101
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Yeap BB, Marriott RJ, Antonio L, Bhasin S, Dobs AS, Dwivedi G, Flicker L, Matsumoto AM, Ohlsson C, Orwoll ES, Raj S, Reid CM, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Sociodemographic, lifestyle and medical influences on serum testosterone and sex hormone-binding globulin in men from UK Biobank. Clin Endocrinol (Oxf) 2021; 94:290-302. [PMID: 32979890 DOI: 10.1111/cen.14342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Serum testosterone concentrations are affected by factors unrelated to hypothalamo-pituitary-testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone-binding globulin (SHBG) in men aged 40-69 years. DESIGN Cross-sectional analysis of 208,677 community-dwelling men from the UK Biobank. MEASUREMENTS We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models and effect size estimates. RESULTS Median (interquartile range) for serum testosterone was 11.6 (9.4-14.1) nmol/L, SHBG 36.9 (27.9-48.1) nmol/L and cFT 213 (178-255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age and inversely with BMI (all P < .001). Living with a partner, (South) Asian ethnicity, never or previous smoker and some medical conditions were associated with lower testosterone. Poultry or fish eater, and higher physical activity were associated with higher testosterone (all P < .001). Testosterone was lowered by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2 , ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity and 0.3-1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L and cFT by ~60 pmol/L. CONCLUSIONS The identified modifiable risk factors support lifestyle-based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalized interpretation of testosterone testing results with respect to existing reference ranges.
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adrian S Dobs
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, WA, Australia
- Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, WA, Australia
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric S Orwoll
- Oregon Health and Science University, Portland, OR, United States
| | - Suchitra Raj
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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Gong IY, Atzema CL, Lega IC, Austin PC, Na Y, Rochon PA, Lipscombe LL. Levothyroxine dose and risk of atrial fibrillation: A nested case-control study. Am Heart J 2021; 232:47-56. [PMID: 33022231 DOI: 10.1016/j.ahj.2020.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022]
Abstract
Contemporary data on the effect of levothyroxine dose on the occurrence of atrial fibrillation (AF) are lacking, particularly in the older population. Our objective was to determine the effect of cumulative levothyroxine exposure on risk of AF and ischemic stroke in older adults. METHODS We conducted a population-based observational study using health care databases from Ontario, Canada. We identified adults aged ≥66 years without a history of AF who filled at least 1 levothyroxine prescription between April 1, 2007, and March 31, 2016. Cases were defined as cohort members who had incident AF (emergency room visit or hospitalization) between the date of first levothyroxine prescription and December 31, 2017. Index date was date of AF. Cases were matched with up to 5 controls without AF on the same index date. Secondary outcome was ischemic stroke. Cumulative levothyroxine exposure was estimated based on total milligrams of levothyroxine dispensed in the year prior to index date. Using nested case-control approach, we compared outcomes between older adults who received high (≥0.125 mg/d), medium (0.075-0.125 mg/d), or low (0-0.075 mg/d) cumulative levothyroxine dose. We compared outcomes between current, recent past, and remote past levothyroxine use. RESULTS Of 183,360 older adults treated with levothyroxine (mean age 82 years; 72% women), 30,560 (16.1%) had an episode of AF. Compared to low levothyroxine exposure, high and medium exposure was associated with significantly increased risk of AF after adjustment for covariates (adjusted odds ratio [aOR] 1.29, 95% CI 1.23-1.35; aOR 1.08, 95% CI 1.04-1.11; respectively). No association was observed between levothyroxine exposure and ischemic stroke. Compared with current levothyroxine use, older adults with remote levothyroxine use had lower risks of AF (aOR 0.56, 95% CI 0.52-0.59) and ischemic stroke (aOR 0.61, 95% CI 0.56-0.67). CONCLUSIONS Among older persons treated with levothyroxine, levothyroxine at doses >0.075 mg/d is associated with an increased risk of AF compared to lower exposure.
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Farag A, Hammam M, Alnaidany N, Badr E, Elshaib M, El-Swah A, Shehata W. Methimazole in the Treatment of Melasma: A Clinical and Dermascopic Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:14-20. [PMID: 34221222 PMCID: PMC8211339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND: Melasma is a chronic hypermelanotic disorder that is challenging to treat; no single effective therapeutic agent for it has been discovered. Methimazole, an oral antithyroid drug, has a skin depigmenting effect when used topically. OBJECTIVE: We sought to evaluate the efficacy and safety of methimazole, applied during microneedling sessions and additional topical use in between sessions, for the treatment of melasma. METHODS: This split-face study included 30 Egyptian patients with melasma, each of whom received 12 microneedling sessions once per week for 12 weeks followed by topical methimazole on the right side of face and placebo on the left side. In between the sessions, topical methimazole 5% cream was applied twice per day on the right side and placebo on the left side. Assessments were performed using the Hemi-melasma Area and Severity Index (hemi-MASI) percentage of improvement, patient satisfaction, dermoscopy, and thyroid-stimulating hormone (TSH) serum levels. RESULTS: There were significant clinical and dermoscopic improvements; hemi-MASI scores on the methimazole-treated right sides were decreased (p<0.001). The percent of hemi-MASI score improvement was significantly associated with the malar pattern (p=0.031) and epidermal type (p=0.04) of melasma. About 70 percent of our studied patients reported being satisfied with their treatment response (7% excellent, 33% good, 30% fair). No significant local or systemic side effects were observed. Pre- and posttreatment serum TSH levels were within the normal range in all treated cases. CONCLUSIONS: Methimazole has the potential to be a safe and promising therapeutic agent for the treatment of melasma via dermapen-delivered microneedling sessions with topical use in between sessions.
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Affiliation(s)
- Azza Farag
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Mostafa Hammam
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Nada Alnaidany
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Eman Badr
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Mustafa Elshaib
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Aliaa El-Swah
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
| | - Wafaa Shehata
- Drs. Farag, Hammam, El-Swah, and Shehata are with the Dermatology, Andrology and Venereology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Alnaidany is with the Clinical Pharmacy Department, Faculty of Pharmacy, MSA University in 6th of October City, Egypt
- Dr. Badr is with the Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Dr. Shehata is with the Faculty of Medicine, Menoufia University in Al Minufya, Egypt
- Mr. Elshaib is a medical student at Menoufia University in Al Minufya, Egypt
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5538] [Impact Index Per Article: 1846.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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105
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Gencer B, Cappola AR, Rodondi N, Collet TH. Challenges in the Management of Atrial Fibrillation With Subclinical Hyperthyroidism. Front Endocrinol (Lausanne) 2021; 12:795492. [PMID: 35058884 PMCID: PMC8764445 DOI: 10.3389/fendo.2021.795492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Subclinical thyroid disorders have a high prevalence among older individuals and women. Subclinical hypothyroidism is diagnosed by elevated serum levels of thyroid-stimulating hormone (TSH) with thyroxine levels within the reference range, and subclinical hyperthyroidism is diagnosed by low TSH in conjunction with thyroxine and triiodothyronine levels within reference ranges. Atrial fibrillation is the most commonly diagnosed cardiac arrhythmia and has been associated with an increased risk of mortality, heart failure, stroke, and depression. Mechanistic data from animal and human physiology studies as well as observational data in humans support an association of subclinical hyperthyroidism with atrial fibrillation. Guidelines recommend the measurement of TSH in the evaluation of new-onset atrial fibrillation. All patients with overt hyperthyroidism should be treated, and treatment of subclinical hyperthyroidism should be considered in patients older than 65 years with TSH < 0.4 mlU/L, or in younger patients with TSH < 0.1 mlU/L. Guidelines also recommend screening for AF in patients with known hyperthyroidism. Wearable devices that measure the heart electrical activity continuously may be a novel strategy to detect atrial fibrillation in patients at risk. In this review, we explore the interplay between thyroid hormones and atrial fibrillation, management controversies in subclinical hyperthyroidism, and potential strategies to improve the management of atrial fibrillation in patients with subclinical hyperthyroidism.
