{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:10:09Z","timestamp":1778281809590,"version":"3.51.4"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hyperparathyroidism has been associated with an increased risk of stroke in\n                    several previous studies; but the findings have not been consistent, which\n                    prompts further investigation. This study aimed to elucidate the\n                    association between high serum parathyroid hormone levels and stroke through a\n                    systematic review and meta-analysis. PubMed, Embase, Scopus and Google Scholar\n                    were systematically searched up to May 2025 for relevant and original\n                    observational studies. Pooled odds ratios and hazard ratios were calculated with\n                    corresponding 95% confidence intervals, along with heterogeneity and publication\n                    bias. The combined search yielded 2,063 unique articles, and 14 studies were\n                    included in statistical analysis. Two associations were analysed: nine studies\n                    focused on comparing the risk of stroke between populations with normal and high\n                    parathyroid hormone levels and the remaining five studies focused on comparing\n                    the rate of hyperparathyroidism between populations with stroke and normal\n                    population. In the first group, subgroup analyses of studies reported that both\n                    hazard ratios and odds ratios demonstrated stroke to be more likely in groups\n                    with hyperparathyroidism (odds ratio: 1.49 and 95% confidence interval:\n                    1.38\u20131.61; hazard ratio: 1.38 and 95% confidence interval: 1.09\u20131.75). In the\n                    second group, analysis demonstrated that groups with stroke are more likely to\n                    have higher level of parathyroid hormone (mean difference of parathyroid hormone\n                    levels: 10.30 pg\/mL and 95% confidence interval: 1.60\u201319.00). There were no\n                    significant publication biases in any of the analyses (p&gt; 0.05). This\n                    review is supportive of the association between hyperparathyroidism and stroke\n                    but does not establish a conclusive causal relationship.<\/jats:p>","DOI":"10.1055\/a-2818-9158","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T23:43:21Z","timestamp":1773445401000},"page":"177-185","source":"Crossref","is-referenced-by-count":0,"title":["Association between Hyperparathyroidism and the Risk of\n                    Cerebrovascular Disease in the General Population"],"prefix":"10.1055","volume":"58","author":[{"given":"Grace H.","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Sydney, Sydney,\n                    Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-0088","authenticated-orcid":false,"given":"Femi E.","family":"Ayeni","sequence":"additional","affiliation":[{"name":"Nepean Institute of Academic Surgery, The University of\n                    Sydney, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy D.","family":"Eslick","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Sydney, Sydney,\n                    Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senarath","family":"Edirimanne","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Sydney, Sydney,\n                    Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021:\n                    A systematic analysis for the global burden of disease study 2021","volume":"23","author":"GBD 2021 Stroke Risk Factor\n                        Collaborators","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"4343171","DOI":"10.1155\/2017\/4343171","article-title":"Parathyroid hormone levels in the prediction of ischemic stroke risk","volume":"2017","author":"G \u00c7elik","year":"2017","journal-title":"Dis Markers"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.ahj.2014.04.017","article-title":"Parathyroid hormone concentration and risk of cardiovascular diseases: The\n                    atherosclerosis risk in communities (ARIC) study","volume":"168","author":"A R Folsom","year":"2014","journal-title":"Am Heart J"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1210\/jc.2012-4022","article-title":"Incidence and prevalence of primary hyperparathyroidism in a racially mixed\n                    population","volume":"98","author":"M W Yeh","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"e936","DOI":"10.1097\/MD.0000000000000936","article-title":"Reduced stroke risk after parathyroidectomy in end-stage renal disease: A\n                    13-year population-based cohort study","volume":"94","author":"Y H Hsu","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.cca.2016.01.034","article-title":"Parathyroid hormone, cardiovascular and all-cause mortality: A\n                    meta-analysis","volume":"455","author":"B Yang","year":"2016","journal-title":"Clin Chim Acta"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ahj.2013.02.014","article-title":"Parathyroid hormone and cardiovascular disease events: A systematic review and\n                    meta-analysis of prospective studies","volume":"165","author":"A J van Ballegooijen","year":"2013","journal-title":"Am Heart J"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/cen.12819","article-title":"Normocalcaemic, vitamin D-sufficient hyperparathyroidism\u2014high prevalence and low\n                    morbidity in the general population: A long-term follow-up study, the WHO MONICA\n                    project, Gothenburg, Sweden","volume":"83","author":"G Kontogeorgos","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1002\/jrsm.1240","article-title":"Power analysis for random-effects meta-analysis","volume":"8","author":"D Jackson","year":"2017","journal-title":"Res Synth Methods"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: A proposal for\n                    reporting. 