Nilsson Martin, Smith J Gustav, Thier Mark, Nordenström Erik, Bergenfelz Anders, Almquist Martin
Department of Surgery, Skåne University Hospital Lund, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Clin Endocrinol (Oxf). 2025 Nov;103(5):669-681. doi: 10.1111/cen.70015. Epub 2025 Aug 12.
Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT).
The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls.
Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors.
TIA was increased in patients pre-and postoperatively with a peak 1-4 years before PTX (IRR: 2.06, CI 95%: 1.31-3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51-6.85), and heart failure (IRR: 1.37, 1.11-1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively.
The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.
尽管先前的研究表明甲状旁腺切除术后（PTX）心血管事件有所减少，但尚不清楚这是否适用于目前诊断和治疗的病情较之前更轻的患者。这项全国性研究的目的是确定PTX后对心血管事件的影响，并全面评估原发性甲状旁腺功能亢进症（pHPT）患者的心血管疾病表现。
该队列由5009例行PTX的患者组成，这些患者来自斯堪的纳维亚甲状腺、甲状旁腺和肾上腺手术质量登记处。患者与14983名人群对照进行匹配。
数据与国家患者和死亡登记处相链接。估计PTX前后急性心肌梗死、中风、短暂性脑缺血发作（TIA）复发事件以及冠状动脉疾病、心力衰竭、主动脉和二尖瓣狭窄、颈动脉狭窄、外周动脉疾病和主动脉瘤（AA）首次发病诊断的发病率比（IRR）。分析血清钙和腺体重量作为预测指标。
PTX前后患者的TIA均增加，在PTX前1 - 4年达到峰值（IRR：2.06，95%CI：1.31 - 3.25）。急性心肌梗死和中风的发病率在术前和术后均未增加。二尖瓣狭窄（IRR：3.22，1.51 - 6.85）和心力衰竭（IRR：1.37，1.11 - 1.67）在术前增加，但术后未增加。AA在术前和术后均增加。
pHPT患者术前二尖瓣狭窄和心力衰竭的发病率增加，术后恢复正常。相比之下，TIA和AA的发病率在术后仍然升高。
