MON-844 - Cardiovascular Calcification Diagnoses and Coronary Calcium Testing after Primary Hyperparathyroidism: A Matched Global EHR Study

Background:
Cardiovascular and valvular calcification has been linked to primary hyperparathyroidism (PHPT), and CT-based studies suggest higher coronary artery calcium (CAC) burden in selected PHPT cohorts. Whether PHPT confers incremental real-world calcification diagnoses or CAC testing beyond non-PHPT hypercalcemia remains uncertain.

Methods:
Using the TriNetX Global Collaborative Network (168 healthcare organizations), we identified adults (≥18 years) with PHPT (ICD-10-CM E21.0) and a comparator cohort with non- PHPT hypercalcemia (ICD-10-CM E83.52, excluding E21.0), with index diagnoses on or before 12/31/2022. The index date was the first qualifying diagnosis. Outcomes were assessed from day 1 to 3 years after index, excluding patients with the outcome recorded before the window. One-to-one propensity score matching balanced demographics, diagnostic groupings, procedures, medication classes, and laboratory values. Outcomes included calcified coronary lesion (I25.84), CAC scan utilization (CPT 75571), and a composite of cardiovascular calcifications (I25.84/I34.81/I35.0/I70.0).

Results:
Before matching, cohorts included 143,612 PHPT and 506,894 hypercalcemia patients. After matching, 101,407 patients remained in each cohort; median follow-up was 1095 days (mean 873.6 vs 839.5 days). Calcified coronary lesion occurred in 349/101,134 (0.35%) PHPT vs 377/101,136 (0.37%) comparators (risk ratio 0.926; risk-difference p=0.298; Kaplan-Meier HR 0.890, 95% CI 0.769-1.029; log-rank p=0.115; event-free 99.57% vs 99.52%). CAC testing was similarly uncommon (373/101,139 [0.37%] vs 382/101,137 [0.38%]; risk-difference p=0.743; HR 0.936, 95% CI 0.811-1.079; log-rank p=0.361; event-free 99.53% vs 99.50%). The composite outcome occurred in 2,998/96,947 (3.09%) PHPT vs 3,503/96,433 (3.63%) comparators (risk difference -0.005, 95% CI -0.007 to -0.004, p< 0.001; risk ratio 0.851; HR 0.820, 95% CI 0.781-0.861; log-rank p< 0.001; event-free 96.16% vs 95.41%).

Conclusion:
Over 3 years in a large matched global EHR cohort, PHPT was not associated with higher rates of coded coronary calcified lesions or CAC scan utilization compared with hypercalcemia without PHPT, while a broader cardiovascular/valvular/aortic calcification composite was lower. Findings reflect real‑world testing and coding capture rather than imaging‑derived CAC severity and suggest prospective, risk‑stratified studies integrating biochemical phenotype with imaging to guide when CAC testing or systematic calcification assessment should be prioritized in PHPT.

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