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Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.12.029","article-title":"Parathyroid hormone and subclinical cerebrovascular disease: The atherosclerosis\n                    risk in communities brain magnetic resonance imaging study","volume":"25","author":"S K Korada","year":"2016","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"6718","DOI":"10.3390\/jcm12216718","article-title":"Primary hyperparathyroidism and cardiovascular disease: An association study\n                    using clinical natural language processing systems and big data analytics","volume":"12","author":"P Iglesias","year":"2023","journal-title":"J Clin Med"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/j.1365-2265.2010.03958.x","article-title":"A record linkage study of outcomes in patients with mild primary\n                    hyperparathyroidism: The parathyroid epidemiology and audit research study\n                    (PEARS)","volume":"75","author":"N Yu","year":"2011","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.ahj.2011.05.005","article-title":"Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease:\n                    dependent or independent risk factors?","volume":"162","author":"J L Anderson","year":"2011","journal-title":"Am Heart J"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/00365513.2019.1683763","article-title":"Hyperparathyroidism in men\u2014morbidity and mortality during 21 years\u2019\n                    follow-up","volume":"80","author":"G Kontogeorgos","year":"2020","journal-title":"Scand J Clin Lab Invest"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"e2215396","DOI":"10.1001\/jamanetworkopen.2022.15396","article-title":"Analysis of comorbidities, clinical outcomes, and parathyroidectomy in adults\n                    with primary hyperparathyroidism","volume":"5","author":"K F Axelsson","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"36","key":"ref21","first-page":"4628","article-title":"Study on the level of parathyroid hormone and severity and prognosis of cerebral\n                    ischemic stroke severity in middle-aged and elderly people","volume":"24","author":"D Zhang","year":"2021","journal-title":"Chin Gener Pract"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"4343171","DOI":"10.1155\/2017\/4343171","article-title":"Parathyroid hormone levels in the prediction of ischemic stroke risk","volume":"2017","author":"G \u00c7elik","year":"2017","journal-title":"Dis Markers"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"30","DOI":"10.15537\/smj.2017.1.15813","article-title":"Diagnostic performance of bone metabolic indexes for the detection of\n                    stroke","volume":"38","author":"L M Tan","year":"2017","journal-title":"Saudi Med J"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"721","DOI":"10.4103\/2230-8210.139241","article-title":"Vitamin D status and risk of ischemic stroke in North Indian patients","volume":"18","author":"A Gupta","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"C162","DOI":"10.1016\/j.jacc.2013.08.475","article-title":"Parathyroid hormone levels is increased in ischemic cerebrovascular events and\n                    related with decreased aortic distensibility","volume":"62","author":"H Altay","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"e842","DOI":"10.1210\/clinem\/dgad103","article-title":"Morbidity associated with primary hyperparathyroidism-a population-based study\n                    with a subanalysis on Vitamin D","volume":"108","author":"E Soto-Pedre","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"e4810","DOI":"10.1097\/MD.0000000000004810","article-title":"Parathyroid hormone and risk of heart failure in the general population: A\n                    meta-analysis of prospective studies","volume":"95","author":"F Meng","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"709024","DOI":"10.1155\/2014\/709024","article-title":"Association between parathyroid hormone levels and inflammatory markers among US\n                    adults","volume":"2014","author":"S P Cheng","year":"2014","journal-title":"Mediators Inflammation"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s11883-012-0293-5","article-title":"Vitamin D, calcium, and atherosclerotic risk: Evidence from serum levels and\n                    supplementation studies","volume":"15","author":"P L Lutsey","year":"2013","journal-title":"Curr Atheroscler Rep"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1159\/000226578","article-title":"Osteoporosis after stroke: A review of the causes and potential treatments","volume":"28","author":"S Carda","year":"2009","journal-title":"Cerebrovasc Dis"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1681\/ASN.V12102131","article-title":"Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone\n                    with cardiac mortality risk in chronic hemodialysis patients","volume":"12","author":"S K Ganesh","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1160\/TH16-07-0551","article-title":"Serum 25-hydroxyvitamin D and the risk of stroke in Hong Kong Chinese","volume":"117","author":"R Y Leung","year":"2017","journal-title":"Thromb Haemost"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"781","DOI":"10.2215\/CJN.09570912","article-title":"Serum FGF23 and risk of cardiovascular events in relation to mineral metabolism\n                    and cardiovascular pathology","volume":"8","author":"J \u00c4rnl\u00f6v","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1161\/STROKEAHA.116.013195","article-title":"Association between serum phosphate levels and stroke risk in patients\n                    undergoing hemodialysis: The Q-cohort study","volume":"47","author":"S Yamada","year":"2016","journal-title":"Stroke"},{"key":"ref35","volume-title":"Chapter 13: Assessing risk of bias due to missing evidence in a meta-analysis\n                    [last updated August 2024]","author":"M J Page","year":"2024"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/1747493015607515","article-title":"Vitamin D deficiency and incident stroke risk in community-living black and\n                    white adults","volume":"11","author":"S E Judd","year":"2016","journal-title":"Int J Stroke"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.nut.2011.10.015","article-title":"25-Hydroxyvitamin D deficiency is associated with fatal stroke among whites but\n                    not blacks: The NHANES-III linked mortality files","volume":"28","author":"E D Michos","year":"2012","journal-title":"Nutrition"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.05.045","article-title":"Age and gender differences in the association between serum 25-hydroxyvitamin D\n                    and stroke in the general US Population: The national health and nutrition\n                    examination survey, 2001\u20132006","volume":"26","author":"J Li","year":"2017","journal-title":"J Stroke Cerebrovasc Dis"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2818-9158.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:41:01Z","timestamp":1778280061000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2818-9158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":37,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,5,8]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2818-9158","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]}}}