High cholesterol doubles your rate of heart disease and stroke, but did you know that high blood calcium is far more dangerous than high cholesterol? Hyperparathyroidism caries many significant health risks.

High Blood Calcium Risks

High blood calcium levels are almost never normal and increases the chances of developing a number of other health problems and even early death if ignored. For adults over 35 years of age, this means we should not have blood calcium higher than 10.0 mg/dl (2.5 mmol/l).  High blood calcium due to hyperparathyroidism occurs in 1% of women over 50, and one in 200 men, yet a lot of doctors aren't paying attention to this problem.  High blood cholesterol, on the other hand, is much more common (one in 6 Americans). We have all known for many years that we need to keep our cholesterol into the normal range, and for many of us that means taking a "statin" type of drug. Why does everybody know about the risks of high cholesterol while the risks of high calcium are often ignored even though high calcium is considerably more dangerous?  Could it be that the big drug companies have educated us about high cholesterol, but since there is no drug for high calcium nobody has bothered to teach us? Well, let's learn this today, and then let's print the references at the bottom of this parathyroid blog and teach our doctors!

Risks of high calcium vs the risks of high cholesterol:  A closer look at Parathyroid Risks

Hyperparathyroidism and high blood calcium -even a "little bit high" carries significantly more risk than high cholesterol. So why is your doctor "watching" your high calcium? High blood calcium -  even a little bit high - causes risks to many organ systems, and it makes you feel bad!

High cholesterol: A problem without symptoms.  

High cholesterol doesn't worry some people because:

• It doesn't cause symptoms. So you don’t know you have it unless you get a blood cholesterol test.
• It doesn't cause pain. So you may be less likely to seek treatment or keep taking your cholesterol-lowering medicine.
• High cholesterol doesn't make people feel bad.

High Calcium: A problem with symptoms.

In contrast to high cholesterol that doesn't have any symptoms, high blood calcium and high parathyroid hormone is almost always associated with symptoms-typically at least 4 of the following:

• Chronic fatigue and tiredness
• Poor memory
• GERD
• Muscle aches and cramps
• Bone pain
• Poor sex drive
• Osteoporosis and broken bones
• Kidney stones
• Heart rhythm problems such as atrial fibrillation

Thus both high calcium and high cholesterol are dangerous, but high calcium (even a little bit high) is much more dangerous than high cholesterol, and the high calcium makes you feel bad. Why are we ignoring high calcium? Why do half of doctors know so little about the risks of high calcium.

Both high calcium and high cholesterol cause damage over many years.

It is very important to understand that the health risks from high cholesterol AND the risks high calcium aren't immediate. The damage accumulates over years - even decades.  Because the effects take time, some people may not feel the urgency to treat it. You may think you can deal with it later – but you may wait too long. This delay in treatment is a major problem with doctors who don't know much about primary hyperparathyroidism (including a lot of endocrinologists). We hear doctors tell their patients all the time: "your calcium is little high… let's keep an eye on it and watch it for a while to see if it goes higher".  This is like saying "Your cholesterol is high, let's watch it for a while".  Better yet, it's like saying "your house is on fire, but it's a small fire… so let's keep an eye on it for a while".  We know that many years of high cholesterol will decrease your life expectancy because of the higher chance of heart attack and stroke. HOWEVER, the risks of high blood calcium and the risks of hyperparathyroidism are at least twice that of high cholesterol (probably about 4 times higher risk) because the high calcium doesn't just cause an increase in the rate of heart attack and stroke, it also increases the risk of several cancers (breast, prostate, colon, kidney), and increases the risk of kidney failure, high blood pressure, cardiomyopathy (poor ejection of heart blood), atrial fibrillation and heart arrhythmias, and bone marrow failure (with low platelets, MGUS, low red cells, and low white cells) and a host of other problems outlined in our reference section below.  Please read the reference list at the bottom of this article for published research articles on the risks of hyperparathyroidism and the risks of prolonged elevations of high blood calcium.

