Thyroid function is associated with presence and severity of coronary atherosclerosis

Auer, Johann; Berent, Robert; Weber, Thomas; Laßnig, Elisabeth; Eber, Bernd

doi:10.1002/clc.4960261205

Cited by 100 publications

(89 citation statements)

References 26 publications

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“…Perhaps more importantly, data regarding left ventricular systolic function were not provided, an important drawback in light of the well-known consequences of heart failure on the thyroid system. 2,3 Our study lends support to the theory advanced by Auer et al 5 in so far as we confirmed their results in a large cohort of patients in whom the impact of potential confounders was minimized by applying stringent exclusion criteria. The reduction in fT3 levels observed in patients with CAD could be interpreted simply as a marker of disease rather than as an element contributing directly to disease progression.…”

Section: Discussionsupporting

confidence: 89%

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Coceani

Iervasi

Pingitore

et al. 2009

Clinical Cardiology

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Background: Overt thyroid dysfunction, hypothyroidism in particular, may lead to coronary artery disease (CAD). Whether more subtle anomalies of thyroid hormone metabolism influence the progression of CAD remains a matter of speculation. Hypothesis: The occurrence of CAD and long-term prognosis in patients without a history of either primary thyroid disease, myocardial infarction, or chronic heart failure is related to serum levels of biologically active free triiodothyronine (fT3). Methods: The cohort consisted of 1047 clinically and biochemically euthyroid patients (median age 65.6 y and 69% male) who underwent coronary angiography in our institute for suspected CAD. Results: Lower fT3 levels were predictive of both single-vessel (p = 0.012) and multivessel (p = 0.009) CAD. Through a multivariate logistic regression analysis, fT3 was still linked to the presence of CAD (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.34-0.68, p < 0.001). After a mean follow-up of 31 months, the survival rate was 95% and total mortality (log-rank 6.75, p = 0.009), as well as cardiac mortality (log-rank 8.26, p = 0.004), was greater among patients with low T3 (fT3<2.10 pg/mL) syndrome. At subsequent multivariate Cox regression analysis, the association between low T3 syndrome and survival was maintained (total mortality HR: 1.80, 95% CI: 1.05-3.10, p = 0.034; cardiac mortality HR: 2.58, 95% CI: 1.13-5.93, p = 0.025). Conclusions:In this selected population, fT3 levels were inversely correlated to the presence of CAD and low T3 syndrome conferred an adverse prognosis, even after adjusting for traditional coronary risk factors.

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Section: Discussionsupporting

confidence: 89%

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Coceani

Iervasi

Pingitore

et al. 2009

Clinical Cardiology

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“…Our findings showed a significant and positive association between baseline OPG and baseline vWF or TSH in hypothyroid patients (Table 2). Since vWF is a reliable parameter for endothelial vascular injury (17 -21), particularly in hypothyroid patients (21), these findings support the notion that an increase in serum OPG levels is also a reliable marker for vascular injury in hypothyroidism (8,9). However, the baseline level of vWF, but not that of TSH, was significantly and independently negatively associated with the change in serum OPG during 1 year of euthyroidism (Table 4).…”

Section: Discussionmentioning

confidence: 55%

“…Hypothyroidism, even in its latent form, is associated with increased morbidity from cardiovascular disease (8,9). We recently reported that intima-media thickness (IMT) in the common carotid artery, a good predictor for cardiovascular events (10,11), is increased in hypothyroid patients, and that increased IMT normalized after one year of levothyroxine (L-T4) replacement therapy (12).…”

Section: Introductionmentioning

confidence: 99%

Increased levels of serum osteoprotegerin in hypothyroid patients and its normalization with restoration of normal thyroid function

Nagasaki¹,

Inaba²,

Jono³

et al. 2005

eur j endocrinol

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Hypothyroidism is associated with increased morbidity from cardiovascular disease, and an increase in serum osteoprotegerin (OPG) has recently been reported to be associated with the severity of coronary heart disease and cardiovascular mortality. The present study was designed to examine whether hypothyroidism causes an increase in serum OPG, and to determine whether levothyroxine (L-T4) replacement therapy might suppress serum OPG levels in hypothyroid patients. Fifty-three hypothyroid patients with chronic thyroiditis and age-and sex-matched normal control subjects were examined for the levels of serum OPG and plasma von Willebrand factor (vWF), a vascular injury marker. Thirty-seven of the hypothyroid patients were further monitored for changes in these markers during 1 year in a euthyroid state induced by L-T4 replacement therapy. Baseline OPG was significantly higher in hypothyroid patients than in normal controls (4.51^0.50 vs 3.72^0.23 pmol/l (mean^S.E.); P ¼ 0.0182). In multivariate analysis, baseline OPG was significantly associated with baseline levels of TSH (r ¼ 0.280, P ¼ 0.0162) and vWF (r ¼ 0.626, P , 0.0001). During one year of L-T4 replacement therapy, hypothyroid patients showed a significant decrease in OPG levels from 4.35^0.51 to 3.48^0.26 pmol/l (P ¼ 0.0166), a level comparable to normal controls. The change in serum OPG levels during L-T4 replacement therapy was significantly and independently associated in a negative fashion with baseline vWF (r ¼ 2 0.503, P ¼ 0.0014). This study suggested that the severity of hypothyroidism and vascular injury might have important independent roles in increasing the serum OPG level in hypothyroid patients. Furthermore, it was demonstrated that a sustained euthyroid state might have the potential to decrease the serum OPG level in hypothyroid patients and that the degree of vascular injury in the hypothyroid state is independently associated with a decrease in serum OPG during a 1-year normalization of thyroid function.

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“…In contrast, Auer and cols. (12) showed that higher serum fT4 levels were inversely correlated with the severity of coronary atherosclerosis and higher thyrotropin levels correlated positively. The reasons proposed to underlie the differences in the study results are as follows: i) study populations that are too small to detect an association between subtle changes in fT4 level and coronary atherosclerosis because of the narrow reference range for serum fT4 level; ii) inclusion of heterogeneous patient groups having either stable angina pectoris or acute coronary syndrome.…”

Section: Discussionmentioning

confidence: 98%

“…While TH indirectly modifies atherosclerotic risk factors such as lipid profile (2,3) and blood pressure (4), direct effects act via vascular smooth muscle cells, altering vascular tone (5), angiotensin-II type 1 receptor modulating the proliferation of vascular smooth muscle cells (6), upregulation of basic fibroblast growth factor causing enhanced angiogenesis (7), modulating the maturation and functioning of macrophages (8), and acting on the renin-angiotensin system (9,10). However, clinical studies yield conflicting results and mechanistic explanations remain elusive (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis

Canpolat

Turak

Özcan

et al. 2017

Arch. Endocrinol. Metab.

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Objective: Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods: We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results: ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion: Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris. Arch Endocrinol Metab. 2017;61(2):130-6.

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Thyroid function is associated with presence and severity of coronary atherosclerosis

Cited by 100 publications

References 26 publications

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Increased levels of serum osteoprotegerin in hypothyroid patients and its normalization with restoration of normal thyroid function

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis

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