MON-764 - Increased Prevalence of Coronary Artery Disease in Patients with Post-Surgical Hypoparathyroidism

Introduction: Hypoparathyroidism (HypoPT) is a rare disease characterized by hypocalcemia and deficient parathyroid hormone secretion. Emerging evidence from large cohort studies suggests an elevated cardiovascular (CV) risk in patients with chronic HypoPT. However, direct imaging-based assessment of coronary artery disease (CAD) in this population is limited. We aimed to characterize CV risk factors and evaluate the prevalence of CAD using coronary computed tomography angiography (CCTA) in patients with post-surgical HypoPT.

Methods: We conducted a cross-sectional study of 50 patients with chronic post-surgical HypoPT and 50 age- and sex-matched controls randomly selected from the general population. Individuals with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 were excluded.

Results: Mean age of patients was 60 years (range 31-84), 86% were female, and the median duration of HypoPT was 12 years (range 5-49). Compared with controls, patients had a lower eGFR (78 vs. 83 mL/min, p = 0.04) and were more frequently treated with antihypertensive medication (56% vs. 36%, p = 0.05). Use of lipid-lowering therapy was numerically higher (34% vs. 18%, p = 0.07). Prevalence of diabetes, smoking status, office blood pressure, cholesterol levels, and arterial stiffness assessed by carotid-femoral wave velocity did not differ between groups. CCTA revealed coronary atherosclerotic plaques in 68% of patients, compared with 42% in controls (p < 0.01). This association remained significant after adjustment for sex, age, and presence of any CAD risk factor, corresponding to a 24-percentage point higher prevalence of coronary atherosclerosis. Severe CAD, defined as a coronary artery calcium score (CACS) ≥400, was present in 18% of patients, compared with only 2% in controls (p = 0.02). HypoPT was associated with increased odds of coronary calcification (CACS >0; OR 3.19, 95% CI 1.40–7.24, p < 0.01), independent of renal function.

Conclusion: Chronic post-surgical HypoPT is associated with a markedly increased burden of coronary atherosclerosis that is not fully explained by conventional CV risk factors. These findings support growing evidence that HypoPT confers excess CV risk and suggest that enhanced CV risk stratification and preventive strategies may be warranted in this population.

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