High blood calcium carries dramatic risks of heart disease, cancer, bone failure and kidney failure. Thus, the approach by doctors that say "the calcium is not that high, let's watch if for now" is not based in science (outlined below) and what we know about long-term high blood calcium risks. Having high calcium, just like having high cholesterol may not hurt you today or tomorrow, but if you don't do something about it, it can have a terrible cost down the road.  We have taken care of nearly 25,000 patients with hyperparathyroidism and high blood calcium, and we can't remember ever seeing somebody with this disease for 25 years-they are all deceased from the list of complications above. When we see patients with high blood calcium for 15 years, almost all of them have decreased kidney function (see our blog on this), severe osteoporosis, are on 3 or more blood pressure medications, and have had to quit work because they can't concentrate and are so tired all the time. When we see patients with high blood calcium for 20 years, at least half of them are using a walker because they are too weak to walk any distance, and almost all of them are in atrial fibrillation with over half having a pacemaker. Prolonged high calcium, even a ‘little bit high" for years will absolutely, in EVERY case, cause multiple organs to fail. We see this every single day.

The longer the calcium is high, the more risky, dangerous, and deadly it becomes.

High blood cholesterol for years increases your risk of heart attack and stroke. High blood calcium for years carries far greater risks to your heart, but also to your bones, kidneys, breasts, prostate, colon, and brain

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. Likewise, some people with calcium levels "just a little bit elevated" have no symptoms, while others have terrible fatigue. Many doctors will say that a lot of patients with hyperparathyroidism are "asymptomatic" (without symptoms) because they are not counting the fatigue, GERD, memory loss, high blood pressure and osteoporosis. They are only counting the "old-time" definition of hyperparathyroid symptoms which are kidney stones and spine / hip fractures.  Because of the many studies performed in the past 2 decades (some of which are listed below), we now have overwhelming evidence that virtually all patients with high blood calcium and hyperparathyroidism have symptoms, and those uncommon "asymptomatic" patients (no symptoms) will develop symptoms if the calcium is not decreased by removing the parathyroid tumor. As you will see from reading the list of articles below and their conclusions, 10 or more years of even slightly high calcium will increase a persons risk for heart attack, stroke, heart muscle failure, cardiomyopathy, kidney failure, carotid artery thickening, aorta calcification, and more…  Ten years of high calcium is more dangerous than 20 years of high cholesterol.

How to decrease the risk? One takes decades of drugs, the other takes less than 20 minutes!

High cholesterol requires taking cholesterol-reducing drugs daily for decades to have an impact on a person's risk of heart attack. Every day, tens of millions of people take some form of "statin" drug, in hopes of decreasing their high cholesterol levels. People in their 40's and 50's take these drugs for decades in hopes of delaying a heart attack while in their 60's and 70's.  

High blood calcium due to hyperparathyroidism carries greater risks for the development of multiple medical problems leading to early death when compared to high cholesterol, but it is very different in that hyperparathyroidism can be cured in virtually all people in less than 20 minutes. We cure over 50 people per week by removing their parathyroid tumor, sending them home an hour or so later. Sure, everybody cannot come to Florida to have surgery, but you must find an expert parathyroid surgeon and have the parathyroid tumor removed.  In contrast to taking drugs for high cholesterol, the health benefits from getting the parathyroid tumor removed are immediate-they are not delayed 20 or 30 years down the road. When the parathyroid tumor is removed and the hyperparathyroidism (and high calcium) are cured, the risk for breast cancer decreases within a year or two; the risk for kidney stones and kidney failure decrease dramatically within hours; the blood flow through the coronary arteries increases within weeks; cardiac muscle contraction increases within weeks; the risk of bone fractures decreases within months; and on and on.  The list below is a very small sample of the research showing these risks and their improvements following successful parathyroid surgery.

We have treated over 25,000 patients with primary hyperparathyroidism, now performing an average of 52 parathyroid operations weekly on patients from all over the world. We see these patients treated by some doctors who understand the risks of high calcium and demand that the patient have the parathyroid tumor removed at the very first high blood calcium. However, every day we see patients treated by doctors who have no clue about the high risks of "watching" the high blood calcium, thinking that "since the calcium is not that high, we can just keep checking it to see if it goes higher". Hopefully the reader of this article knows this:  How high the calcium has become is irrelevant - the height of calcium is a very poor indicator of the severity of parathyroid disease. The complications, health problems, and death due to high blood calcium are related to the length of time the calcium has been high-just like it is with high cholesterol.  How long, not how high!

