# Parathyroidectomy and Cardiometabolic Risks in Patients With Primary Hyperparathyroidism

## TL;DR

This study finds that primary hyperparathyroidism increases cardiometabolic risks, and surgery may lower the risk of type 2 diabetes.

## Contribution

The study shows parathyroidectomy is linked to reduced type 2 diabetes risk in pHPT patients, a novel surgical benefit.

## Key findings

- Patients with pHPT had higher long-term risks of hypertension, type 2 diabetes, cardiovascular disease, and cerebrovascular accidents.
- Parathyroidectomy was associated with a 44% lower risk of type 2 diabetes compared to nonsurgical treatment.
- No significant differences were observed in other cardiometabolic outcomes following parathyroidectomy.

## Abstract

Is primary hyperparathyroidism (pHPT) associated with increased cardiometabolic risks, and might parathyroidectomy help reduce these risks?

In this cohort study including 50 199 patients with pHPT and 150 265 matched controls, pHPT was associated with significantly increased incidence of hypertension, type 2 diabetes, cardiovascular disease, and cerebrovascular accident. Among 6654 patients with pHPT who underwent parathyroidectomy, the incidence of type 2 diabetes was significantly lower compared with those receiving nonsurgical treatment; no differences were found for other types of cardiometabolic risk.

These findings suggest that parathyroidectomy may be associated with reduced risk of type 2 diabetes in patients with pHPT.

This cohort study assesses the prevalence and severity of cardiovascular complications in patients with primary hyperparathyroidism and examines whether parathyroidectomy is associated with improved cardiometabolic outcomes among these patients.

Primary hyperparathyroidism (pHPT) is a common endocrine disorder linked to elevated parathyroid hormone and calcium levels, which may contribute to increased cardiometabolic risk.

To evaluate the long-term cardiometabolic risks associated with pHPT and to assess whether parathyroidectomy is associated with reduced incidence of these outcomes.

This retrospective cohort study used data from Clalit Health Services, Israel’s largest health care organization. A total of 50 199 patients diagnosed with pHPT between January 1, 2000, and November 29, 2023, and 150 265 matched controls (matched 1:3 by age, sex, and socioeconomic status) were included. Patients with secondary hyperparathyroidism were excluded. Among patients with pHPT, 6654 underwent parathyroidectomy. Duration of follow-up was as long as 15 years. Data were analyzed from November 1, 2024, to April 1, 2025.

Diagnosis of pHPT and parathyroidectomy.

Incidence of hypertension, type 2 diabetes (T2D), cardiovascular disease (CVD), and cerebrovascular accidents (CVA). Events were analyzed using Kaplan-Meier curves and multivariable-stratified Cox proportional hazards regression models adjusted for Charlson Comorbidity Index, body mass index, and ethnicity.

A total of 200 464 individuals were included (median age, 66 [IQR, 55-75] years; 136 884 [68.3%] female), comprising 50 199 patients with pHPT and 150 265 matched control individuals. Patients with pHPT exhibited an elevated long-term risk of hypertension (adjusted hazard ratio [AHR], 1.22; 95% CI, 1.17-1.33; P < .001), T2D (AHR, 1.07; 95% CI, 1.01-1.16; P = .02), CVD (AHR, 1.28; 95% CI, 1.21-1.42; P < .001), and CVA (AHR, 1.22; 95% CI, 1.17-1.33; P < .001) compared with controls. Between patients who underwent parathyroidectomy and those who underwent nonsurgical management, parathyroidectomy was associated with a reduced risk of T2D only, with the incidence decreasing from 15.18 (95% CI, 14.58-15.81) to 10.77 (95% CI, 9.80-11.83) per 1000 person-years (AHR, 0.56; 95% CI, 0.30-0.89; P = .002).

The findings of this cohort study suggest that pHPT is associated with increased long-term cardiometabolic risks. Parathyroidectomy may be associated with reduced incidence of T2D, supporting consideration of surgical intervention in appropriate patients.