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Affiliation(s)
- Baris Gencer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tinh-Hai Collet
- Division of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- *Correspondence: Tinh-Hai Collet,
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Wang C, Li Y, Teng D, Shi X, Ba J, Chen B, Du J, He L, Lai X, Li Y, Chi H, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Tang X, Tong N, Wang G, Zhang JA, Wang Y, Xue Y, Yan L, Yang J, Yang L, Yao Y, Ye Z, Zhang Q, Zhang L, Zhu J, Zhu M, Shan Z, Teng W. Hyperthyroidism Prevalence in China After Universal Salt Iodization. Front Endocrinol (Lausanne) 2021; 12:651534. [PMID: 34122333 PMCID: PMC8194401 DOI: 10.3389/fendo.2021.651534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Universal salt iodization (USI) was implemented in mainland China in 1996. The prevalence of hyperthyroidism and its risk factors now require examination. METHODS Data were acquired from a nationwide Thyroid, Iodine, and Diabetes Epidemiological survey (TIDE 2015-2017) of 78,470 subjects from 31 provinces. Iodine status, and thyroid hormones and antibodies were measured. RESULTS After two decades of USI, the prevalence of overt hyperthyroidism (OH), Graves' disease (GD), severe subclinical hyperthyroidism (severe SCH), and mild subclinical hyperthyroidism (mild SCH) in mainland China was 0.78%, 0.53%, 0.22%, and 0.22%, respectively. OH and GD prevalence were higher in women than in men (OH: 1.16% vs. 0.64%, P<0.001; GD: 0.65% vs. 0.37%, P<0.001).Prevalence was significantly decreased after 60 years-of-age compared with 30-39 years-of-age (OH:0.61% vs. 0.81%, P<0.001; GD: 0.38% vs. 0.57%, P<0.001).Excessive iodine(EI) and deficient iodine(DI) were both related to increased prevalence of OH (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.68-2.59; OR1.35, 95%CI 1.07-1.72, respectively); however, only deficient iodine was associated with increased prevalence of GD (OR1.67, 95%CI 1.30-2.15). Increased thyroid peroxidase antibody and thyroglobulin antibody levels were significantly associated with prevalence of OH and GD, but not severe SCH and mild SCH. Although hyperthyroidism was more prevalent in women, the association disappeared after adjusting for other factors such as antibody levels. CONCLUSION OH and GD prevalences in mainland China are stable after two decades of USI. Iodine deficiency, elevated thyroid antibody levels, and middle age are the main risk factors for OH and GD. The severe SCH population, rather than the mild SCH population, shows similar characteristics to the OH population.
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Affiliation(s)
- Chuyuan Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Di Teng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoguang Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jianming Ba
- Department of Endocrinology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jianling Du
- Department of Endocrinology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Jinfeng, China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanbo Li
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haiyi Chi
- Department of Endocrinology, Hohhot First Hospital, Hohhot, China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Libin Liu
- Fujian Institute of Hematology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Guijun Qin
- International Medical Center, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yingfen Qin
- Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hui Sun
- Department of Endocrinology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xulei Tang
- Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, China
| | - Nanwei Tong
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Jilin University, Changchun, China
| | - Jin-an Zhang
- Department of Endocrinology, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Youmin Wang
- Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanming Xue
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Li Yan
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining, China
| | - Zhen Ye
- Zhejiang Center for Disease Control and Prevention (Zhejiang CDC), Hangzhou, China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang, China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhongyan Shan, ; Weiping Teng,
| | - Weiping Teng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhongyan Shan, ; Weiping Teng,
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Yan D, Chen C, Yan H, Liu T, Yan H, Yuan J. Mortality Risk After Radioiodine Therapy for Hyperthyroidism: A Systematic Review and Meta-Analysis. Endocr Pract 2020; 27:362-369. [PMID: 33616040 DOI: 10.1016/j.eprac.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Radioiodine has been increasingly used to treat hyperthyroidism for many years. Although widely regarded as an effective therapy, radioiodine treatment for hyperthyroidism has been suspected to be associated with the risk of mortality. This study aimed to quantify the mortality outcomes in patients who were treated for hyperthyroidism with radioiodine. METHODS Systematic search and meta-analysis were performed to determine the risk of mortality in patients treated with radioiodine for hyperthyroidism. Relevant studies were searched through August 2020 and selected in accordance with the inclusion criteria. RESULTS A total of 13 studies were identified. The summary odds ratios (ORs) showed an increased risk of all-cause mortality in patients who were treated with radioiodine for hyperthyroidism (OR = 1.20; 95% CI = 1.07-1.35). The risk of death attributed to all forms of circulatory, respiratory, and endocrine and metabolic diseases was significantly increased, with summary ORs of 1.23 (95% CI, 1.12-1.35), 1.43 (95% CI, 1.17-1.75), and 2.38 (95% CI, 1.85-3.06), respectively. The summary ORs revealed no significant association between radioiodine treatment for hyperthyroidism and the risk of cancer mortality (OR = 1.03; 95% CI, 0.98-1.09). Radioiodine treatment for hyperthyroidism was not associated with the risk of mortality from breast, respiratory system, gastrointestinal, and genitourinary cancers. CONCLUSION Radioiodine treatment for hyperthyroidism is associated with the risk of all-cause mortality but not cancer mortality. Future research needs to address the causes of hyperthyroidism, effects of radioiodine therapy, and potential effects of confounding to identify causality.
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Affiliation(s)
- Dandan Yan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Honglin Yan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Tian Liu
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Hong Yan
- Department of Health Toxicology, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong-Road, Wuhan, 430030, P.R. China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China.
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Steinberger E, Pilz S, Trummer C, Theiler-Schwetz V, Reichhartinger M, Benninger T, Pandis M, Malle O, Keppel MH, Verheyen N, Grübler MR, Voelkl J, Meinitzer A, März W. Associations of Thyroid Hormones and Resting Heart Rate in Patients Referred to Coronary Angiography. Horm Metab Res 2020; 52:850-855. [PMID: 32886945 DOI: 10.1055/a-1232-7292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Resting heart rate (RHR) is associated with increased risk of cardiovascular morbidity and mortality. Thyroid hormones exert several effects on the cardiovascular system, but the relation between thyroid function and RHR remains to be further established. We evaluated whether measures of thyroid hormone status are associated with RHR in patients referred to coronary angiography. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxin (FT4), and RHR were determined in 2795 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study. Median (25th to 75th percentile) serum concentrations were 1.25 (0.76-1.92) mU/l for TSH, 4.8 (4.2-5.3) pmol/l for FT3 and 17.1 (15.4-19.0) pmol/l for FT4, and mean (±standard deviation) RHR was 68.8 (±11.7) beats/min. Comparing the highest versus the lowest quartile, RHR (beats/min) was significantly higher in the fourth FT4 quartile [3.48, 95% confidence interval (CI): 2.23-4.73; p <0.001] and in the fourth FT3 quartile (2.30, 95% CI: 1.06-3.55; p <0.001), but there was no significant difference for TSH quartiles. In multiple linear regression analyses adjusting for various potential confounders, FT3 and FT4 were significant predictors of RHR (p <0.001 for both). In subgroups restricted to TSH, FT3, and FT4 values within the reference range, both FT3 and FT4 remained significant predictors of RHR (p <0.001 for all). In conclusion, in patients referred to coronary angiography, FT3 and FT4 but not TSH were positively associated with RHR. The relationship between free thyroid hormones and RHR warrants further investigations regarding its diagnostic and therapeutic implications.
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Affiliation(s)
- Eva Steinberger
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Verena Theiler-Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | | | - Thomas Benninger
- Institute of Automation and Control, Graz University of Technology, Graz, Austria
| | - Marlene Pandis
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Oliver Malle
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Martin R Grübler
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Jakob Voelkl
- Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Holding GmbH, Mannheim, Germany
- Medical Clinic 5, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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109
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Fitzgerald SP, Bean NG, Falhammar H, Tuke J. Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:1695-1709. [PMID: 32349628 PMCID: PMC7757573 DOI: 10.1089/thy.2019.0535] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Though the functional states of other endocrine systems are not defined on the basis of levels of controlling hormones, the assessment of thyroid function is based on levels of the controlling hormone thyrotropin (TSH). We, therefore, addressed the question as to whether levels of thyroid hormones [free thyroxine (fT4), total triiodothyronine (TT3)/free triiodothyronine (fT3)], or TSH levels, within and beyond the reference ranges, provide the better guide to the range of clinical parameters associated with thyroid status. Methods: A PubMed/MEDLINE search of studies up to October 2019, examining associations of levels of thyroid hormones and TSH, taken simultaneously in the same individuals, with clinical parameters was performed. We analyzed atrial fibrillation, other cardiac parameters, osteoporosis and fracture, cancer, dementia, frailty, mortality, features of the metabolic syndrome, and pregnancy outcomes. Studies were assessed for quality by using a modified Newcastle-Ottawa score. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. A meta-analysis of the associations was performed to determine the relative likelihood of fT4, TT3/fT3, and TSH levels that are associated with the clinical parameters. Results: We identified 58 suitable articles and a total of 1880 associations. In general, clinical parameters were associated with thyroid hormone levels significantly more often than with TSH levels-the converse was not true for any of the clinical parameters. In the 1880 considered associations, fT4 levels were significantly associated with clinical parameters in 50% of analyses. The respective frequencies for TT3/fT3 and TSH levels were 53% and 23% (p < 0.0001 for both fT4 and TT3/fT3 vs. TSH). The fT4 and TT3/fT3 levels were comparably associated with clinical parameters (p = 0.71). More sophisticated statistical analyses, however, indicated that the associations with TT3/fT3 were not as robust as the associations with fT4. Conclusions: Thyroid hormones levels, and in particular fT4 levels, seem to have stronger associations with clinical parameters than do TSH levels. Associations of clinical parameters with TSH levels can be explained by the strong negative population correlation between thyroid hormones and TSH. Clinical and research components of thyroidology currently based on the measurement of the thyroid state by reference to TSH levels warrant reconsideration.
