Parathyroidectomy Lowers Diabetes Risk but Not Other Cardiometabolic Outcomes in primary hyperparathyroidism: JAMA
A new study published in the Journal of the American Medical Association showed that patients with primary hyperparathyroidism (pHPT) have higher long-term cardiometabolic risks when compared to healthy controls. Among them, those who underwent parathyroidectomy showed a reduced risk of developing type 2 diabetes, while other cardiometabolic outcomes did not differ significantly between surgical and nonsurgical management.
Primary hyperparathyroidism is associated with high levels of calcium and parathyroid hormone, which may raise the risk of cardiometabolic disease. Thus, this study investigated the long-term cardiometabolic risks associated with pHPT and to assess if parathyroidectomy is linked with lower occurrence of these events.
The largest healthcare institution in Israel, Clalit Health Services, provided data for this retrospective cohort research. A total of 150,265 matched controls (matched 1:3 by age, sex, and socioeconomic level) and 50,199 patients diagnosed with pHPT between January 1, 2000, and November 29, 2023 were included. Individuals who had secondary hyperparathyroidism were not included. 6654 people with pHPT had parathyroidectomies.
The incidence of hypertension, cardiovascular disease (CVD), type 2 diabetes (T2D), and cerebrovascular accidents (CVA) were the main outcomes. Kaplan-Meier curves and multivariable-stratified Cox proportional hazards regression models that were adjusted for body mass index, ethnicity, and Charlson Comorbidity Index were used to examine the events.
50 199 patients with pHPT and 150 265 matched control subjects made up the total of 200 464 participants (median age, 66 [IQR, 55-75] years; 136 884 [68.3%] female). The 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).
The incidence of T2D only decreased after parathyroidectomy, 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). Overall, increased long-term cardiometabolic risks were linked to pHPT in this cohort analysis of patients. While there were no correlations found for hypertension, CVD, or CVA, parathyroidectomy was linked to a markedly lower incidence of T2D.
Source:
Tsur, N., Edri, N., Kerman, T., Talmor-Barkan, Y., Kushnir, S., & Bachar, G. (2025). Parathyroidectomy and cardiometabolic risks in patients with primary hyperparathyroidism. JAMA Network Open, 8(11), e2544623. https://doi.org/10.1001/jamanetworkopen.2025.44623