Remove the parathyroid tumor: Feel better & live longer

It takes 20 minutes (often less!) to cure almost all patients of hyperparathyroidism, leading to tremendous health benefits for the rest of your life. As discussed in another blog, your surgeon should look at all four parathyroid glands because 30% of people will have more than one bad parathyroid gland. Leaving one small, overactive parathyroid gland in your neck (even after taking out a large tumor) will not provide the health benefits you are looking for and expecting, thus all four parathyroid glands should be examined. If your surgeon wants to take out the one tumor that shows on the scan and not look at the other three parathyroid glands, then you may want to find a more expert surgeon-after all, you want one operation to put this disease (and it's risks!) behind you forever!

Please look closely at the TWO sections below. The first is a list of conclusions that come directly from the medical journal publications listed in the second section. Each article (in the second section) has a link directly to the medical journal article. Print this reference list to take to your doctor. Heck, print this entire page (and then don't leave their office until they read it!).

  IMPORTANT CONCLUSIONS FROM THE SCIENTIFIC ARTICLES (bottom of page) REGARDING THE RISKS OF HYPERPARATHYROIDISM.

1. Primary hyperparathyroidism (PHPT) is associated with significant increases in cardiovascular morbidity and premature death.
2. A strong correlation exists between breast cancer and primary hyperparathyroidism.
3. Cancers of the prostate, colon, breast, and kidney are all seen more frequently in patients with primary hyperparathyroidism.
4. Mortality and morbidity are increased for patients with mild untreated hyperparathyroidism, which is similar to more severe hyperparathyroidism. The increased risks are substantial.
5. Primary hyperparathyroidism is a risk factor of higher cardiovascular mortality, mainly because hyperparathyroidism is related to arterial hypertension, arrhythmias, structural heart abnormalities and activation of the renin-angiotensin- aldosterone system.
6. There is a high prevalence of left ventricular hypertrophy in primary hyperparathyroidism. The correlation between PTH values and left ventricular mass index suggests an action of PTH. The reversal of left ventricular mass index after parathyroidectomy could affect mortality in primary hyperparathyroidism.
7. Patients suffering from symptomatic pHPT have increased mortality, mainly due to an over-representation of cardiovascular death.
8. pHPT is reported to be associated with hypertension, disturbances in the renin-angiotensin-aldosterone system, and structural and functional alterations in the vascular wall.
9. Recently, studies have indicated an association between pHPT and heart disease, and studies in vitro have produced a number of theoretical approaches. An increased prevalence of cardiac structural abnormalities such as left ventricular hypertrophy (LVH) and valvular and myocardial calcification has been observed.
10. The prevalence of obesity, hypertension, hyperlipidemia, Type 2 diabetes, and coronary artery disease (CAD) is higher in PHPT patients compared to the general population, increasing risk by nearly 5-fold.
11. PHPT strongly influences gene regulation in fat tissue, which may result in altered adipose tissue function and release of pathogenic factors that increase the risk of cardiovascular disease.
12. pHPT is associated with increased aortic stiffness, which improves after parathyroid surgery.
13. PTH is independently associated with all cause and cardiovascular mortality in patients with heart failure.
14. Patients with mild PHPT had an increased risk of mortality, fatal and nonfatal cardio-vascular disease, and the risk of developing other co-morbidities was also increased.
15. Primary hyperparathyroidism is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels.
16. There is a clear role for PTH in the development of heart failure even in patients with very mild hyperparathyroidism.
17. Hyperparathyroidism increases aortic stiffness index and decreases aortic distensibility of primary hyperparathyroid patients compared with normal population.
18. Untreated mild elevations in blood calcium in patients with primary hyperparathyroidism is associated with a moderate derangement of lipid and glucose metabolism.
19. Primary hyperparathyroidism is associated with a variety of cardiovascular disturbances such as left ventricular (LV) hypertrophy, diastolic cardiac dysfunction, and hypertension.
20. Patients with primary hyperparathyroidism show an evidence of left ventricular asynchrony by TSI. Asynchrony may contribute to the harmful cardiovascular effects and cardiac risks of primary hyperparathyroidism.
21. Hyperparathyroidism patients have coronary micro-vascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary micro-vascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in patients with primary hyperparathyroidism.