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Affiliation(s)
- Stephen P. Fitzgerald
- Department of General Medicine and Royal Adelaide Hospital, Adelaide, South Australia
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Nigel G. Bean
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Adelaide, Adelaide, South Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research and Royal Darwin Hospital, Tiwi, Australia
| | - Jono Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Adelaide, Adelaide, South Australia
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110
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Stojković M, Žarković M. Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Disease. Curr Pharm Des 2020; 26:5617-5627. [PMID: 33213317 DOI: 10.2174/1381612826666201118094747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023]
Abstract
The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD's role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.
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111
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New-onset arrhythmia associated with patients hospitalized for thyroid dysfunction. Heart Lung 2020; 49:758-762. [PMID: 32979641 DOI: 10.1016/j.hrtlng.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thyroid dysfunction has been associated with cardiovascular dysfunction in the literature. However, the frequency of new-onset arrhythmias associated with thyroid disease hospitalization is unknown. Hence, we analyzed frequency, in-hospital outcomes, and resource utilization of new-onset arrhythmias associated with thyroid dysfunction hospitalizations. METHODS The patients who were admitted with the primary reason of thyroid dysfunction were included using appropriate international classification of disease, ninth revision, clinical modification (ICD-9-CM) codes. We then identified new-onset arrhythmias using appropriate ICD-9-CM codes. We utilized the "present on admission" variable to exclude arrhythmias that were present on admission. RESULTS Among the eligible patients with thyroid dysfunction, only 3% (n=12,111) developed a new-onset arrhythmia. Atrioventricular block (1.49%) is the most frequent followed by atrial fibrillation (0.92%), ventricular tachycardia (0.47%), atrial flutter (0.23%), supraventricular tachycardia (0.1%) and ventricular fibrillation (0.07%). Patients with new-onset arrhythmias were older (mean age 76.7±12.5 years), more predominantly white (n=9008, 74.4%), higher females (n= 7632, 63%), and had a higher frequency of comorbidities. In-hospital mortality occurred in 827 (6.8%) patients with new-onset arrhythmias and 8632 (2.2%) patients without new-onset arrhythmias (P-value <0.001). The medical length of stay and cost of hospitalization was also higher in these patients. CONCLUSION Thyroid dysfunction is not associated with significantly higher rates of new-onset arrhythmias while inpatient. However, when developed, these arrhythmias are associated with higher mortality and resource utilization. The patients admitted to the hospital should have thyroid function checked when found to have an arrhythmia.
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112
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Matsuo R, Yamazaki T, Suzuki M, Toyama H, Araki K. A random forest algorithm-based approach to capture latent decision variables and their cutoff values. J Biomed Inform 2020; 110:103548. [PMID: 32866626 DOI: 10.1016/j.jbi.2020.103548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
Abstract
Although reference intervals (RIs) and clinical decision limits (CDLs) are vital laboratory information for supporting the interpretation of numerical clinical pathology results, there is evidence that RIs and CDLs vary in certain contexts as well as other evidence that RIs and CDLs are flawed. We propose a random forest algorithm-based exploration methodology by using phenotype transformation of independent variables in relation to dependent variables to capture latent decision variables and their cutoff values. We denote certain CDLs within the RIs estimated by an indirect method that affect some diagnostics or outcomes in the context of specific patients' conditions as latent CDLs. We then apply the proposed methodology to clinical laboratory data regarding bodily fluids, such as blood, urine at the admission of patients for the exploration of latent CDLs of hospital length of stay (HLOS) for each patients' condition identified by diseases of patients who undergoing surgeries. From the exploration results, we found that free Thyroxine (T4) above five unique cutoff values: 1.16 ng/dL, 1.19 ng/dL, 1.2 ng/dL, 1.23 ng/dL and 1.25 ng/dL for tachyarrhythmia predicted longer HLOS, though these cutoff values fall within the estimated RIs as well as the hospital-determined RIs. In addition to the evidence that higher free Thyroxine (T4) levels within the RIs have an association with the corresponding disease, on the whole, the cutoff values except 1.16 ng/dL tended to affect long HLOS with the significant differences. The cutoff values could be taken up for discussion among clinical experts whether it is meaningful to alert the risk of patients' conditions and the long HLOS at the admission of patients. If clinical experts appreciate its meaningfulness in clinical practice, the alerts could be embedded in electronic medical records for handling those risks at the admission of patients.
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Affiliation(s)
- Ryosuke Matsuo
- Faculty of Medicine, University of Miyazaki Hospital, 5200, Kihara, Kiyotake-cho, Miyazaki-shi, Miyazaki, 889-1692, Japan.
| | - Tomoyoshi Yamazaki
- Faculty of Medicine, University of Miyazaki Hospital, 5200, Kihara, Kiyotake-cho, Miyazaki-shi, Miyazaki, 889-1692, Japan.
| | - Muneou Suzuki
- Faculty of Medicine, University of Miyazaki Hospital, 5200, Kihara, Kiyotake-cho, Miyazaki-shi, Miyazaki, 889-1692, Japan.
| | - Hinako Toyama
- Institute of Medical Data Sciences, 1-10-2, Tsukushino, Abiko-shi, Chiba, 270-1164, Japan.
| | - Kenji Araki
- Faculty of Medicine, University of Miyazaki Hospital, 5200, Kihara, Kiyotake-cho, Miyazaki-shi, Miyazaki, 889-1692, Japan.
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113
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Chbat J, Ezzat S, Papi G. Subclinical hypothyroidism. Minerva Endocrinol (Torino) 2020; 46:238-242. [PMID: 32744440 DOI: 10.23736/s2724-6507.20.03176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Subclinical hypothyroidism (i.e. a condition characterized by serum TSH concentrations above the normal reference range in the presence of normal serum T4 levels) affects 4 to 20% of the population living in iodine-sufficient areas. The present work reviewed the clinical challenges regarding the signs and symptoms possibly related to subclinical hypothyroidism and the most recent guideline recommendations to treatment.
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Affiliation(s)
- Jessica Chbat
- Endocrine Oncology Site Group, Princess Margaret Cancer Center, Toronto, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, Princess Margaret Cancer Center, Toronto, Canada
| | - Giampaolo Papi
- Unit of Endocrinology, Northern Area, USL Modena, Modena, Italy -
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114
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Marouli E, Kus A, Del Greco M F, Chaker L, Peeters R, Teumer A, Deloukas P, Medici M. Thyroid Function Affects the Risk of Stroke via Atrial Fibrillation: A Mendelian Randomization Study. J Clin Endocrinol Metab 2020; 105:dgaa239. [PMID: 32374820 PMCID: PMC7316221 DOI: 10.1210/clinem/dgaa239] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/01/2020] [Indexed: 01/07/2023]
Abstract
CONTEXT Observational studies suggest that variations in normal range thyroid function are associated with cardiovascular diseases. However, it remains to be determined whether these associations are causal or not. OBJECTIVE To test whether genetically determined variation in normal range thyroid function is causally associated with the risk of stroke and coronary artery disease (CAD) and investigate via which pathways these relations may be mediated. DESIGN, SETTING, AND PARTICIPANTS Mendelian randomization analyses for stroke and CAD using genetic instruments associated with normal range thyrotropin (TSH) and free thyroxine levels or Hashimoto's thyroiditis and Graves' disease. The potential mediating role of known stroke and CAD risk factors was examined. Publicly available summary statistics data were used. MAIN OUTCOME MEASURES Stroke or CAD risk per genetically predicted increase in TSH or FT4 levels. RESULTS A 1 standard deviation increase in TSH was associated with a 5% decrease in the risk of stroke (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91-0.99; P = 0.008). Multivariable MR analyses indicated that this effect is mainly mediated via atrial fibrillation. MR analyses did not show a causal association between normal range thyroid function and CAD. Secondary analyses showed a causal relationship between Hashimoto's thyroiditis and a 7% increased risk of CAD (OR, 1.07; 95% CI, 1.01-1.13; P = 0.026), which was mainly mediated via body mass index. CONCLUSION These results provide important new insights into the causal relationships and mediating pathways between thyroid function, stroke, and CAD. We identify variation in normal range thyroid function and Hashimoto's thyroiditis as risk factors for stroke and CAD, respectively.
