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Iglesias P, Arias J, López G, Romero I, Díez JJ. Primary Hyperparathyroidism and Cardiovascular Disease: An Association Study Using Clinical Natural Language Processing Systems and Big Data Analytics. J Clin Med 2023; 12:6718. [PMID: 37959184 PMCID: PMC10650925 DOI: 10.3390/jcm12216718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) seems to be associated with different cardiovascular diseases (CVDs). We evaluated the association of PHPT with major CV risk factors (CVRFs) and CVDs by using artificial intelligence (AI) tools. An observational and retrospective study was conducted using data from the electronic health records (EHRs) of the Hospital Universitario Puerta de Hierro Majadahonda (Spain). Of a total of 699,157 patients over 18 years of age studied (54.7% females), 6515 patients (0.9%; 65.4% women; mean age 67.6 ± 15.9 years) had a diagnosis of PHPT. The overall frequencies of hypertension, dyslipidemia, diabetes mellitus, and smoking habit in the cohort of patients with PTHP were all significantly (p < 0.001) higher than those found in patients without a diagnosis of PTHP. The total frequency of stroke, ischemic heart disease, atrial fibrillation, deep vein thrombosis, and pulmonary embolism in the cohort of PHPT patients were significantly (p < 0.001) higher than that found in patients without the diagnosis of PHPT. A multivariate regression analysis showed that PHPT was significantly (p < 0.001) and independently associated with all the CVDs evaluated. Our data show that there is a significant association between the diagnosis of PHPT and the main CVRFs and CVDs in our hospital population.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Javier Arias
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | | | - Iago Romero
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | - Juan J. Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Abstract
PURPOSE OF REVIEW Hyperparathyroidism may be due to an autonomous hypersecretion of parathyroid hormone (PTH) or occurs in response to a number of physiological stimuli. A number of recent findings have provided new insights into the importance of the calcium-parathyroid-vitamin D axis to bone in normal physiology and pathological conditions. RECENT FINDINGS PTH is known to affect bone microarchitecture with different effects on cortical and trabecular bone compartments. In trabecular bone, PTH may exert anabolic effects, whereas PTH promotes bone resorption in cortical bone. Vertebral fractures are prevalent in primary hyperparathyroidism (PHPT), and patients seem to fracture at higher values of bone mineral density (BMD) than patients with osteoporosis. This may be explained by changes in bone microarchitecture, which cannot be detected by measuring BMD. Even in mild PHPT, bone seems to benefit from parathyroidectomy. In secondary hyperparathyroidism, bone seems much more susceptible to fracture with insufficient levels of vitamin D compared with a replete vitamin status. If elevated PTH levels cannot be explained by conditions known to cause secondary hyperparathyroidism, the condition is termed normocalcemic PHPT, which also has been associated with an increased risk of fractures. Hyperparathyroidism is harmful to bone, which is why it is of importance to normalize PTH levels either by parathyroidectomy in PHPT or by counteracting conditions known to increase PTH in secondary hyperparathyroidism.
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MESH Headings
- Adenoma/complications
- Adenoma/metabolism
- Adenoma/surgery
- Bone Density
- Bone Diseases, Metabolic/etiology
- Bone Diseases, Metabolic/metabolism
- Bone Diseases, Metabolic/pathology
- Bone Remodeling
- Fractures, Spontaneous/etiology
- Humans
- Hypercalcemia/congenital
- Hypercalcemia/metabolism
- Hypercalcemia/pathology
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/metabolism
- Hyperparathyroidism, Primary/pathology
- Hyperparathyroidism, Primary/surgery
- Hyperparathyroidism, Secondary/complications
- Hyperparathyroidism, Secondary/metabolism
- Hyperparathyroidism, Secondary/pathology
- Hyperparathyroidism, Secondary/therapy
- Parathyroid Neoplasms/complications
- Parathyroid Neoplasms/metabolism
- Parathyroid Neoplasms/surgery
- Parathyroidectomy
- Risk Factors
- Spinal Fractures/etiology
- Vitamin D Deficiency/metabolism
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Affiliation(s)
- Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Henriette Ejlsmark-Svensson
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark
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Santos GDD, Elias RM, Dalboni MA, Silva GVD, Moysés RMA. Chronic kidney disease patients who smoke have higher serum phosphorus. J Bras Nefrol 2019; 41:288-292. [PMID: 30534856 PMCID: PMC6699427 DOI: 10.1590/2175-8239-jbn-2018-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD)
constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin
D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific
cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an
increased risk of cardiovascular disease. However, it is not known whether
or not smoking impacts the cardiovascular risk in CKD- MBD. Objective: To analyze the relationship between smoking and CKD-MBD markers. Methods: We evaluated 92 patients divided into: 1) Control Group: non-smokers without
CKD; 2) CKD group in stages III and IV under conservative treatment (20
non-smokers and 17 smokers); 3) CKD group on dialysis (21 non-smokers and 19
smokers). Clinical, demographic, and biochemical markers were compared
between the groups. Results: FGF-23 and Klotho levels were not different between smokers and non-smokers.
