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The aim of this study was to investigate the risk of death among patients treated for primary hyperparathyroidism during the past decade.Using the national patient register, all patients operated on for primary hyperparathyroidism in Sweden during 1987-94 were identified and then searched for in the national register of deaths and causes of death during the same period. The control group was the whole Swedish population, matched for age, sex and calendar year.We found that patients treated for primary hyperparathyroidism run an increased risk of death. The risk ratios for death from cardiovascular disease were 1.71 for male and 1.85 for female patients. These estimations are of high precision because of the large patient series (n = 4461), with 95% confidence limits of 1.34-2.15 and 1.62-2.11 for men and women respectively.This finding, together with previous findings that parathyroid adenoma weight, serum calcium level and parathyroid hormone level are predictive of the risk of death, suggests the possibility that surgery in patients with primary hyperparathyroidism may offer not only relief from signs and symptoms but also improved prognosis.