Increased Central Arterial Stiffness in Hypothyroidism

Abstract

Hypothyroidism is associated with cardiovascular dysfunction. It is increasingly apparent that stiffening of central arteries may lead to increased afterload and cardiac dysfunction. We noninvasively studied the peripheral and central pressure waveforms in 12 untreated hypothyroid patients as well as in 12 age-, sex-, and body mass index-matched controls using the technique of pulse wave analysis from recordings at the radial artery. Indexes of arterial stiffness, augmentation index (AI) and augmentation of central arterial pressure (AG), were derived as well as time of travel of the reflected wave (TR), a direct estimate of aortic pulse wave velocity. At baseline, there were no significant differences between the 2 groups in brachial and aortic blood pressures. Hypothyroid patients had significantly higher AI than controls (mean +/- SEM[SCAP], 32.0 +/- 3.4% vs. 17.0 +/- 2.4%; P < 0.0005) even when corrected for heart rate (AI(C); 28.0 +/- 3.2% vs. 17.0 +/- 2.4%; P < 0.006) and AG (13.0 +/- 2.2 vs. 7.0 +/- 2.1 mm Hg; P < 0.03) together with a lower TR (132.0 +/- 4.1 vs. 142.0 +/- 1.5 msec; P < 0.03). After 6 months of therapy with T(4), all patients were euthyroid. AI(C) had decreased in the patient group (23.0 +/- 3.2% vs. 28.0 +/- 3.2%; P < 0.01) as had AG (9.0 +/- 1.5 vs. 13.0 +/- 2.2 mm Hg; P < 0.008), but TR was significantly higher (142.0 +/- 3.0 vs. 132.0 +/- 4.1 msec; P < 0.008). AI correlated with age in all groups (hypothyroid group: r = 0.937; P < 0.0005; control group: r = 0.804; P < 0.0005), but correlated with TSH level only among controls (r = 0.591; P < 0.05). This study confirms that hypothyroidism is associated with increased cardiovascular risk, as evidenced by increased augmentation of central aortic pressures and central arterial stiffness. Furthermore, these abnormalities are reversed after adequate T(4) replacement.

Response to Improvement of Arterial Stiffness in the Transition From Acute Decompensated Heart Failure to Chronic Compensated Heart Failure

“…It is increasingly apparent that stiffening of central arteries may lead to increased afterload and cardiac dysfunction. 3 When arterial stiffness parameters were assessed with respect to their relationships with other studied parameters in patients, central aortic pressure showed significant relationships with serum vitamin B12 and phosphorus levels, whereas augmentation indexes had significant correlations, albumin, and magnesium levels. 4 Impaired renal function may be associated with increased arterial stiffness.…”

Thyroid Hormone and Vascular Remodeling

“…Hypothyroidism also affects systolic blood pressure levels. It is suggested that development of systolic and diastolic high blood pressure in hypothyroid patients was due to an increase in peripheral vascular resistance 31) and arterial stiffness 32) , respectively. Arterial stiffening can be evaluated by brachial-ankle pulse wave velocity.…”

Guilt by association: a paradigm for detection of silent aortic disease

“…Hypothyroidism: there is evidence to suggest that in patients with hypothyroidism the arterial stiffness (including that of the thoracic aorta) is increased (60,61). Clinical data are limited to a few case reports on patients with thoracic aortic disease and hypothyroidism (62,63).…”