{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:33:08Z","timestamp":1787758388672,"version":"build-2784847793"},"reference-count":36,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Primary hyperparathyroidism (PHPT) has been associated with cardiovascular abnormalities, but the extent to which these reflect PHPT or conventional risk factors remains uncertain. We compared cardiovascular risk profiles and cardiac findings in patients with PHPT and controls. Methods: In this single-center cross-sectional case\u2013control study, 5868 hospitalized patients were screened between January 2024 and December 2025. Fifty-four patients with biochemically confirmed PHPT and 23 age- and sex-comparable controls underwent standardized clinical, laboratory, 12-lead electrocardiogram (ECG), 24-h Holter ECG, and transthoracic echocardiographic assessment. Results: Patients with PHPT had higher systolic blood pressure (132.5 vs. 130.0 mmHg; p = 0.049), more type 2 diabetes (18.5% vs. 0%; p = 0.028), left ventricular hypertrophy (57.4% vs. 30.4%; p = 0.046), longer transmitral flow deceleration time (281.5 vs. 222.0 ms; p &lt; 0.001), higher pulmonary artery systolic pressure (PASP) (24.5 vs. 19.0 mmHg; p &lt; 0.001), and more aortic valve sclerosis\/fibrotic thickening (38.9% vs. 13.0%; p = 0.032). High\/very high cardiovascular risk was present in 54\/54 (100%) PHPT patients versus 20\/23 (86.96%) controls (p = 0.024). After adjustment, PHPT remained associated with longer deceleration time, higher PASP, aortic valve sclerosis\/fibrotic thickening, and pericardial effusion. Conclusions: PHPT was associated with selected echocardiographic abnormalities, but causality cannot be inferred. Larger prospective studies are needed.<\/jats:p>","DOI":"10.3390\/jcm15176605","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:04:32Z","timestamp":1787756672000},"page":"6605","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Alterations in Primary Hyperparathyroidism: Associations with Risk Profile, Cardiac Structure, and Function"],"prefix":"10.3390","volume":"15","author":[{"given":"Desislava","family":"Zamfirova","sequence":"first","affiliation":[{"name":"Endocrinology Clinic, UMHAT \u201cAlexandrovska\u201d, Medical University of Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5695-2831","authenticated-orcid":false,"given":"Mihail","family":"Boyanov","sequence":"additional","affiliation":[{"name":"Endocrinology Clinic, UMHAT \u201cAlexandrovska\u201d, Medical University of Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0855-7861","authenticated-orcid":false,"given":"Stefan","family":"Naydenov","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases \u201cProf. St. Kirkovich\u201d, Medical University of Sofia, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1002\/jbmr.4665","article-title":"Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism","volume":"37","author":"Minisola","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1002\/jbmr.4677","article-title":"Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop","volume":"37","author":"Bilezikian","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nrendo.2017.104","article-title":"Primary hyperparathyroidism","volume":"14","author":"Walker","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Iglesias, P., Arias, J., L\u00f3pez, G., Romero, I., and D\u00edez, J.J. (2023). Primary Hyperparathyroidism and Cardiovascular Disease: An Association Study Using Clinical Natural Language Processing Systems and Big Data Analytics. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216718"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/BF03346443","article-title":"Cardiovascular aspects of primary hyperparathyroidism","volume":"31","author":"Walker","year":"2008","journal-title":"J. Endocrinol. Investig."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dobreva, E.A., Gorbacheva, A.M., Bibik, E.E., Eremkina, A.K., Elfimova, A.R., Salimkhanov, R., Kovaleva, E.V., Maganeva, I.S., and Mokrysheva, N.G. (2023). Cardiovascular and metabolic status in patients with primary hyperparathyroidism: A single-center experience. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1266728"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(17)31430-7","article-title":"Hyperparathyroidism","volume":"391","author":"Bilezikian","year":"2018","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s40618-021-01645-x","article-title":"Cardiac structural and functional abnormalities in primary hyperparathyroidism","volume":"45","author":"Purra","year":"2021","journal-title":"J. Endocrinol. Investig."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ando.2020.02.006","article-title":"The cardiovascular consequences of hyperaldosteronism","volume":"82","author":"Rossi","year":"2021","journal-title":"Ann. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ando.2020.02.005","article-title":"PTH and cardiovascular risk","volume":"82","author":"Gruson","year":"2021","journal-title":"Ann. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"117130","DOI":"10.1016\/j.bone.2024.117130","article-title":"Association between primary hyperparathyroidism and cardiovascular outcomes: A systematic review and meta-analysis","volume":"185","author":"Kong","year":"2024","journal-title":"Bone"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-S\u00e1nchez, \u00c1., Meneses, D., Bellasai, E.R.A., C\u00e1rdenas-Salas, J., Paniagua, A., V\u00e1zquez, C., and Ruiz-S\u00e1nchez, J.G. (2025). Impact of Parathormone (PTH) Levels on the Presence of Cardiovascular Disease in Patients with Primary Aldosteronism and Essential Hypertension. Endocrines, 6.","DOI":"10.3390\/endocrines6010008"},{"key":"ref_13","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 meta-analysis of prospective studies","volume":"165","author":"Reinders","year":"2013","journal-title":"Am. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.amjsurg.2023.04.004","article-title":"Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis","volume":"226","author":"Nabata","year":"2023","journal-title":"Am. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1097\/HJH.0000000000003822","article-title":"Primary aldosteronism prevalence enhanced by strict adherence to 2016 Endocrine Society guidelines: Insights from an endocrine hypertension unit","volume":"42","author":"Rossello","year":"2024","journal-title":"J. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zheng, M.H., Li, F.X.Z., Xu, F., Lin, X., Wang, Y., Xu, Q.S., Guo, B., and Yuan, L.Q. (2020). The Interplay Between the Renin-Angiotensin-Aldosterone System and Parathyroid Hormone. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00539"},{"key":"ref_17","first-page":"1065","article-title":"Parathyroid diseases and metabolic syndrome","volume":"46","author":"Modica","year":"2023","journal-title":"J. Endocrinol. Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ijcard.2016.11.080","article-title":"Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample","volume":"227","author":"Kalla","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"142","DOI":"10.21037\/gs.2019.10.21","article-title":"Primary hyperparathyroidism and hypertension","volume":"9","author":"Fisher","year":"2020","journal-title":"Gland Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1210\/clinem\/dgab157","article-title":"Meta-analysis on the Effect of Mild Primary Hyperparathyroidism and Parathyroidectomy Upon Arterial Stiffness","volume":"106","author":"Bernardi","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5628","DOI":"10.2174\/1381612824999201105165642","article-title":"Cardiovascular Risk in Patients with Primary Hyperparathyroidism","volume":"26","author":"Tournis","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.endonu.2014.05.007","article-title":"Factores de riesgo cardiovascular en pacientes con hiperparatiroidismo primario asintom\u00e1tico","volume":"61","year":"2014","journal-title":"Endocrinol. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e2544623","DOI":"10.1001\/jamanetworkopen.2025.44623","article-title":"Parathyroidectomy and Cardiometabolic Risks in Patients with Primary Hyperparathyroidism","volume":"8","author":"Tsur","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ando.2015.03.001","article-title":"Asymptomatic and mild primary hyperparathyroidism","volume":"76","author":"Macfarlane","year":"2015","journal-title":"Ann. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"R33","DOI":"10.1530\/EJE-21-1044","article-title":"European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)","volume":"186","author":"Bollerslev","year":"2022","journal-title":"Eur. J. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lancellotti, P., and Cosyns, B. (2015). Examination. The EACVI Echo Handbook [Internet], Oxford University Press. [1st ed.].","DOI":"10.1093\/med\/9780198713623.003.0001"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1093\/ehjci\/jex244","article-title":"Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: An expert consensus document of the European Association of Cardiovascular Imaging","volume":"18","author":"Galderisi","year":"2017","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1093\/ehjci\/jew333","article-title":"EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: A report of literature and current practice review","volume":"18","author":"Steeds","year":"2017","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1016\/j.ehj.2004.07.010","article-title":"Primary hyperparathyroidism and heart disease ? A review","volume":"25","author":"Andersson","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_31","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 meta-analysis of prospective studies","volume":"95","author":"Meng","year":"2016","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1046\/j.1365-2265.1999.00651.x","article-title":"Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy","volume":"50","author":"Piovesan","year":"1999","journal-title":"Clin. Endocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e327401","DOI":"10.1161\/CIRCRESAHA.125.327401","article-title":"Parathyroid Hormone Contributes to Pulmonary Hypertension in Hypoxic Conditions","volume":"138","author":"Joki","year":"2026","journal-title":"Circ. Res."},{"key":"ref_34","first-page":"1052","article-title":"Cardiac calcific deposits in patients with primary hyperparathyroidism: Preliminary results of a prospective echocardiographic study","volume":"108","author":"Niederle","year":"1990","journal-title":"Surgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1210\/jc.2011-2107","article-title":"Aortic valve calcification in mild primary hyperparathyroidism","volume":"97","author":"Iwata","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Costantini, P., Perone, F., Siani, A., Groenhoff, L., Muscogiuri, G., Sironi, S., Marra, P., Carriero, S., Pavon, A.G., and Guglielmo, M. (2022). Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation. J. Imaging, 8.","DOI":"10.3390\/jimaging8100278"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6605\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:13:30Z","timestamp":1787757210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":36,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176605"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176605","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}