Читать книгу Parathyroid Disorders - Группа авторов - Страница 48

NPHPT patients had a higher risk of high blood pressure than subjects with normal PTH [35]; in particular, the subjects with NPHPT had higher levels of blood pressure than the subjects in the cohort with normal PTH. After adjustment for all potential confounders, the difference was still statistically significant. NPHPT is therefore a good model to analyze the different effects of hypercalcemia versus hyperparathyroidism on blood pressure. PTH has been shown to increase the cardiovascular risk by: (1) acting on endothelial cells of the vascular walls and myocardium leading to vascular stiffness and left ventricular hypertrophy; (2) activating the renin-aldosterone system, the secretion of cortisol from the adrenal cortex, and sympathetic activity [36].

Besides these data, NPHPT failed to be associated with the coronary calcium score, which is correlated with coronary artery disease [37]. Although there are no data in the current literature on mortality in NPHPT [38], it has been demonstrated that cardiovascular risk factors are almost similar in NPHPT compared to HPHPT, thus strengthening the role of PTH in cardiovascular involvement. Indeed, in the general population, higher serum levels of PTH are associated with increased risk of fatal cardiovascular disease events [39].

Nonetheless, in the general population, PTH correlated positively with baseline body mass index, fat mass, diastolic blood pressure, triglycerides, total and low-density lipoprotein cholesterol, and with the category of coronary artery calcium score. Therefore, some authors suggested that adiposity should be considered as an independent cause of SHPT and that all these cardiometabolic parameters may be relevant to patients with NPHPT, in whom high PTH levels may be a marker of adiposity and cardiometabolic risk rather than always indicating parathyroid autonomy [40].