Coronary calcium score in patients with post-surgical hypoparathyroidism

Sartori, Jhenifer Franco de Souza; Santos, Maria Luiza dos; Stollmeier, Aline; Cerci, Rodrigo Julio; Moreira, Carolina Aguiar; Borba, Victoria Zeghbi Cochenski

doi:10.20945/2359-4292-2023-0053

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Archives of Endocrinology and Metabolism

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Sumário

Original Article • Arch. Endocrinol. Metab. 68 • 2024 • https://doi.org/10.20945/2359-4292-2023-0053 copy

Coronary calcium score in patients with post-surgical hypoparathyroidism

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

This study aimed to evaluate the cardiovascular risk of patients with post-surgical hypoparathyroidism through coronary calcium score (CACS) evaluation and cardiovascular risk calculators.

Subjects and methods:

Patients with post-surgical hypoparathyroidism (HG = 29) were compared to a control group (CG = 29), matched by sex and age. Demographic and clinical data were captured by a questionnaire or patient files. Both groups performed a thoracic-computed tomography to evaluate the CACS and the cardiovascular risk was calculated by two risk calculators.

Results:

In the HG, the supplementation of calcium varied between 500 to 2,000 mg/day and the mean calcitriol was 0.5 ± 0.29 mcg/day. The mean serum calcium and phosphorus were 8.32 ± 0.68 and 4.92 ± 0.87 mg/dL, respectively, and in the range recommended for hypoparathyroidism. The Brazilian Society of Cardiology's risk calculator showed a difference among groups, with no patient in the HG with low risk, but the CACS was similar. A positive CACS in the HG was associated with obesity and high BMI but not with calcium and/or vitamin D supplementation.

Conclusion:

In conclusion, patients with hypoparathyroidism did not show increased CACS, and it was not related to supplementation.

Keywords
Hypoparathyroidism; calcium supplementation; cardiovascular risk; coronary calcium score

Variables n (%)		HG (n = 29)	CG (n = 29)	p-value
Variables n (%)		Sex			1
	Female	25 (86.21%)	24 (82.76%)
	Male	4 (13.70%)	5 (17.24%)
Age (years), mean ± SD		57.90 ± 15.28	55.07 ± 13.35	0.200
Race, n (%)				0.004
	White	28 (96.55%)	18 (62.07%)
	Black	1 (3.45%)	11 (37.89%)
Smoking
	Current	3 (10.34%)	2 (6.89%)	0.224
	Past	9 (31.03%)	5 (17.24%)	0.643
BMI (kg/m²), mean ± SD		28.69 ± 6.51	28.70 ± 3.94	0.470
Obesity		7 (26.9%)	8 (27.5%)	0.415
Menopause		14	15	0.107
	Hormone therapy	2	1
Time since surgery				<0.001
	5-10 years	2 (8.69%)	18 (62.07%)
	11-20 years	10 (43.48%)	9 (31.03%)
	>20 years	11 (47.83%)	2 (6.9%)
Reason for surgery				0.008
	Cancer	13 (56.52%)	23 (85.2%)
	Graves disease	0	1 (3.7%)
	Multinodular goiter	8 (34.78%)	1 (3.7%)
	Functioning goiter	0	1 (3.7%)
	Adenoma	2 (8.7%)	1 (3.7%)
Family history
	Myocardial infarction	3 (10.34%)	10 (34.48%)	0.050
	Sudden death	2 (6.89 %)	1 (3.34%)	1
	Stroke	6 (20.68%)	6 (20.68%)	1
Comorbidities
	Hypertension	18 (62.06%)	19 (65.51%)	1
	Dyslipidemia	13 (44.82%)	15 (51.72%)	0.590
	Prediabetes/T2 DM	6 (20.68%)	11 (37.93%)	0.153
	Obesity	7 (24.10%)	8 (27.58%)	1
	Osteoporosis	5 (17.24%)	2 (6.89%)	0.420
	Nephrolithiasis	3 (10.34%)	2 (6.89%)	1
	Nephrocalcinosis	3 (10.34%)	0	0.230
	Arrhythmia	2 (6.89%)	1 (3.34%)	1
	Chronic kidney disease	2 (6.89%)	0	0.490
	Pulmonary disease	0	2 (6.89%)	0.490