22. Long term risks of heart attack and lethal MI is decreased following parathyroid surgery (parathyroidectomy).
23. The cardiovascular risk associated with normo-calcemic primary hyperparathyroidism should not be underestimated and is likely the same as hyperparathyroidism associated with high blood calcium.
24. Parathyroidectomy in hypertensive patients seems to reduce both systolic and diastolic blood pressure.
25. There is a higher prevalence of metabolic disorders and coronary heart disease in parathyroid patients. Male hyperparathyroidism patients had larger parathyroid adenomas at the time of surgery and had a higher prevalence of obesity, Type 2 diabetes and coronary artery disease compared to female hyperparathyroid patients.
26. Hyperparathyroid symptoms are numerous and improve after curative parathyroid surgery.
27. Medication use for related symptoms can be beneficially reduced by surgery.
28. The drugs patients take should be routinely reviewed and adjusted after parathyroid surgery anticipating elimination of some.
29. Risks of high blood calcium are decreased following successful parathyroid surgery.
30. Impairment of catecholamine response to physical stress is seen in patients with primary hyperparathyroidism along with changes of heart rate variability, also indicating adrenergic dysfunction.
31. Anemia is common in patients with symptomatic primary hyperparathyroidism (seen in 16%), and was associated with bone marrow fibrosis in the majority of the patients who underwent bone biopsy. Both anemia and bone marrow fibrosis improved after curative parathyroid surgery.
32. Primary hyperparathyroidism (PHPT) is associated with higher rates of cardiovascular morbidity and premature death, but the underlying mechanisms are incompletely understood, likely due to the multitude of adverse actions the high calcium and PTH have on nearly all organ systems.
33. Depression, anxiety, and decreased Quality of Life appear to be related to hyperparathyroidism. Successful parathyroidectomy seems to reduce psychopathologic symptoms and improve Quality of life in this setting.
34. There is a substantially greater probability of "metabolic syndrome" and insulin resistance in patients with primary hyperparathyroidism. Serum calcium is a predictor of these cardiovascular risk factors.
35. Increased parathyroid hormone (PTH) level is associated with all-cause mortality in patients with heart failure.
36. Increased PAI-1, PAI-1/t-PA ratios and decreased TFPI levels in parathyroid patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess mortality due to cardiovascular disease seen in patients with primary hyperparathyroidism.
37. Patients with hyperparathyroidism are at significant increased risk for the development of DVT (deep venous thrombosis) and hypercoaguable states.
38. Calcium is clotting factor IV, and likely plays a direct role in the higher risk of DVT (blood clots) in patients with hyperparathyroidism.
39. Patients with severe primary hyperparathyroidism have increased risk for cardiovascular disease, mainly due to the effect of calcium and PTH and also the duration of disease. Elevated PAI-1 levels may imply that hypercoagulability may be involved in the pathogenesis of cardovascular disease in parathyroid patients.
40. There are important differences in the hemostatic parameters between the patients with hyperparathyroidism and healthy controls. Increased platelet count, F VII and FX activities and D-Dimer levels in patients with PHPT represent a potential hypercoagulable state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess mortality rate due to cardiovascular disease in patients with primary hyperparathyroidism.
41. Hyperparathyroid symptoms are numerous and improve after curative parathyroid surgery. Medication use for related symptoms can be beneficially reduced by surgery. Drug profiles should be routinely reviewed and adjusted after parathyroidectomy.

Additional Resources:

• Watch this video of parathyroid surgery to see how of a procedure it should be. There is no blood on this educational video and you will understand how safe, small, and simple parathyroid surgery is in the hands of an expert.
• Read more on the Parathyroid blog.
• Become our patient
• Check out our sister surgeons at the Clayman Thyroid Center, the Scarless Thyroid Surgery Center and the Carling Adrenal Center. We are now united under one roof, operating at the Hospital for Endocrine Surgery. 

References:

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• Clin Epidemiol. 2011 Mar 25;3:103-6.  Breast cancer associated with primary hyperparathyroidism: a nested case control study.
• Cancer Causes Control. 2010 Feb;21(2):251-7.  Serum calcium levels are elevated among women with untreated postmenopausal breast cancer.
• J Cancer Res Ther. 2009 Jan-Mar;5(1):46-8. Hypercalcemia and treated breast cancers: the diagnostic dilemma.
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