Cardiometabolic disorders have been associated with primary hyperparathyroidism 
(PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic 
syndrome (MS) with different clinical presentation of PHPT remains undefined. 
Our aim was to evaluate CRS, MS and its components in PHPT looking for their 
correlation to different clinical forms. In 68 consecutive PHPT patients and 68 
matched controls, CRS, MS and its components were assessed to perform an 
observational case-control study at an ambulatory referral center for Bone 
Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic 
PHPT; these latter were divided in high-risk and low-risk subgroups for 
end-organ damage. An increased proportion of PHPT patients had intermediate-high 
CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 
11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was 
prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted 
prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, 
mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and 
LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only 
LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and 
controls without cardiometabolic risk factors, HOMA-IR index was significantly 
increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 
0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted 
MS after adjusting for age, sex, and BMI. Our data show an increased frequency 
of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT 
while MS prevails in low-risk asymptomatic PHPT, supporting the potential for 
cardiovascular morbidity and mortality also in this form.