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Affiliation(s)
- Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, UK
| | - Aleksander Kus
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Fabiola Del Greco M
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lubeck, Bolzano, Italy
| | - Layal Chaker
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marco Medici
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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115
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[The thyroid gland in old age : Physiology and pathology]. Wien Med Wochenschr 2020; 170:410-419. [PMID: 32572659 DOI: 10.1007/s10354-020-00761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
In healthy older people the metabolism of thyroid hormones is physiologically altered and can possibly even actively contribute to longevity. This should also be taken into consideration in the treatment of diseases of the thyroid and principally also for younger patients. For example, with progressing age comorbidities become more prevalent and especially in cardiovascular diseases, hyperthyroidism is less well tolerated, and should be treated more aggressively. Benign multinodular goiter also becomes more prevalent in old age and should be surgically treated when causing mechanical symptoms. The treatment concept for malignant diseases should be adapted to the holistic situation of the patient but principally in the same manner as in younger patients. Old and very old patients also benefit from adequate, risk-adapted treatment of thyroid gland diseases so that appropriate diagnostics and clarification are meaningful, regardless of age.
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116
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Tribulova N, Kurahara LH, Hlivak P, Hirano K, Szeiffova Bacova B. Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism. Int J Mol Sci 2020; 21:E2844. [PMID: 32325836 PMCID: PMC7215427 DOI: 10.3390/ijms21082844] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
A perennial task is to prevent the occurrence and/or recurrence of most frequent or life-threatening cardiac arrhythmias such as atrial fibrillation (AF) and ventricular fibrillation (VF). VF may be lethal in cases without an implantable cardioverter defibrillator or with failure of this device. Incidences of AF, even the asymptomatic ones, jeopardize the patient's life due to its complication, notably the high risk of embolic stroke. Therefore, there has been a growing interest in subclinical AF screening and searching for novel electrophysiological and molecular markers. Considering the worldwide increase in cases of thyroid dysfunction and diseases, including thyroid carcinoma, we aimed to explore the implication of thyroid hormones in pro-arrhythmic signaling in the pathophysiological setting. The present review provides updated information about the impact of altered thyroid status on both the occurrence and recurrence of cardiac arrhythmias, predominantly AF. Moreover, it emphasizes the importance of both thyroid status monitoring and AF screening in the general population, as well as in patients with thyroid dysfunction and malignancies. Real-world data on early AF identification in relation to thyroid function are scarce. Even though symptomatic AF is rare in patients with thyroid malignancies, who are under thyroid suppressive therapy, clinicians should be aware of potential interaction with asymptomatic AF. It may prevent adverse consequences and improve the quality of life. This issue may be challenging for an updated registry of AF in clinical practice. Thyroid hormones should be considered a biomarker for cardiac arrhythmias screening and their tailored management because of their multifaceted cellular actions.
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Affiliation(s)
- Narcis Tribulova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia
| | - Lin Hai Kurahara
- Department of Cardiovascular Physiology, Faculty of Medicine, Kagawa University, Kagawa 76 0793, Japan; (L.H.K.); (K.H.)
| | - Peter Hlivak
- Department of Arrhythmias and Pacing, National Institute of Cardiovascular Diseases, Pod Krásnou Hôrkou 1, 83348 Bratislava, Slovakia;
| | - Katsuya Hirano
- Department of Cardiovascular Physiology, Faculty of Medicine, Kagawa University, Kagawa 76 0793, Japan; (L.H.K.); (K.H.)
| | - Barbara Szeiffova Bacova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia
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117
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Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015343. [PMID: 32242478 PMCID: PMC7428644 DOI: 10.1161/jaha.119.015343] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Historically, atrial fibrillation has been observed in clinical settings of prolonged hemodynamic stress, eg, hypertension and valvular heart disease. However, recently, the most prominent precedents to atrial fibrillation are metabolic diseases that are associated with adipose tissue inflammation (ie, obesity and diabetes mellitus) and systemic inflammatory disorders (ie, rheumatoid arthritis and psoriasis). These patients typically have little evidence of left ventricular hypertrophy or dilatation; instead, imaging reveals abnormalities of the structure or function of the atria, particularly the left atrium, indicative of an atrial myopathy. The left atrium is enlarged, fibrotic and noncompliant, potentially because the predisposing disorder leads to an expansion of epicardial adipose tissue, which transmits proinflammatory mediators to the underlying left atrium. The development of an atrial myopathy not only leads to atrial fibrillation, but also contributes to pulmonary venous hypertension and systemic thromboembolism. These mechanisms explain why disorders of systemic or adipose tissue inflammation are accompanied an increased risk of atrial fibrillation, abnormalities of left atrium geometry and an enhanced risk of stroke. The risk of stroke exceeds that predicted by conventional cardiovascular risk factors or thromboembolism risk scores used to guide the use of anticoagulation, but it is strongly linked to clinical evidence and biomarkers of systemic inflammation.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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118
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Environmental factors, serum biomarkers and risk of atrial fibrillation: an exposure-wide umbrella review of meta-analyses. Eur J Epidemiol 2020; 35:223-239. [PMID: 32180061 DOI: 10.1007/s10654-020-00618-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/24/2020] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. We designed an umbrella review to systematically assess the epidemiological credibility of the associations of non-genetic factors with risk of AF. We searched PubMed and EMBASE from inception to December 31, 2018 to identify systematic reviews and meta-analyses of observational studies for the association of non-genetic factors with risk of AF. For each meta-analysis, we used the random-effects model, and we estimated the 95% confidence and prediction intervals. We also assessed between-study heterogeneity, small-study effects and excess significance bias. We identified 34 eligible papers that examined 51 associations of 42 unique non-genetic factors with risk of AF. Eighteen associations remained statistically significant at P value < 1 × 10-6. Thirty-one associations presented large or very large between-study heterogeneity. Eight associations presented evidence for small-study effects and 13 associations had evidence for excess significance bias. Ten associations, i.e. corrected QT interval, alcohol consumption (highest vs. lowest category, per 1 drink/day increase), body mass index (> 30 units vs. < 30 units, per 5 units increase), waist circumference, body weight, type 2 diabetes mellitus, and smoking (ever vs. never, per 10 cigarettes/day increase) were supported by convincing or highly suggestive evidence in meta-analyses of prospective cohort studies. Type 2 diabetes mellitus, markers of adiposity, alcohol consumption, smoking, and corrected QT interval constitute credible risk factors of AF. Our proposed grading may guide the design of future studies, including Mendelian randomization studies, to assess whether these associations are causal.
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119
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Hoermann R, Midgley JE, Larisch R, Dietrich JW. Heterogenous biochemical expression of hormone activity in subclinical/overt hyperthyroidism and exogenous thyrotoxicosis. J Clin Transl Endocrinol 2020; 19:100219. [PMID: 32099819 PMCID: PMC7031309 DOI: 10.1016/j.jcte.2020.100219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Subclinical hyperthyroidism/thyrotoxicosis originates from different causes and clinical conditions, sharing the laboratory constellation of a suppressed TSH in the presence of thyroid hormone concentrations within the reference range. Aim Presentation of hyperthyroidism can manifest itself in several ways. We questioned whether there is either a consistent biochemical equivalence of thyroid hormone response to these diagnostic categories, or a high degree of heterogeneity may exist both within and between the different clinical manifestations. Methods This secondary analysis of a former prospective cross-sectional trial involved 461 patients with untreated thyroid autonomy, Graves’ disease or on levothyroxine (LT4) after thyroidectomy for thyroid carcinoma. TSH response and biochemical equilibria between TSH and thyroid hormones were contrasted between endogenous hyperthyroidism and thyrotoxicosis (LT4 overdose). Results Concentrations of FT4, FT3, TSH, deiodinase activity and BMI differed by diagnostic category. Over various TSH strata, FT4 concentrations were significantly higher in LT4-treated thyroid carcinoma patients, compared to the untreated diseases, though FT3 levels remained comparable. They were concentrated in the upper FT4- but low deiodinase range, distinguishing them from patients with thyroid autonomy and Graves’ disease. In exogenous thyrotoxicosis, TSH and FT3 were less responsive to FT4 concentrations approaching its upper normal/hyperthyroid range. Conclusions The presence or lack of TSH feedforward activity determines the system response in the thyroid-active (hyperthyroidism) and no-thyroid response to treatment (thyrotoxicosis). This rules out a consistent thread of thyroid hormone response running through the different diagnostic categories. TSH measurements should therefore be interpreted conditionally and differently in subclinical hyperthyroidism and thyrotoxicosis.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
- Corresponding author at: Klinikum Lüdenscheid, Paulmannshöher Str 14, D-58515 Lüdenscheid, Germany.
