Cardiovascular parameters following parathyroidectomy in primary hyperparathyroidism: a systematic review and meta-analysis

Introduction There is conflicting evidence on the benefits of parathyroidectomy (PTx) in reducing the incidence of cardiovascular disease (CVD) in patients with primary hyperparathyroidism (PHPT). Aim To perform a systematic review and meta-analysis to investigate the impact of PTx in PHPT on cardiovascular outcomes. Methods A systematic review was performed as per PRISMA guidelines. Pre- and post-operative data were expressed as continuous outcomes, reported as mean differences, and expressed with 95% confidence intervals following estimation using the Mantel-Haenszel method. Results In total, there were 16 studies included in the meta-analysis with a combined total of 796 patients. Fourteen studies were prospective, one was retrospective and one was a randomised control trial. This analysis found a significant reduction in SBP post-operatively (P = 0.003). The difference in DBP was NS (P = 0.050). Fasting blood glucose levels were also significantly reduced after surgery (P < 0.0001). Echocardiographic values showed that left ventricular mass index was not significantly reduced (P = 0.070) and left ventricular ejection fraction was not affected (P = 0.680). Cholesterol levels were not impacted by surgery. Conclusion This meta-analysis shows that PTx likely improves SBP and blood glucose levels in patients with PHPT. It is unclear if this in turn has any impact on long-term outcomes.