Kalla A, Krishnamoorthy P, Gopalakrishnan A, Garg J, Patel N C, Figueredo V M
Einstein Medical Center, Cardiology Division, 5501 Old York Road, Levy 3232, Philadelphia, PA 19141, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Int J Cardiol. 2017 Jan 15;227:335-337. doi: 10.1016/j.ijcard.2016.11.080. Epub 2016 Nov 9.
Primary hyperparathyroidism (pHPT), most commonly caused by solitary parathyroid adenomas, leads to mobilization of calcium and is known to result in nephrolithiasis and osteoporosis. To date, studies of pHPT and cardiovascular risk factors and events have produced discrepant findings, likely due to small sample sizes and enrolling populations with varying disease severity.
We utilized a national registry, hypothesizing an association between pHPT and cardiovascular risk factors and events.
Patients >18years with a diagnosis of pHPT were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Diseases code 252.01. Demographics, risk factors, and cardiovascular event rates were collected and compared to general population data.
pHPT was present in 0.1% (n=37,922) of hospital admissions. There was a significant increase in the prevalence of most cardiac risk factors including hypertension (HTN), diabetes mellitus, hyperlipidemia, obesity, and chronic kidney disease. The rates of heart failure (HF) and coronary artery disease (CAD) were higher in the pHPT population. However, after performing multivariate regression for age and cardiac risk factors, pHPT did not independently predict HF or CAD. The risk of HTN, however, was independently predicted by pHPT (OR 1.3; p<0.001).
Primary hyperparathyroidism independently predicted the risk of hypertension in a patient population from a large national database. Despite significant differences in univariate analysis of cardiac risk factors and events, pHPT did not independently predict risk of HF or CAD after multivariate regression analysis. Future studies should explore potential mechanisms relating hypertension to pHPT.
原发性甲状旁腺功能亢进症（pHPT）最常见的病因是孤立性甲状旁腺腺瘤，可导致钙的动员，已知会导致肾结石和骨质疏松症。迄今为止，关于pHPT与心血管危险因素及事件的研究结果存在差异，这可能是由于样本量小以及纳入的疾病严重程度不同的人群所致。
我们利用一个全国性登记系统，假设pHPT与心血管危险因素及事件之间存在关联。
在2009 - 2010年全国住院患者样本数据库中，使用国际疾病分类第九版代码252.01识别出年龄大于18岁且诊断为pHPT的患者。收集人口统计学、危险因素和心血管事件发生率，并与一般人群数据进行比较。
pHPT在0.1%（n = 37,922）的住院患者中存在。大多数心脏危险因素的患病率显著增加，包括高血压（HTN）、糖尿病、高脂血症、肥胖和慢性肾脏病。pHPT人群中心力衰竭（HF）和冠状动脉疾病（CAD）的发生率较高。然而，在对年龄和心脏危险因素进行多变量回归分析后，pHPT并不能独立预测HF或CAD。然而，HTN的风险可由pHPT独立预测（比值比1.3；p < 0.001）。
原发性甲状旁腺功能亢进症在一个大型全国性数据库的患者人群中独立预测高血压风险。尽管在心脏危险因素和事件的单变量分析中存在显著差异，但在多变量回归分析后，pHPT并不能独立预测HF或CAD的风险。未来的研究应探索高血压与pHPT相关的潜在机制。