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, D-44791 Bochum, Germany
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120
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Rosenkranz S, Howard LS, Gomberg-Maitland M, Hoeper MM. Systemic Consequences of Pulmonary Hypertension and Right-Sided Heart Failure. Circulation 2020; 141:678-693. [PMID: 32091921 DOI: 10.1161/circulationaha.116.022362] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary hypertension (PH) is a feature of a variety of diseases and continues to harbor high morbidity and mortality. The main consequence of PH is right-sided heart failure which causes a complex clinical syndrome affecting multiple organ systems including left heart, brain, kidneys, liver, gastrointestinal tract, skeletal muscle, as well as the endocrine, immune, and autonomic systems. Interorgan crosstalk and interdependent mechanisms include hemodynamic consequences such as reduced organ perfusion and congestion as well as maladaptive neurohormonal activation, oxidative stress, hormonal imbalance, and abnormal immune cell signaling. These mechanisms, which may occur in acute, chronic, or acute-on-chronic settings, are common and precipitate adverse functional and structural changes in multiple organs which contribute to increased morbidity and mortality. While the systemic character of PH and right-sided heart failure is often neglected or underestimated, such consequences place additional burden on patients and may represent treatable traits in addition to targeted therapy of PH and underlying causes. Here, we highlight the current state-of-the-art understanding of the systemic consequences of PH and right-sided heart failure on multiple organ systems, focusing on self-perpetuating pathophysiological mechanisms, aspects of increased susceptibility of organ damage, and their reciprocal impact on the course of the disease.
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Affiliation(s)
- Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Germany (S.R.).,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Germany (S.R.)
| | - Luke S Howard
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, United Kingdom (L.S.H.)
| | | | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Germany (M.M.H.).,German Center for Lung Research (DZL), Hannover, Germany (M.M.H.)
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121
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Manolis AA, Manolis TA, Melita H, Manolis AS. Subclinical thyroid dysfunction and cardiovascular consequences: An alarming wake-up call? Trends Cardiovasc Med 2020; 30:57-69. [DOI: 10.1016/j.tcm.2019.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
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122
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Ellervik C, Roselli C, Christophersen IE, Alonso A, Pietzner M, Sitlani CM, Trompet S, Arking DE, Geelhoed B, Guo X, Kleber ME, Lin HJ, Lin H, MacFarlane P, Selvin E, Shaffer C, Smith AV, Verweij N, Weiss S, Cappola AR, Dörr M, Gudnason V, Heckbert S, Mooijaart S, März W, Psaty BM, Ridker PM, Roden D, Stott DJ, Völzke H, Benjamin EJ, Delgado G, Ellinor P, Homuth G, Köttgen A, Jukema JW, Lubitz SA, Mora S, Rienstra M, Rotter JI, Shoemaker MB, Sotoodehnia N, Taylor KD, van der Harst P, Albert CM, Chasman DI. Assessment of the Relationship Between Genetic Determinants of Thyroid Function and Atrial Fibrillation: A Mendelian Randomization Study. JAMA Cardiol 2020; 4:144-152. [PMID: 30673084 DOI: 10.1001/jamacardio.2018.4635] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Increased free thyroxine (FT4) and decreased thyrotropin are associated with increased risk of atrial fibrillation (AF) in observational studies, but direct involvement is unclear. Objective To evaluate the potential direct involvement of thyroid traits on AF. Design, Setting, and Participants Study-level mendelian randomization (MR) included 11 studies, and summary-level MR included 55 114 AF cases and 482 295 referents, all of European ancestry. Exposures Genomewide significant variants were used as instruments for standardized FT4 and thyrotropin levels within the reference range, standardized triiodothyronine (FT3):FT4 ratio, hypothyroidism, standardized thyroid peroxidase antibody levels, and hyperthyroidism. Mendelian randomization used genetic risk scores in study-level analysis or individual single-nucleotide polymorphisms in 2-sample MR for the summary-level data. Main Outcomes and Measures Prevalent and incident AF. Results The study-level analysis included 7679 individuals with AF and 49 233 referents (mean age [standard error], 62 [3] years; 15 859 men [29.7%]). In study-level random-effects meta-analysis, the pooled hazard ratio of FT4 levels (nanograms per deciliter) for incident AF was 1.55 (95% CI, 1.09-2.20; P = .02; I2 = 76%) and the pooled odds ratio (OR) for prevalent AF was 2.80 (95% CI, 1.41-5.54; P = .003; I2 = 64%) in multivariable-adjusted analyses. The FT4 genetic risk score was associated with an increase in FT4 by 0.082 SD (standard error, 0.007; P < .001) but not with incident AF (risk ratio, 0.84; 95% CI, 0.62-1.14; P = .27) or prevalent AF (OR, 1.32; 95% CI, 0.64-2.73; P = .46). Similarly, in summary-level inverse-variance weighted random-effects MR, gene-based FT4 within the reference range was not associated with AF (OR, 1.01; 95% CI, 0.89-1.14; P = .88). However, gene-based increased FT3:FT4 ratio, increased thyrotropin within the reference range, and hypothyroidism were associated with AF with inverse-variance weighted random-effects OR of 1.33 (95% CI, 1.08-1.63; P = .006), 0.88 (95% CI, 0.84-0.92; P < .001), and 0.94 (95% CI, 0.90-0.99; P = .009), respectively, and robust to tests of horizontal pleiotropy. However, the subset of hypothyroidism single-nucleotide polymorphisms involved in autoimmunity and thyroid peroxidase antibodies levels were not associated with AF. Gene-based hyperthyroidism was associated with AF with MR-Egger OR of 1.31 (95% CI, 1.05-1.63; P = .02) with evidence of horizontal pleiotropy (P = .045). Conclusions and Relevance Genetically increased FT3:FT4 ratio and hyperthyroidism, but not FT4 within the reference range, were associated with increased AF, and increased thyrotropin within the reference range and hypothyroidism were associated with decreased AF, supporting a pathway involving the pituitary-thyroid-cardiac axis.
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Affiliation(s)
- Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carolina Roselli
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Ingrid E Christophersen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Collen M Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bastiaan Geelhoed
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Xiuqing Guo
- Division of Genomic Outcomes, Institute for Translational Genomics and Population Sciences, Torrance, California.,Department of Pediatrics, Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henry J Lin
- Division of Genomic Outcomes, Institute for Translational Genomics and Population Sciences, Torrance, California.,Department of Pediatrics, Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Honghuang Lin
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts
| | - Peter MacFarlane
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christian Shaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Albert V Smith
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor.,Icelandic Heart Association, Kopavogur, Iceland
| | - Niek Verweij
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stefan Weiss
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics, University Medicine and University Greifswald, Greifswald, Germany
| | - Anne R Cappola
- Smilow Center for Translational Research, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marcus Dörr
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Susan Heckbert
- Department of Epidemiology, University of Washington, Seattle
| | - Simon Mooijaart
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, Epidemiology, and Health Services, University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Paul M Ridker
- Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dan Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Henry Völzke
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Graciela Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Ellinor
- Harvard Medical School, Boston, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, Massachusetts.,Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Georg Homuth
- University Medicine Greifswald, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Johan W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Steven A Lubitz
- Cardiovascular Research Center, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Samia Mora
- Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michiel Rienstra
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jerome I Rotter
- Division of Genomic Outcomes, Institute for Translational Genomics and Population Sciences, Torrance, California.,Department of Pediatrics, Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - M Benjamin Shoemaker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Kent D Taylor
- Division of Genomic Outcomes, Institute for Translational Genomics and Population Sciences, Torrance, California.,Department of Pediatrics, Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christine M Albert
- Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel I Chasman
- Harvard Medical School, Boston, Massachusetts.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4966] [Impact Index Per Article: 1241.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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124
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Davis JD, Kovar AJ. The Cardiovascular Effects of Subclinical Thyroid Dysfunction. J Cardiothorac Vasc Anesth 2020; 34:35-38. [DOI: 10.1053/j.jvca.2019.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023]
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125
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5437] [Impact Index Per Article: 1087.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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126
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Anderson JL, Jacobs V, May HT, Bair TL, Benowitz BA, Lappe DL, Muhlestein JB, Knowlton KU, Bunch TJ. Free thyroxine within the normal reference range predicts risk of atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:18-29. [DOI: 10.1111/jce.14183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffrey L. Anderson
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
- School of MedicineUniversity of Utah Salt Lake City Utah
| | - Victoria Jacobs
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
| | - Heidi T. May
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
- School of MedicineUniversity of Utah Salt Lake City Utah
| | - Tami L. Bair
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
| | - Barry A. Benowitz
- School of MedicineUniversity of Utah Salt Lake City Utah
- EndocrinologyLDS Hospital Salt Lake City Utah
| | - Donald L. Lappe
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
| | - Joseph B. Muhlestein
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
- School of MedicineUniversity of Utah Salt Lake City Utah
| | - Kirk U. Knowlton
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
- School of MedicineUniversity of Utah Salt Lake City Utah
| | - T. Jared Bunch
- Intermountain Medical CenterIntermountain Heart Institute Salt Lake City Utah
- Department of MedicineStanford University Stanford California
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García-Padilla C, Domínguez JN, Aránega AE, Franco D. Differential chamber-specific expression and regulation of long non-coding RNAs during cardiac development. BIOCHIMICA ET BIOPHYSICA ACTA. GENE REGULATORY MECHANISMS 2019; 1862:194435. [PMID: 31678627 DOI: 10.1016/j.bbagrm.2019.194435] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
Cardiovascular development is governed by a complex interplay between inducting signals such as Bmps and Fgfs leading to activation of cardiac specific transcription factors such as Nkx2.5, Mef2c and Srf that orchestrate the initial steps of cardiogenesis. Over the last decade we have witnessed the discovery of novel layers of gene regulation, i.e. post-transcriptional regulation exerted by non-coding RNAs. The function role of small non coding RNAs has been widely demonstrated, e.g. miR-1 knockout display several cardiovascular abnormalities during embryogenesis. More recently long non-coding RNAs have been also reported to modulate gene expression and function in the developing heart, as exemplified by the embryonic lethal phenotypes of Fendrr and Braveheart knock out mice, respectively. In this study, we investigated the differential expression profile during cardiogenesis of previously reported lncRNAs in heart development. Our data revealed that Braveheart, Fendrr, Carmen display a preferential adult expression while Miat, Alien, H19 preferentially display chamber-specific expression at embryonic stages. We also demonstrated that these lncRNAs are differentially regulated by Nkx2.5, Srf and Mef2c, Pitx2 > Wnt > miRNA signaling pathway and angiotensin II and thyroid hormone administration. Importantly isoform-specific expression and distinct nuclear vs cytoplasmic localization of Braveheart, Carmen and Fendrr during chamber morphogenesis is observed, suggesting distinct functional roles of these lncRNAs in atrial and ventricular chambers. Furthermore, we demonstrate by in situ hybridization a dynamic epicardial, myocardial and endocardial expression of H19 during cardiac development. Overall our data support novel roles of these lncRNAs in different temporal and tissue-restricted fashion during cardiogenesis.
