Hyperphosphatemia is associated with cardiac valve calcification in chronic hypoparathyroidism

J Endocrinol Invest. 2022 Jul;45(7):1359-1366. doi: 10.1007/s40618-022-01770-1. Epub 2022 Mar 2.


Purpose: To evaluate the association between metabolic abnormalities and cardiovascular risk factors in patients with chronic hypoparathyroidism (HPP).

Patients and methods: Patients 18 years and older, glomerular filtration > 30 mL/min/1.73 m2 and no documented coronary artery disease were selected. Serum calcium, phosphorus, glucose, lipids, PTH, 25(OH)D and FGF23 were measured. Cardiovascular risk was estimated by the European Society of Cardiology (ESC) calculator. Transthoracic echocardiogram and carotid ultrasound were performed to detect carotid plaques (CP), carotid intima-media thickness (IMT), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH).

Results: Thirty-seven patients (94.6% female), aged 56.0 ± 13.5 years and HPP duration 7.0 (4.0; 11.3) years, were included. Fifteen were classified as low cardiovascular risk, 9 as intermediate risk, 9 as high risk and none as very high risk. The prevalence of CP, CVC and LVH was 24.3%, 24.3% and 13.5%, respectively. IMT values were within normal ranges in all cohort. FGF23 were not associated with CP, IMT, CVC or LVH. After logistic regression, phosphorus was the only significant metabolic variable impacting CVC in univariate analysis (OR 2.795; 95% CI 1.132-6.905; p = 0.026), as well as in the multivariate analysis (OR 3.572; 95% CI 1.094-11.665; p = 0.035). Analysis by ROC curve showed serum phosphorus > 5.05 mg/dL (AUC 0.748; CI 0.584-0.877; p = 0.05) as the best cutoff point associated with valve heart calcification (sensitivity 78%; negative predictive value 91.3%).

Conclusion: Hyperphosphatemia was associated with CVC in HPP patients. Further studies are needed to investigate whether the control of hyperphosphatemia may reduce cardiovascular risk in this population.

Keywords: Cardiac valves; Cardiovascular risk; Hypoparathyroidism; Phosphorus; Vascular calcification.

MeSH terms

  • Carotid Intima-Media Thickness
  • Female
  • Heart Valves
  • Humans
  • Hyperphosphatemia* / complications
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / epidemiology
  • Hypertrophy, Left Ventricular / etiology
  • Hypoparathyroidism* / complications
  • Hypoparathyroidism* / epidemiology
  • Male
  • Phosphorus
  • Risk Factors


  • Phosphorus