Hyperparathyroidism and Cardiovascular Disease.

It is likely you've been told by doctors there is no connection... Think Again.

If any doctor thinks sick patients enjoy having to research their condition, they should try to understand that many of us feel we have no option if we are to survive it. Faced with a clinician we rely on to help us, who isn't up to date, is very daunting. Many hyperparathyroid patients understand what 'fighting for my life' implies. Fight or flight is 'an instinctive physiological response to a threatening situation which readies one to resist forcibly or run away.' We hear from many more patients who had to fight for their life compared to those who tell us diagnosis was a straight forward procedure.

One example is when a patient is told that hyperparathyroidism doesn't cause cardiac disease. Oh dear, that is so untrue. Please read the following reviews or do your own research to catch up with us;

The Parathyroid Gland and Heart Disease (2017). 'This review evaluates current studies and relationships between parathyroid disease and the cardiovascular system and highlights the important implications for mortality and morbidity stemming from these disorders'; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512678/?fbclid=IwAR37-JHVZRIrKElLeADWf9TVRLJNygcYRY1xJp3yneZPRR78I9cL7hXu9Hg

doi: 10.14797/mdcj-13-2-49

You may have seen my posts about the recent increase in the upper PTH range, which started off in Oxford and Birmingham, and is slowly spreading to other NHS Trusts...

Many patients are aware that the NHS often refuses to test PTH if calcium isn't elevated, to save £8 per person (according to 2019 costings in NG132). I was informed by a biochemist in Oxford that the increase of upper PTH range was 'because healthy people were found to have a PTH of 12pmol/L.'

How healthy were their hearts? How many of them are consequently heading unknowingly to a final destination?

Have a read of this;

PTH: A New Target in Arteriosclerosis? 'Growing evidence demonstrates that hyperparathyroidism is associated with an increased risk of cardiovascular morbidity and mortality.'

https://doi.org/10.1210/jc.2013-1621

'The presence of serum PTH levels within the upper normal range is highly related to CVD. This association may partly be explained by calcifications of the abdominal aorta. Because CVD poses an important health risk, further elucidation of the role of serum PTH in CVD and arteriosclerosis is relevant'; https://academic.oup.com/jcem/article/98/10/E1583/2833385... I posted that in our support group last week. A member pointed out it was quite dated from 2013, and asked if there were any more recent studies. I thought, 'it's been known about for a decade?' I went on to find these;

2018: Association between Serum Parathyroid Hormone Levels and the Prevalence of Atrial Fibrillation: the Dong-gu Study

https://e-kcj.org/DOIx.php?id=10.4070%2Fkcj.2017.0187&fbclid=IwAR2IbaH-0djhHPXKwqcTd7Cj9nO4st6zYIXc3VwRrXVizBFCideN8mCnFMY

https://doi.org/10.4070/kcj.2017.0187

'Conclusions; Higher levels of serum PTH were associated with higher prevalence of AF. Further studies are needed to determine whether this association is present in other populations and in a prospective study setting.'

2019; Serum parathyroid hormone levels in patients with chronic right heart failure. https://www.spandidos-publications.com/10.3892/br.2019.1262?fbclid=IwAR2R6xYV2zvXGB8ezhXJdhtB3AXsUMHP1SSJg-bK8Z2lEYRsB91dXC5ZSpo;

https://doi.org/10.3892/br.2019.126

'Parathyroid hormone (PTH) is a novel cardiovascular biomarker which is particularly useful for detection and assessment of heart failure (HF).''There an increasing number of studies demonstrating that PTH serves an important role in the development and progression of cardiovascular diseases, particularly in HF. PTH can independently predict the incidence of non-ischemic and whole HF, improve the risk stratification of patients with HF and assist in the determination of the optimal hospitalization time for outpatients with HF. It may also be used to guide individualized treatment of HF.' 'The present study serves as a preliminary analysis of the relationship between PTH levels and clinical indices of right HF. The conclusions made within, provide a starting point for future research, which should include determination of the role and underlying mechanisms of serum PTH levels in right HF.' 'In conclusion, the serum PTH levels are correlated with right HF, and thus may be used for the clinical assessment of right heart function.'

I'm currently processing data regarding primary hyperparathyroidism, hypercalcaemia, heart attacks and strokes, across NHS Trusts from 2019-2022. The numbers I've seen so far, are quite horrific. I know there will have been great numbers of patients with normocalcaemic PHPT undetected or dismissed, so it is very unlikely PTH will have been recorded in the vast numbers of heart attacks and Ischaemic strokes recorded.

In the meantime in Turkey:

2020; The Association Between Hyperparathyroidism and Ischemic Stroke Subtypes https://www.neurores.org/index.php/neurores/article/view/564/526?fbclid=IwAR1iREqjCVWrsUBJohDkD5Y9TO2bIXeixcdscdn10NWl-y9CVDv9kSyOtoI doi: https://doi.org/10.14740/jnr564

'Conclusions: We have found a high rate of hyperparathyroidism in our group of patients with ischemic stroke. Remarkably, the elevation of PTH was found to be significantly associated with the ischemic stroke subtype of extracranial atherosclerosis. Clarification of these results in the future large-scale studies may provide crucial perspectives regarding our understanding of the pathophysiology of some subtypes of ischemic stroke and potentially lead to a large public health implication in this area.'

I hope some doctors will find this information very helpful...