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We aimed to determine the incidence of major cardiovascular and cerebrovascular events in elderly patients with primary hyperparathyroidism (pHPT) and the impact of parathyroidectomy.pHPT is under-diagnosed and under-treated in the United States. It is associated with increased cardiovascular disease risk but its association with cerebrovascular disease risk is not well-established. It is also unknown if parathyroidectomy reduces these risks.The incidence of major cerebrovascular and cardiovascular events in 108,869 patients with pHPT diagnosed in the Medicare database between 2008 and 2018 and a matched comparison group of 1,088,690 Medicare subjects was prospectively evaluated. We estimated hazards ratios (HR) for the association of pHPT and parathyroidectomy for the risk of these outcomes from Cox proportional hazards models. Survival curves were calculated to obtain five-year disease-free survival (DFS) estimates.For patients with pHPT, five-year DFS was lower and HRs were higher than the comparison group for any outcome (75.9% vs. 78.4; HR 1.11, 95% confidence interval [CI] 1.09-1.13), major cerebrovascular events (84.5% vs. 86.3%; HR 1.14, 95% CI 1.12-1.17), and major cardiovascular events (87.7% vs. 88.8%; HR 1.06, 95% CI 1.03-1.08). However, in patients who had parathyroidectomy, the risks of major cerebrovascular and cardiovascular events did not differ from the comparison cohort. The lower risk in patients who had parathyroidectomy were maintained in subgroup analyses.Older patients with pHPT have an increased risk of major cerebrovascular and cardiovascular events compared to patients without the disease. Physicians treating older patients with primary hyperparathyroidism should consider parathyroidectomy.Ruth M. Pfeiffer, Naris Nilubol These authors contributed equally to the preparation of this manuscript.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.


Robert R C Grant, Brian E Moroz, Chanigan Nilubol, Elizabeth K Cahoon, Ruth M Pfeiffer, Naris Nilubol. Parathyroidectomy and the Risk of Major Cerebrovascular and Cardiovascular Events in the Elderly. Annals of surgery. 2023 Jul 17

PMID: 37450696

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