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Affiliation(s)
- Carlos García-Padilla
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - Jorge N Domínguez
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - Amelia E Aránega
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - Diego Franco
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaen, Jaen, Spain.
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128
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Song RH, Wang B, Yao QM, Li Q, Jia X, Zhang JA. The Impact of Obesity on Thyroid Autoimmunity and Dysfunction: A Systematic Review and Meta-Analysis. Front Immunol 2019; 10:2349. [PMID: 31681268 PMCID: PMC6797838 DOI: 10.3389/fimmu.2019.02349] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background: To help inform decision making in the clinical setting, we carried out a systematic review and meta-analysis to estimate the association of thyroid disease risks with obesity. Methods: Pubmed, Embase, Web of Science, Cochrane database and Google Scholar electronic databases were searched from inception to October 31, 2018 without language restrictions to explore the relationship between thyroid disorders and obesity. The relative risk (RR) or odds risk (OR) for thyroid disorders were pooled using the SPSS and STATA software. Results: A total of 22 studies were included in the study. (1) Meta-analysis showed that obesity was significantly associated with an increased risk of hypothyroidism (RR = 1.86, 95% CI 1.63–2.11, P < 0.001). Meta-analyses after stratification further showed that obese population had increased risks of overt hypothyroidism (RR = 3.21, 95% CI 2.12–4.86, P < 0.001) and subclinical hypothyroidism (RR = 1.70, 95% CI 1.42–2.03, P < 0.001). (2) Further meta-analysis also showed obesity was clearly associated with Hashimoto's thyroiditis (RR = 1.91, 95% CI 1.10–3.32, P = 0.022), but not with Graves' disease. (3) In the meta-analysis of antibodies, obesity was correlated with positive thyroid peroxidase antibody (TPOAb) (RR = 1.93, 95% CI 1.31–2.85, P = 0.001), but not with positive thyroglobulin antibody (TGAb). Conclusions: Obesity was significantly related to hypothyroidism, HT, and TPOAb, implying that prevention of obesity is crucial for thyroid disorders. Systematic Review Registration: PROSPERO: CRD42018096897.
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Affiliation(s)
- Rong-Hua Song
- Department of Endocrinology & Rheumatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qiu-Ming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qian Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xi Jia
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of Endocrinology & Rheumatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Drugs Context 2019; 8:212597. [PMID: 31516533 PMCID: PMC6726361 DOI: 10.7573/dic.212597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
Levothyroxine (LT4) therapy has a long history, a well-defined pharmacological profile and a favourable safety record in the alleviation of hypothyroidism. However, questions remain in defining the threshold for the requirement of treatment in patients with subclinical hypothyroidism, assessing the dose adequacy of the drug, and selecting the best treatment mode (LT4 monotherapy versus liothyronine [LT3]/LT4 combinations) for subpopulations with persisting complaints. Supplied as a prodrug, LT4 is enzymatically converted into the biologically more active thyroid hormone, triiodothyronine (T3). Importantly, tetraiodothyronine (T4) to T3 conversion efficiency may be impaired in patients receiving LT4, resulting in a loss of thyroid-stimulating hormone (TSH)-mediated feed-forward control of T3, alteration of the interlocking equilibria between serum concentrations of TSH, free thyroxine (FT4), and free triiodothyonine (FT3), and a decrease in FT3 to FT4 ratios. This downgrades the value of the TSH reference system derived in thyroid health for guiding the replacement dose in the treatment situation. Individualised conditionally defined setpoints may therefore provide appropriate biochemical targets to be clinically tested, together with a stronger focus on clinical presentation and future endpoint markers of tissue thyroid state. This cautionary note encompasses the use of aggregated statistical data from clinical trials which are not safely applicable to the individual level of patient care under these circumstances.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
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130
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Li J, Liu Z, Zhao H, Yun F, Liang Z, Wang D, Zhao X, Zhang J, Cang H, Zou Y, Li Y. Alterations in atrial ion channels and tissue structure promote atrial fibrillation in hypothyroid rats. Endocrine 2019; 65:338-347. [PMID: 31175577 DOI: 10.1007/s12020-019-01968-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE It is well known that hyperthyroidism is associated with atrial fibrillation (AF); however, the relationship between hypothyroidism and AF remains controversial. METHODS Hypothyroidism was established in rats by two methods: methimazole-induced (MMI) and thyroidectomy (TX). MMI model includes control (n = 10), MMI (n = 10), and MMI + L-thyroxine (T4, n = 10). Methimazole was given intragastrically in MMI and MMI + T4 for 12 weeks, and T4 was added intragastrically in MMI + T4 at week 5. TX model includes sham (n = 10), TX (n = 10), and TX + T4 (n = 10). Four weeks after surgery, rats in TX + T4 received T4 for 8 weeks. Triiodothyronine (T3), T4, and thyroid-stimulating hormone (TSH) were measured. Electrophysiology, tissue structure and function, and protein levels of potassium and L-type calcium channels were assessed in the atria. RESULTS Severe changes in the atrial structure of hypothyroid rats were observed. Compared with euthyroid rats, atrial effective refractory period (AERP) in hypothyroid rats was significantly shortened; accordingly, inducibility and duration of AF were considerably increased. Protein levels of minK, Kv1.5, Kv4.2, Kv4.3, Kv7.1, and Cav1.2 were upregulated in hypothyroid rats, whereas there was only a tendency toward increased Kir2.1. Kv11.1 was statistically upregulated in the MMI model and had an increasing tendency in the TX model. Conversely, Kir3.1 and Kir3.4 were downregulated in hypothyroid rats. The above changes could be partially inhibited by T4 treatment. CONCLUSIONS AERP shortening due to altered protein levels of ion channels and atrial structural changes increased the susceptibility to AF in hypothyroidism. Thyroid replacement therapy could prevent electrical and structural remodeling under hypothyroid condition.