Patients in the CKD group on conservative treatment had higher serum P than
non-smokers (p = 0.026) even after adjusted for renal
function (p = 0.079), gender (p = 0.145)
and age (p = 0.986). Conclusion: Smoking confers a higher cardiovascular risk to CKD patients under
conservative treatment as it is associated with higher levels of P. Further
studies are needed to confirm and better elucidate this finding.
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Affiliation(s)
| | - Rosilene Motta Elias
- Universidade Nove de Julho, São Paulo, SP, Brasil.,Hospital das Clínicas, São Paulo, SP, Brasil
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Ghadimi R, Hosseini SR, Asefi S, Bijani A, Heidari B, Babaei M. Influence of Smoking on Bone Mineral Density in Elderly Men. Int J Prev Med 2018; 9:111. [PMID: 30687462 PMCID: PMC6326023 DOI: 10.4103/ijpvm.ijpvm_234_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 04/03/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Smoking has deleterious effects on bone mass and is associated with the subsequent development of osteoporosis, particularly in elderly participants. The purpose of this study was to determine the influence of smoking in the elderly male smokers. Methods: All male participants aged 60 years and older of the Amirkola cohort who performed bone densitometry entered the study. Bone mineral density (BMD) was measured at the lumbar spine (LS) and femoral neck (FN) using the dual-energy X-ray absorptiometry method. In statistical analysis, the smokers and nonsmokers were compared according to BMD, frequency of low bone mass defined as BMD T-score <−1 at either LS or FN, and the number of bone fractures. SPSS software version 18 was used for analysis. Results: A total of 203 smokers with mean smoking duration of 21.67 ± 17.7 years and the mean number of 36.4 + 15.8 cigarettes per day were compared with 408 nonsmokers. The mean BMD values in LS (0.90 ± 0.14 vs. 0.94 ± 0.19) and FN section (0.87 ± 0.13 vs. 0.89 ± 0.15) and also the frequency of bone fractures were significantly lower, and the frequency of low bone mass at either LS and FN was significantly higher in smokers (P = 0.014, 0.038, 0.003, and 0.004, respectively). In multiple logistic regression analysis, smoking was independently associated with low bone mass by odds ratio of = 2.27 (95% confidence interval: 1.49–3.44). Conclusions: These findings indicate a significant association between low bone mass and bone fracture at either LS or FN in the elderly male smokers.
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Affiliation(s)
- Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Social Medicine, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Seyyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Social Medicine, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Samaneh Asefi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Behzad Heidari
- Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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Håglin L. High serum phosphate concentration as the result of smoking might underlie the lower risk of Parkinson's disease. Med Hypotheses 2015. [PMID: 26206759 DOI: 10.1016/j.mehy.2015.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological studies have found a negative association between cigarette smoking and Parkinson's disease (PD): PD patients are approximately 50% less likely to have smoked cigarettes than age- and sex-matched controls. In both women and men, the PD protection effect of smoking may be explained by higher levels of phosphate in serum (S-P) and triglycerides (S-TG) in smokers compared to non-smokers. That is, the protecting effect from smoking could be mediated by either a high S-P or high S-TG levels. I suggest that higher S-P as the result of smoking may be associated with intracellular depletion of Pi in skeletal muscle and that this depletion of Pi is associated with increased availability of phosphate for the brain. This increased phosphate availability would protect against PD, as oxidative phosphorylation in the mitochondria is a central and persistent phenomenon in the pathogenesis cascade of PD. Phosphate is necessary for energy production in the form of creatine phosphate (CP) and adenosine-tri-phosphate (ATP) in the brain and skeletal muscle. As such, hypophosphatemia increases risk of cell death. In some clinical instances, this energy depletion may pre-dispose to dopamine neuron death. Mitochondrial dysfunction is associated with the generation of oxidative stress and mediates the induction of apoptosis. Studies with NMR spectroscopy reveal that an energy deficit in brain cells is a strong mark for PD although this differed for men and women. Compared to women, men had lower serum phosphate and ATP levels in the brain (about 15% lower). In addition to sex differences, age, stress, and malnutrition may cause low serum phosphate levels, a situation that could contribute to the lack of energy available to the brain and the risk of PD. As hypophosphatemia is present in overnutrition and has an inverse relation with a high BMI, both obesity and malnutrition are considered to be presumptive risk factor for PD.
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Affiliation(s)
- L Håglin
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden.
