Association between primary hyperparathyroidism and cardiovascular outcomes: A systematic review and meta-analysis

Excess parathyroid hormone (PTH) is associated with an increased risk of cardiovascular disease (CVD). We aimed to evaluate the correlation between primary hyperparathyroidism (PHPT) and CVD or cardiovascular (CV) death. Comprehensive searches of PubMed, Embase and ClinicalTrials.gov until May 20, 2023 with the following keywords: "primary hyperparathyroidism," "cardiovascular disease," and "mortality." Cohort studies and randomized controlled trials comparing PHPT patients to the general population and those who had received parathyroidectomy (PTX) to those who did not. Three investigators independently extracted data and assessed study quality. Eleven cohort studies and one randomized controlled trial were identified, including 264,227 PHPT patients with or without PTX, and the average age reported in the studies was 62 years. PHPT was associated with a higher risk of total death (RR 1.39 [95 % confidence interval (CI) 1.23–1.57) and CV death (RR 1.61 [95 % CI 1.47–1.78]) than the general population. However, there was no significant difference in CVD risk between patients with PHPT and the general population (RR 1.73 [95 % CI 0.87–3.47]). When compared to patients without PTX, PTX had a lower risk of CV death (RR 0.75 [95 % CI 0.71–0.80]), total death (RR 0.64 [95 % CI 0.60–0.70]) and CVD (RR 0.92 [95 % CI 0.90–0.94]). High heterogeneity among the included articles, and most of them were retrospective and older studies. PHPT was associated with higher risk of total death and CV death while PTX was associated with lower risk of total death, CV death, and CVD.