Prognostic Role of Sub-Clinical Hypothyroidism in Chronic Heart Failure Outpatients

Iacoviello, Massimo; Guida, Pietro; Guastamacchia, Edoardo; Triggiani, Vincenzo; Forleo, Cinzia; Catanzaro, R; Cicala, Maria Verena; Basile, Teresa Maria Altomare; Sorrentino, Sandro; Favale, Stefano

doi:10.2174/138161208786264142

Cited by 71 publications

(70 citation statements)

References 19 publications

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“…In this large cohort of older people (5316 subjects, aged 70 -82 y) with previous CV risk, the persistence of elevated serum TSH value (Ͼ10 mIU/L) was associated with an age-and sex-adjusted increased risk of HF events over 3.2 years of follow-up. In addition, sHT was independently associated with a greater likelihood of disease progression and a risk factor for increased mortality in hospitalized patients with incident HF (75,79). However, increased prevalence of HF events over a period of 12 years was described also in older sHT patients (aged Ͼ65 y, with serum TSH Ͼ 10 mIU/L) without previous CV risk (74).…”

Section: Sht and Heart Failure (Hf)mentioning

confidence: 98%

Is Subclinical Hypothyroidism a Cardiovascular Risk Factor in the Elderly?

Pasqualetti

Tognini

Polini

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context:The negative impact of subclinical hypothyroidism (sHT) on cardiovascular risk, widely recognized in young adults (aged Ͻ55-60 y), is still debated in the elderly (Ͼ65 y), especially in the oldest olds (Ͼ80 y).Evidence Acquisition: We searched Medline for reports published with the following search terms: "hypothyroidism," "subclinical hypothyroidism," "ageing," "elderly," "L-thyroxin," "thyroid," "guidelines," "treatment," "quality of life," "cardiovascular risk," "heart failure," "coronary heart disease" (CHD), "atherosclerosis," and "endothelial dysfunction." We limited our search to reports in English published after 1980, although we incorporated some reports published before 1980. We supplemented the search with records from personal files, textbooks, and relevant articles. Analyzed parameters included the epidemiology of thyroid failure, the effect of thyroid hormone on the aging process, cardiovascular function, and CHD risk factors. We also included the potential benefits of L-T 4 therapy on the quality of life, cardiovascular events, and survival.Evidence Synthesis: TSH levels increase with age, even in older people without thyroid disease. Most longitudinal studies show an increased risk for CHD events and mortality in sHT participants. This increase is less evident in the elderly, mainly in cases of serum TSH values above 10 mIU/L. Lower mortality rate in a cohort of the oldest olds (Ͼ85 y) has been reported. Conclusions: sHT in older people should be not regarded as a unique condition, and moderately old patients (aged Ͻ70 -75 y) could be considered clinically similar to the adult population, albeit with a higher optimal TSH target value. Conversely, the oldest old subjects should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. The decision to treat elderly people is still an unresolved clinical challenge-first, due to a lack of appropriately powered randomized controlled trials of L-T 4 in sHT patients, examining cardiovascular hard endpoints in various classes of age; and second, because of the negative effects of possible overtreatment. (J Clin Endocrinol Metab 98: 2256 -2266, 2013) S ubclinical hypothyroidism (sHT), defined as serum TSH concentration above the upper limit of the reference range in the face of normal free T 4 (FT 4 ) and free T 3 (FT 3 ) levels, is common in the elderly (1-3). This biochemical condition encompasses several pathological entities, mainly represented by chronic autoimmune thyroiditis even if increasing TSH may represent a physiological aging process (4).Depending on the degree of TSH elevation, sHT has been related to hyperlipidemia, intermediary metabolism changes, arterial hypertension, reduced glomerular filtration rate, and neuropsychiatric alterations (5-11). The negative impact of sHT in terms of coronary heart disease (CHD) and global cardiovascular (CV) risk is mostly acknowledged in young adults, whereas it remains to be established in the elderly, especially in the oldest old (aged Ͼ 80 y) (4). Moreover, t...

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Section: Sht and Heart Failure (Hf)mentioning

confidence: 98%

Is Subclinical Hypothyroidism a Cardiovascular Risk Factor in the Elderly?

Pasqualetti

Tognini

Polini

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Some studies suggest that SHypo is a risk factor for cardiac death in patients with chronic HF (12,94,95). In PROSPER, patients with persistent SHypo had an increased rate of HF hospitalization compared with euthyroid controls with an age-and sex-adjusted HR of 4.99 (95% CI, 1.59-15.67) (12).…”

Section: Hf In Shypomentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Heart failure and thyroid dysfunction

Biondi

2012

European Journal of Endocrinology

237

186

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Context: Heart failure (HF) is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of HF in patients with overt and subclinical thyroid disease and discuss the mechanism of this dysfunction. Evidence Acquisition: Reports published with the following search terms were searched:, thyroid, hypothyroidism, hyperthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, levothyroxine, triiodothyronine, antithyroid drugs, radioiodine, deiodinases, clinical symptoms, heart rate, HF, systolic function, diastolic function, systemic vascular resistance, endothelial function, amiodarone and atrial fibrillation. The investigation was restricted to reports published in English. Evidence Synthesis: The outcome of this analysis suggests that patients with untreated overt thyroid dysfunction are at increased risk of HF. Moreover, persistent subclinical thyroid dysfunction is associated with the development of HF in patients with serum TSH !0.1 or O10 mU/l. Conclusions: The timely recognition and effective treatment of cardiac symptoms in patients with thyroid dysfunction is mandatory because the prognosis of HF may be improved with the appropriate treatment of thyroid dysfunction.

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“…28 In addition, in chronic HF patients, TSH levels even slightly above normal range are independently associated with a greater likelihood of HF progression. 29 Epidemiological data also suggest that scHypo may be the only reversible cause of left ventricular (LV) diastolic dysfunction with slowed myocardial relaxation and impaired filling, particularly in subjects with TSH Ͼ10 IU/mL. 16,30 The Health, Aging, Body Composition population-based study showed that participants with TSH Ͼ7 IU/mL had 3-times-higher HF events than euthyroid patients.…”

Section: Th Imbalance and Heart Diseasementioning

confidence: 99%