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Affiliation(s)
- Jianqiang Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhaorui Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Hongwei Zhao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Fengxiang Yun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhaoguang Liang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Dingyu Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xinbo Zhao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Jiawei Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Hai Cang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yilun Zou
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
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Wildisen L, Moutzouri E, Beglinger S, Syrogiannouli L, Cappola AR, Åsvold BO, Bakker SJL, Ceresini G, Dullaart R, Ferrucci L, Grabe H, Jukema JW, Nauck M, Trompet S, Völzke H, Westendorp RGJ, Gussekloo J, Peeters RP, Klöppel S, Aujesky D, Bauer DC, Rodondi N, Del Giovane C, Feller M. Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies. BMJ Open 2019; 9:e029716. [PMID: 31350252 PMCID: PMC6661665 DOI: 10.1136/bmjopen-2019-029716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms have yielded conflicting findings, possibly because of differences in age, sex, thyroid-stimulating hormone cut-off levels or degree of baseline depressive symptoms. Analysis of individual participant data (IPD) may help clarify this association. METHODS AND ANALYSIS We will conduct a systematic review and IPD meta-analysis of prospective studies on the association between subclinical thyroid dysfunction and depressive symptoms. We will identify studies through a systematic search of the literature in the Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from inception to April 2019 and from the Thyroid Studies Collaboration. We will ask corresponding authors of studies that meet our inclusion criteria to collaborate by providing IPD. Our primary outcome will be depressive symptoms at the first available individual follow-up, measured on a validated scale. We will convert all the scores to the Beck Depression Inventory scale. For each cohort, we will estimate the mean difference of depressive symptoms between participants with subclinical hypothyroidism or hyperthyroidism and control adjusted for depressive symptoms at baseline. Furthermore, we will adjust our multivariable linear regression analyses for age, sex, education and income. We will pool the effect estimates of all studies in a random-effects meta-analysis. Heterogeneity will be assessed by I2. Our secondary outcomes will be depressive symptoms at a specific follow-up time, at the last available individual follow-up and incidence of depression at the first, last and at a specific follow-up time. For the binary outcome of incident depression, we will use a logistic regression model. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. Our findings will have considerable implications for patient care. We will seek to publish this systematic review and IPD meta-analysis in a high-impact clinical journal. PROSPERO REGISTRATION NUMBER CRD42018091627.
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Affiliation(s)
- Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Anne R Cappola
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | - Robin Dullaart
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, Harbor Hospital, Baltimore, National Institute on Aging NIA-ASTRA Unit, Baltimore, Maryland, USA
| | - Hans Grabe
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK, German Centre for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Stella Trompet
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jacobijn Gussekloo
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin P Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Klöppel
- University Hospital of Old Age Psychatry, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
IMPORTANCE Subclinical hypothyroidism, defined as an elevated serum thyrotropin (often referred to as thyroid-stimulating hormone, or TSH) level with normal levels of free thyroxine (FT4) affects up to 10% of the adult population. OBSERVATIONS Subclinical hypothyroidism is most often caused by autoimmune (Hashimoto) thyroiditis. However, serum thyrotropin levels rise as people without thyroid disease age; serum thyrotropin concentrations may surpass the upper limit of the traditional reference range of 4 to 5 mU/L among elderly patients. This phenomenon has likely led to an overestimation of the true prevalence of subclinical hypothyroidism in persons older than 70 years. In patients who have circulating thyroid peroxidase antibodies, there is a greater risk of progression from subclinical to overt hypothyroidism. Subclinical hypothyroidism may be associated with an increased risk of heart failure, coronary artery disease events, and mortality from coronary heart disease. In addition, middle-aged patients with subclinical hypothyroidism may have cognitive impairment, nonspecific symptoms such as fatigue, and altered mood. In the absence of large randomized trials showing benefit from levothyroxine therapy, the rationale for treatment is based on the potential for decreasing the risk of adverse cardiovascular events and the possibility of preventing progression to overt hypothyroidism. However, levothyroxine therapy may be associated with iatrogenic thyrotoxicosis, especially in elderly patients, and there is no evidence that it is beneficial in persons aged 65 years or older. CONCLUSIONS AND RELEVANCE Subclinical hypothyroidism is common and most individuals can be observed without treatment. Treatment might be indicated for patients with subclinical hypothyroidism and serum thyrotropin levels of 10 mU/L or higher or for young and middle-aged individuals with subclinical hypothyroidism and symptoms consistent with mild hypothyroidism.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anne R Cappola
- Perelman School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, the University of Pennsylvania, Philadelphia
- Associate Editor
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, Fishman GI, Goldman S, Cooper DS, Mora S, Kudenchuk PJ, Hollenberg AN, McDonald CL, Ladenson PW. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Circulation 2019; 139:2892-2909. [PMID: 31081673 PMCID: PMC6851449 DOI: 10.1161/circulationaha.118.036859] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyroid hormones have long been known to have a range of effects on the cardiovascular system. However, significant knowledge gaps exist concerning the precise molecular and biochemical mechanisms governing these effects and the optimal strategies for management of abnormalities in thyroid function in patients with and without preexisting cardiovascular disease. In September 2017, the National Heart, Lung, and Blood Institute convened a Working Group with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease. The Working Group reviewed and discussed the roles of normal thyroid physiology, the consequences of thyroid dysfunction, and the effects of therapy in 3 cardiovascular areas: cardiac electrophysiology and arrhythmias, the vasculature and atherosclerosis, and the myocardium and heart failure. This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field, including strategies for leveraging novel approaches using omics and big data. The Working Group recommended research in 3 broad areas: (1) investigation into the fundamental biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; (2) studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and (3) clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormone or thyromimetic drugs.
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Affiliation(s)
- Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Marco Medici
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Debra Egan
- Office of Clinical and Regulatory Affairs, National Center for Complementary and Integrative Health, Bethesda, MD
| | - George Sopko
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | | | - David S. Cooper
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samia Mora
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Peter J. Kudenchuk
- Division of Cardiology, Arrhythmia Services, the University of Washington, Seattle, WA
| | | | - Cheryl L. McDonald
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
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Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, Fishman GI, Goldman S, Cooper DS, Mora S, Kudenchuk PJ, Hollenberg AN, McDonald CL, Ladenson PW. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Thyroid 2019; 29:760-777. [PMID: 31081722 PMCID: PMC6913785 DOI: 10.1089/thy.2018.0416] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thyroid hormones have long been known to have a range of effects on the cardiovascular system. However, significant knowledge gaps exist concerning the precise molecular and biochemical mechanisms governing these effects and the optimal strategies for management of abnormalities in thyroid function in patients with and without preexisting cardiovascular disease. In September 2017, The National Heart, Lung, and Blood Institute convened a Working Group with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease. The Working Group reviewed and discussed the roles of normal thyroid physiology, the consequences of thyroid dysfunction, and the effects of therapy in three cardiovascular areas: cardiac electrophysiology and arrhythmias, the vasculature and atherosclerosis, and the myocardium and heart failure. This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field, including strategies for leveraging novel approaches using omics and big data. The Working Group recommended research in three broad areas: 1) investigation into the fundamental biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; 2) studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and 3) clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormone or thyromimetic drugs.
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Affiliation(s)
- Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Address correspondence to: Anne R. Cappola, MD, MSc, Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104
| | - Akshay S. Desai
- Cardiovascular Division; Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco Medici
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Debra Egan
- Office of Clinical and Regulatory Affairs, National Center for Complementary and Integrative Health, Bethesda, Maryland
| | - George Sopko
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Glenn I. Fishman
- Division of Cardiology, NYU School of Medicine, New York, New York
| | - Steven Goldman
- Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - David S. Cooper
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samia Mora
- Divisions of Preventive and Cardiovascular Medicine; Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter J. Kudenchuk
- Division of Cardiology, Arrhythmia Services, University of Washington, Seattle, Washington
| | | | - Cheryl L. McDonald
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mendes D, Alves C, Silverio N, Batel Marques F. Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis. Eur Thyroid J 2019; 8:130-143. [PMID: 31259155 PMCID: PMC6587201 DOI: 10.1159/000499751] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with undiagnosed hypothyroidism are not treated for the disease and are at high risk of developing serious complications, with major impact on public health. There is a need to systematically review the available evidence on this topic. OBJECTIVE To identify the prevalence of undiagnosed hypothyroidism in Europe. METHODS A systematic review of the literature (Medline, EMBASE, and Cochrane Central) was performed to identify epidemiological studies on the prevalence of undiagnosed hypothyroidism among European populations published between January 2008 and April 2018. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Random-effects meta-analyses were performed to pool estimates of proportions (with 95% confidence intervals [CIs]) of undiagnosed (1) subclinical, (2) overt, and (3) total hypothyroidism. RESULTS The search returned 15,565 citations (4,526 duplicates). Twenty papers were included in the study. Fourteen and 6 studies were of good and moderate methodological quality, respectively. The results of the meta-analyses were as follows for the prevalence of undiagnosed hypothyroidism: subclinical, 4.11% (95% CI 3.05-5.31%, I2 = 99.32%); overt, 0.65% (95% CI 0.38-0.99%, I2 = 96.67%); and total, 4.70% (95% CI 2.98-6.79%, I2 = 99.53%). According to the sensitivity analysis, the prevalence of hypothyroidism tends to be higher in female patients, in those aged ≥65 years, among studies with lower sample sizes, in those with thyroid-stimulating hormone levels <4.5 mIU/L, and in Eastern and Southern Europe. CONCLUSIONS The current evidence suggests that a considerable proportion of the European population has hypothyroidism, particularly subclinical hypothyroidism, which is undiagnosed. This issue deserves further investigation because of possible deleterious consequences for public health.
