A study of the cardiac risk factors emerging out of subclinical hypothyroidism

Dey, Anupam; Kanneganti, Vineetha; Das, Debasish

doi:10.4103/jfmpc.jfmpc_348_19

Cited by 17 publications

(14 citation statements)

References 17 publications

(17 reference statements)

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“…Compared with euthyroid individuals, patients with SHypo have significantly elevated levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) levels and significantly decreased levels of high-density lipoprotein-cholesterol (HDL-C) [37][38][39][40]. Such a change is observed with increasing TSH even when TSH is within International Journal of Endocrinology normal range.…”

Section: Dyslipidemia and Yroid Functionmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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Section: Dyslipidemia and Yroid Functionmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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“…Although patients with overt hypothyroidism often complain of weight gain, the association between SH and weight was less clear, especially in AH patients. Dey A., Kanneganti V., Das D. (2019) found that among SH patients with a mean age of 35.1 ± 10.26 years, 12 % were overweight, 24 % were obese, 44 % had a high waist-to-hip ratio, indicating on central obesity, 20 % had high both BMI and waist-to-hip ratio [13]. A significant relationship between central obesity and SH was found by T. M. J. Santhoshakumari, M. Sneha (2019) [14].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of cardiometabolic risk factors in patients with hypertension and subclinical hypothyroidism

Radchenko

Kolesnikova

2021

ZMJ

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It is known that the presence of overt hypothyroidism carries additional risks of developing cardiovascular diseases due to impaired lipid and carbohydrate metabolism. But whether subclinical hypothyroidism (SH) has the same negative impact is still controversial. The assessment of its role is especially important in patients with existing arterial hypertension (AH) in the early stages of the disease in order to prevent future complications. The aim of this work is to identify and assess the prevalence of early cardiometabolic risk factors in patients with AH combined with SH. Materials and methods. 66 patients (55.4 % women) aged from 25 to 59 years with a median age of 51.1 years were included in the study during 2019–2020 years. All the patients were divided into 3 groups, randomized by age and sex: group 1 (n = 21) – volunteers without AH and SH; group 2 (n = 25) – euthyroid patients with stage 1–2 grade 1–2 AH and low-to-moderate cardiovascular risk (CVR); group 3 (n = 20) – patients with stage 1–2 grade 1–2 AH and low-to-moderate CVR in combination with SH. Blood pressure was measured, anthropometric data were assessed, glucose levels and lipid profile indicators were determined in all patients. Results. Comparative characteristics of the groups showed a rise in the frequency of detecting increased waist circumference and the waist-to-hip ratio, obesity, metabolic syndrome, its individual components and lipid profile disorders, especially the levels of total cholesterol and high-density lipoprotein cholesterol in patients with SH even in the early stages of AH and CVR of low gradations. However, dyslipidemias in general and hypertriglyceridemia in particular were more common in euthyroid hypertensive patients compared to patients with AH and concomitant SH. There was also a tendency towards an increase in gynoid obesity and a worsening of the lipid and carbohydrate profile disorders in SH patients in comparison to euthyroid patients with AH, although the differences were not statistically significant. Conclusions. Evaluation of cardiometabolic risk factors revealed the increase in severity of female obesity and worsening of abnormalities in lipid and carbohydrate profiles with the SH development in patients even in the early stages of AH and low-CVR, that additionally increases the risk of cardiovascular complications.

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“…Демонстрируются противоречивые данные. Авторы указывают на прогрессирование течения дислипидемии, что ведет к прогрессированию коронарного атеросклероза, однако в некоторых источниках указывается на отсутствие статистически значимых ассоциаций гипотиреоза со степенью коронарного атеросклероза [11]. В проведенном нами исследовании обнаружены статистически значимые данные, указывающие на преобладание трехсосудистого поражения коронарных сосудов в группе пациентов с ИБС на фоне первичного манифестного гипотиреоза по сравнению с группой пациентов с ИБС без гипотиреоза.…”

Section: Discussionunclassified

“…Выделяются три основных механизма влияния дисбаланса гормонов щитовидной железы на течение ССЗ: • прямое геномное воздействие на кардиомиоциты через сопряжение с ядерными рецепторами, что, в свою очередь, приводит к регуляции экспрессии генов-мишеней; • внеядерный механизм -влияние гормонов на ионные каналы в клеточной мембране кардиомиоцитов; • экстракардиальный механизм -различные эффекты трийодтиронина (Т3) и тироксина (Т4) на периферическое кровообращение, изменение параметров сердечно-сосудистой гемодинамики, показатели сократимости миокарда (ударный объем) и т. д. [10,11]. Все вышеперечисленные патогенетические механизмы ведут к ухудшению течения ССЗ на фоне гипотиреоза.…”

Section: заключениеunclassified

State of the coronary arteries and assessment of the role of hormone replacement therapy in patients with coronary heart disease against the background of primary manifest hypothyroidism

et al. 2020

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Aim To study features of coronary damage and incidence of different types of acute coronary syndrome (ACS) in history associated with primary symptomatic hypothyroidism in patients with ischemic heart disease (IHD) and possible associations of replacement hormonal therapy with lipidogram indexes.Material and methods This retrospective study included 344 patients with IHD and functional class I-III stable angina (ССS, 1976). Of them 100 patients had primary symptomatic hypothyroidism and 244 had no hypothyroidism. Coronary angiography was performed for all patients included into this study. Routine laboratory, instrumental and clinical indexes were analyzed. Hypothyroidism was confirmed by levels of thyrotropic hormone, free triiodothyronine, and thyroxine. Comparative analysis was performed for the incidence of ACS types in history, types of coronary injury, and laboratory, instrumental and clinical indexes with assessment of potential interrelations. Statistically significant results were reported. Type of data distribution was evaluated with the Kolmogorov-Smirnov test. Quantitative data with normal (Gaussian) distribution were presented as mean (M) and standard deviation (SD). Data with attributes of non-normal distribution were presented as median (Me) with maximum and minimum values (min; max). Statistical significance of differences between means was assessed with the Mann-Whitney test. Logistic regression analysis was used in parallel for evaluating dependence of a quantitative variable on values of two or more quantitative or qualitative variables (factors). Significance level for testing of statistical hypotheses was р<0.05.Results Incidence of ST segment elevation ACS (STEACS) was significantly higher in IHD patients with hypothyroidism than in the group without hypothyroidism (61.6 and 35.6 %, р=0.03) and also with three-vessel coronary artery disease (60.6 and 30.6 %, р=0.001). In the IHD group with hypothyroidism, levels of total cholesterol, triglycerides, and low- and very low-density lipoproteins were significantly increased compared to the respective values in patients without hypothyroidism (р<0.0001). An inverse correlation was found between lipidogram indexes and L-thyroxine (р<0.0001).Conclusion The incidence of STEACS associated with primary symptomatic hypothyroidism in history was significantly higher in the patient group with IHD on the background of primary symptomatic hypothyroidism compared to the comparison group. Also, the incidence of three-vessel coronary disease was significantly greater than in the IHD patient group without hypothyroidism. A significant association was found between the replacement hormonal therapy and the best lipidogram indexes. The authors suggested that the key factor for prevention of adverse cardiovascular events in IHD with hypothyroidism is achieving control of clinical manifestations of hypothyroidism with replacement hormonal therapy.

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A study of the cardiac risk factors emerging out of subclinical hypothyroidism

Cited by 17 publications

References 17 publications

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Prevalence of cardiometabolic risk factors in patients with hypertension and subclinical hypothyroidism

State of the coronary arteries and assessment of the role of hormone replacement therapy in patients with coronary heart disease against the background of primary manifest hypothyroidism

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