Parathyroidectomy and Cardiometabolic Risks in Patients With Primary Hyperparathyroidism
Authors' conclusion
The findings of this cohort study suggest that pHPT is associated with increased long-term cardiometabolic risks. Parathyroidectomy may be associated with reduced incidence of T2D, supporting consideration of surgical intervention in appropriate patients.
Study context
- Population
- Patients with primary hyperparathyroidism, Clalit Health Services, Israel; secondary hyperparathyroidism excluded; median age 66 years, 68.3% femalematched cohort
- Participants
- 200,464 patients
- Exposure
- Primary hyperparathyroidism (pHPT) vs matched controls; parathyroidectomy vs nonsurgical management
- pHPTn = 50,199
- Controlsn = 150,265reference
- Outcome
- Incidence of hypertension, T2D, cardiovascular disease (CVD) and cerebrovascular accidents (CVA)
- Follow-up
- Up to 15 years
Methodological detailsmatched 1:3 by age, sex and socioeconomic status, multivariable-stratified Cox models adjusted for Charlson Comorbidity Index, BMI and ethnicity, Data analyzed November 1, 2024, to April 1, 2025
- Matched 1:3 by age, sex and socioeconomic status
- Multivariable-stratified Cox models adjusted for Charlson Comorbidity Index, BMI and ethnicity
- Data analyzed November 1, 2024, to April 1, 2025
Main finding
As reported in the abstract
Hypertension, T2D, CVD and CVA, pHPT vs controls
Each group vs controlsEstimate (95% CI)P value
pHPT
aHR (hypertension) 1.22(1.17–1.33)
P < 0.001pHPT
aHR (T2D) 1.07(1.01–1.16)
P = 0.02pHPT
aHR (CVD) 1.28(1.21–1.42)
P < 0.001pHPT
aHR (CVA) 1.22(1.17–1.33)
P < 0.001Observational data: associations, not effects.
Further findings
Per 1000 person-years
| Outcome | Parathyroidectomy | Nonsurgical management | aHR (95% CI) | P value | |
|---|---|---|---|---|---|
| T2D incidence, parathyroidectomyvs nonsurgical management | 10.77 (95% CI 9.80–11.83) | 15.18 (95% CI 14.58–15.81) | 0.56 (0.30–0.89) | P = 0.002 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
T2D incidence, parathyroidectomy vs nonsurgical management
- Parathyroidectomy was associated with reduced risk of T2D only
Original publication
Parathyroidectomy and Cardiometabolic Risks in Patients With Primary Hyperparathyroidism. JAMA Netw Open. Published 3 November 2025. doi:10.
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