009). No difference was observed in rates of metabolic syndrome in patients before and 1 year after parathyroidectomy (23.5% versus 17.6%; P > .46). Insulin resistance index values were also unchanged from before to after parathyroidectomy (1.3 ± 0.9 and 1.1 ± 0.9, respectively; P > .68). A substantial increase in spine bone density (5%; P < .05) was notedpostoperatively. Multivariate logistic regression analysis, after adjustment for age and body mass index, revealed that parathyroidectomy did not lead to a significant decrease in likelihood of cardiovascular risk—odds ratio (OR), 1.82; 95% confidence interval (CI), 0.53 to 6.21 (P > .34) for the metabolic syndrome and OR, 0.82; 95% CI, 0.17 to 3.88 (P > .8) for the insulin resistance index.ConclusionIn this study, surgical treatment had no beneficial effect on cardiovascular risk, as assessed by the metabolic syndrome and insulin resistance markers in patients with PHPT 1 year after parathyroidectomy.(Endocr Pract. 2011;17:584-590) |
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