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Ko WC, Liu CL, Lee JJ, Liu TP, Yang PS, Hsu YC, Cheng SP. Negative association between serum parathyroid hormone levels and urinary perchlorate, nitrate, and thiocyanate concentrations in U.S. adults: the National Health and Nutrition Examination Survey 2005-2006. PLoS One 2014; 9:e115245. [PMID: 25514572 PMCID: PMC4267839 DOI: 10.1371/journal.pone.0115245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Perchlorate, nitrate, and thiocyanate are well-known inhibitors of the sodium-iodide symporter and may disrupt thyroid function. This exploratory study investigated the association among urinary perchlorate, nitrate, and thiocyanate concentrations and parathyroid hormone (PTH) levels in the general U.S. population. METHODS We analyzed data on 4265 adults (aged 20 years and older) from the National Health and Nutrition Examination Survey in 2005 through 2006 to evaluate the relationship among urinary perchlorate, nitrate, and thiocyanate concentration and PTH levels and the presence of hyperparathyroidism cross-sectionally. RESULTS The geometric means and 95% confidence interval (95% CI) concentrations of urinary perchlorate, nitrate, and thiocyanate were 3.38 (3.15-3.62), 40363 (37512-43431), and 1129 (1029-1239) ng/mL, respectively. After adjusting for confounding variables and sample weights, creatinine-corrected urinary perchlorate was negatively associated with serum PTH levels in women (P = 0.001), and creatinine-corrected urinary nitrate and thiocyanate were negatively associated with serum PTH levels in both sex groups (P = 0.001 and P<0.001 for men, P = 0.018 and P<0.001 for women, respectively). Similar results were obtained from sensitivity analyses performed for exposure variables unadjusted for creatinine with urinary creatinine added as a separate covariate. There was a negative relationship between hyperparathyroidism and urinary nitrate and thiocyanate [odds ratio (95% CI) = 0.77 (0.60-0.98) and 0.69 (0.61-0.79), respectively]. CONCLUSIONS A higher urinary concentration of perchlorate, nitrate, and thiocyanate is associated with lower serum PTH levels. Future studies are needed to determine the pathophysiological background of the observation.
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Affiliation(s)
- Wen-Ching Ko
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chien-Liang Liu
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan
| | - Tsang-Pai Liu
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chiung Hsu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Håglin LM, Törnkvist B, Bäckman LO. High serum phosphate and triglyceride levels in smoking women and men with CVD risk and type 2 diabetes. Diabetol Metab Syndr 2014; 6:39. [PMID: 24636522 PMCID: PMC3995531 DOI: 10.1186/1758-5996-6-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both low and high serum phosphate levels may be associated with morbidity and mortality from cardiovascular disease. As smoking increases risk for type 2 diabetes (as shown by dyslipidemia and hyperglycemia), we wanted to study whether smoking and type 2 diabetes were associated with serum phosphate and triglyceride levels independently from other CVD risk factors. METHODS Upon admittance to the Vindeln Health Education Centre (VHE-centre) for a four-week comprehensive lifestyle intervention, the participants (1408 women and 1096 men) completed a questionnaire that included their smoking habits - current smoker or non-smoker. We used multiple linear regression analyses to investigate the association between smoking and other CVD risk factors with S-P and S-TG levels. RESULTS In the non-type 2 diabetes populations, the smokers, compared to the non-smokers, had higher S-P and higher serum triglycerides (S-TG). In women, serum-TG in smokers with type 2 diabetes was higher than in smokers with non-type 2 diabetes. Non-type 2 diabetes patients exhibited an inverse relation between S-Glucose (S-Glu) and S-P and a positive association with S-TG. For men only, an association was seen between age (-) and S-Crea (-) and S-P. For women only, an association was seen between BMI (-) and S-Cholesterol (+) (S-Chol) and S-P. CONCLUSIONS Compared to non-smokers, smoking women with non-type 2 diabetes and smoking men with type 2 diabetes had a higher level of S-P and S-TG. The association between smoking and S-P and S-TG levels still existed after adjusting for age and CVD risk factors in the multiple linear regression analyses. TRIAL REGISTRATION The study has been registered as a sub-study to the Lifestyle Intervention Trial no. ISRCTN79355192.
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Affiliation(s)
- Lena M Håglin
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, UMEÅ SE-901 87, Sweden
| | | | - Lennart O Bäckman
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, UMEÅ SE-901 87, Sweden
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Abstract
This review discusses recent findings on the clinical presentation, evaluation, medical and surgical management of primary hyperparathyroidism. Medical management includes the use of cinacalcet and bisphosphonates for bone loss and correction of vitamin D deficiency. Surgical updates reviewed recent studies on the preoperative localization of the disease, specifically, sestamibi scans, 4DCT and MRI. Focused parathyroidectomy continues to be the preferred surgical approach for a select group of patients, guided by intraoperative use of PTH and new technology, such as endoscopic and robotic platforms; however, there appears to be no difference in long-term success compared to the traditional approach.
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Affiliation(s)
- Zeina Habib
- a Mercy Hospital and Medical Center - Internal Medicine, Section of Endocrinology and Metabolism, 2525 S Michigan Ave, Chicago, IL 60616, USA
| | - Adam Kabaker
- b Loyola University - Surgery, Section of Endocrine Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Pauline Camacho
- c Loyola University - Endocrinology and Metabolism, 2160 S. First Avenue, Maywood, IL 60153, USA
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Rolighed L, Vestergaard P, Heickendorff L, Sikjaer T, Rejnmark L, Mosekilde L, Christiansen P. BMD improvements after operation for primary hyperparathyroidism. Langenbecks Arch Surg 2012; 398:113-20. [DOI: 10.1007/s00423-012-1026-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022]
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