Variables		HG (n = 29)	Controls (n = 29)	p-value
Laboratory (mean ± SD)
Calcium (mg/dL)		8.32 ± 0.68	9.21 ± 0.50	<0.001
Phosphorus (mg/dL)		4.92 ± 0.87	3.53 ± 0.74	<0.001
25OHD (ng/mL)		39.36 ± 9.14	33.10 ± 14.10	0.010
PTH (pg/mL)		7.13 ± 3.71	55.05 ± 19.99	<0.001
Urinary calcium (mg/kg/d)		2.51 ± 1.00	3.99 ± 2.14	0.500
Total cholesterol (mg/dL)		191.31 ± 37.81	192.79 ± 39.31	0.880
LDL-cholesterol (mg/dL)		115.50 ± 32.19	120.97 ± 32.65	0.520
HDL-cholesterol (mg/dL)		49.21 ± 11.05	48.07 ± 9.34	0.670
Triglycerides (mg/dL)		123.62 ± 53.33	128.48 ± 68.31	0.810
Fasting glucose (mg/dL)		92.62 ± 8.12	104.59 ± 24.81	0.010
Glycated haemoglobin (%)		5.47 ± 0.42	5.96 ± 1.07	0.170
Creatinin (mg/dL)		0.89 ± 0.16	0.85 ± 0.17	0.350
Calcium-phosphate product		40.5 ± 5.80	33.36 ± 7.56	0.0001
Medications, n (%)
Calcitriol (n %)		27 (93.1%)	-
Calcitriol (mcg/day)		0.5 ± 0.29	-
Calcium				<0.001
	0	3 (10.34%)	22 (75.86%)
	≤500 mg	9 (31.03%)	5 (17.24%)
	501-1,000 mg	8 (27.59%)	2 (6.9%)
	1,001-2,000 mg	8 (27.59%)	0
	>2,000 mg	1 (3.45%)	0
Vitamin D		15 (51.72%)	12 (41.37%)	0.59
Antiresorptives		5 (17.24%)	2 (6.89%)	0.61
Antihypertensives		18 (62.06%)	19 (65.51%)	0.59
Diuretics		11 (37.93%)	9 (31.03%)	0.78
Statins		11 (37.93%)	12 (41.37%)	1

Variable		HG	CG	p-value
ASCVD (mean ± SD)
Risk %		10.86 ± 9.45	10.19 ± 12.81	0.400
ASCVD, n (%)				0.970
	Low	6 (28.57%)	8 (36.36%)
	Borderline	6 (28.57%)	5 (22.73%)
	Intermediate	6 (28.57%)	6 (27.27%)
	High	6 (28.57%)	3 (13.64%)
SBC risk calculator, n (%)
	Low	0	5 (20%)	0.030
	Intermediate	7 (30.43%)	3 (12%)
	High	16 (69.57%)	17 (68%)
	Very high	_	_
CACS (mean ± SD)		32.55 ± 41.53	23.59 ± 36.92	0.390
Positive CACS, n (%)		7 (24.14%)	5 (17.24%)	0.580

Variable		Positive CACS (n = 7)	Negative CACS (n = 22)	p-value
ASCVD risk%, mean ± SD		11.27 ± 10.05	10.40 ± 9.25	0.430
ASCVD risk score, n (%)				0.520
	Low	3 (42.86%)	3 (21.43%)
	Borderline	1 (14.28%)	4 (28.57%)
	Intermediate	3 (42.86%)	4 (28.57%)
	High	0	3 (21.43%)
SBC risk score, n (%)				0.360
	Low	0	0
	Intermediate	1 (14.28%)	6 (37.5%)
	High	6 (85.72%)	10 (62.5%)

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[1] Correspondence to: Victoria Zeghbi Cochenski Borba vzcborba@gmail.com