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Affiliation(s)
- Diogo Mendes
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Carlos Alves
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | | | - Francisco Batel Marques
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
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Einfeldt MN, Olsen AMS, Kristensen SL, Khalid U, Faber J, Torp-Pedersen C, Gislason GH, Selmer C. Long-Term Outcome in Patients With Heart Failure Treated With Levothyroxine: An Observational Nationwide Cohort Study. J Clin Endocrinol Metab 2019; 104:1725-1734. [PMID: 30517746 DOI: 10.1210/jc.2018-01604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Hypothyroidism has detrimental effects on the cardiovascular system, but controversy remains concerning the benefits of levothyroxine (L-T4) substitution in patients with heart failure (HF). OBJECTIVE Examining the effects of L-T4 in patients with HF. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All Danish citizens aged ≥18 years diagnosed with HF between 1997 and 2012. L-T4 treatment was identified from nationwide registers. Incidence rate ratios (IRRs) were calculated with Poisson regression models. MAIN OUTCOME MEASURES All-cause mortality, myocardial infarction (MI), cardiovascular death, and major adverse cardiovascular events (MACEs). RESULTS A total of 224,670 patients were diagnosed with HF [mean age 70.7 (SD ± 14.7) years, 53% male]. Of these, 6560 patients were treated with L-T4 at baseline, and 9007 patients initiated L-T4 during follow-up. A total of 209,103 patients did not receive L-T4. During a median follow-up of 4.8 years [interquartile range (IQR) 9.2] 147,253 patients died. Increased risk of all-cause mortality (IRR 1.25; 95% CI, 1.21 to 1.29; IRR 1.13; 95% CI, 1.10 to 1.16), cardiovascular death (IRR 1.23; 95% CI, 1.18 to 1.27; IRR 1.11; 95% CI, 1.08 to 1.15), and MACE (IRR 1.26; 95% CI, 1.22 to 1.31; IRR 1.05; 95% CI, 1.02 to 1.09) was observed for treatment ongoing at baseline and initiated during follow-up, respectively. Increased risk of MI (IRR 1.32; 95% CI, 1.23 to 1.41) was observed for ongoing treatment, and reduced risk (IRR 0.87; 95% CI, 0.81 to 0.93) was observed for incident treatment. CONCLUSION Ongoing and incident L-T4 treatment in patients with HF was associated with an increased risk of all-cause mortality, cardiovascular death, and MACE. Increased risk of MI was observed for ongoing treatment, and reduced risk was observed for incident treatment.
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Affiliation(s)
| | | | | | - Usman Khalid
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Jens Faber
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Selmer
- Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, Denmark
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Dong J, Cong Z, You M, Fu Y, Wang Y, Wang Y, Fu H, Wei L, Chen J. Effects of perinatal di (2-ethylhexyl) phthalate exposure on thyroid function in rat offspring. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2019; 67:53-60. [PMID: 30716676 DOI: 10.1016/j.etap.2019.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
Di (2-ethylhexyl) phthalate (DEHP) is a commonly used plasticizer in industry and displays the characteristics of an endocrine disruptor. Disorders of the maternal thyroid hormone (TH) during pregnancy can cause adverse effects on the fetus. We investigated the effects and possible mechanism of perinatal DEHP exposure on the thyroid function of pups. Pregnant female Wistar rats were randomly divided into four groups and received doses of DEHP of 0, 30, 300, 750 mg/kg/day by gavage at from gestational day (GD) 0 to postnatal day (PN) 21. The concentration of serum THs and the ultrastructure of thyroid follicular cells in the offspring were examined. Related protein level and gene expression of thyroid proteins in pups were analyzed by western blotting and real-time PCR. We found that DEHP significantly reduced total thyroxine (TT4) and increased thyroid stimulating hormone (TSH) in pups, while total triiodothyronine (TT3) showed no change. Thyroid follicular cells ultrastructure was damaged in DEHP exposed pups as viewed by electron microscopy. Furthermore, exposure to DEHP significantly increased protein and mRNA levels of thyroid transcription factor 1 (TTF-1), paired box 8 (PAX8), sodium iodide symporter (NIS) and thyroid peroxidase (TPO) in pups. In addition, levels of deiodinases of pups were also affected. These findings indicated that DEHP can disrupt thyroid function by damaging thyroid follicles and affecting TTF-1, PAX8, NIS, TPO and the deiodinase protein family.
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Affiliation(s)
- Jing Dong
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Zhangzhao Cong
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Mingdan You
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Yuanyuan Fu
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Yi Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Yuan Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Hui Fu
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Lingling Wei
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China
| | - Jie Chen
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang 110122, People's Republic of China.
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138
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Larsson SC, Allara E, Mason AM, Michaëlsson K, Burgess S. Thyroid Function and Dysfunction in Relation to 16 Cardiovascular Diseases. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2019; 12:e002468. [PMID: 30702347 PMCID: PMC6443057 DOI: 10.1161/circgen.118.002468] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Subclinical thyroid dysfunction, defined as thyroid-stimulating hormone levels outside the reference range with normal free thyroxine levels in asymptomatic patients, is associated with alterations in cardiac hemodynamics. We used Mendelian randomization to assess the role of thyroid dysfunction for cardiovascular disease (CVD). METHODS Single-nucleotide polymorphisms associated with thyroid function were identified from a genome-wide association meta-analysis in up to 72 167 individuals. Data for genetic associations with CVD were obtained from meta-analyses of genome-wide association studies of atrial fibrillation (n=537 409 individuals), coronary artery disease (n=184 305 individuals), and ischemic stroke (n=438 847) as well as from the UK Biobank (n=367 703 individuals). RESULTS Genetically predicted thyroid-stimulating hormone levels and hyperthyroidism were statistically significantly associated with atrial fibrillation but no other CVDs at the Bonferroni-corrected level of significance ( P<7.8×10-4). The odds ratios of atrial fibrillation were 1.15 (95% CI, 1.11-1.19; P=2.4×10-14) per genetically predicted 1 SD decrease in thyroid-stimulating hormone levels and 1.05 (95% CI, 1.03-1.08; P=5.4×10-5) for genetic predisposition to hyperthyroidism. Genetically predicted free thyroxin levels were not statistically significantly associated with any CVD. CONCLUSIONS This Mendelian randomization study supports evidence for a causal association of decreased thyroid-stimulating hormone levels in the direction of a mild form of hyperthyroidism with an increased risk of atrial fibrillation but no other CVDs.
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Affiliation(s)
- Susanna C. Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elias Allara
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Amy M. Mason
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
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139
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Roberts JD. Thyroid Function and the Risk of Atrial Fibrillation: Exploring Potentially Causal Relationships Through Mendelian Randomization. JAMA Cardiol 2019; 4:97-99. [PMID: 30673080 DOI: 10.1001/jamacardio.2018.4614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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140
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Functional and Symptomatic Individuality in the Response to Levothyroxine Treatment. Front Endocrinol (Lausanne) 2019; 10:664. [PMID: 31616383 PMCID: PMC6775211 DOI: 10.3389/fendo.2019.00664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background: For significant numbers of patients dissatisfied on standard levothyroxine (LT4) treatment for hypothyroidism, patient-specific responses to T4 could play a significant role. Aim: To assess response heterogeneity to LT4 treatment, identifying confounders and hidden clusters within a patient panel, we performed a secondary analysis using data from a prospective cross-sectional and retrospective longitudinal study. Methods: Multivariate and multivariable linear models adjusted for covariates (gender, age, and BMI) were stratified by disease-specific treatment indication. During follow-up, pooled observations were compared from the same patient presenting either with or without self-reported symptoms. Statistical analysis was extended to multilevel models to derive intra-class correlation coefficients and reliability measures during follow-up. Results: Equilibria between TSH, FT4, and FT3 serum concentrations in 342 patients were examined by treatment indication (benign goiter, autoimmune thyroiditis, thyroid carcinoma), consequently displaying complex interactive response patterns. Seventy-seven patients treated with LT4 and monitored for thyroid carcinoma presented, in association with changes in LT4 dose, either with hypothyroid symptoms or symptom-free. Significant biochemical differences appeared between the different presentations. Leveled trajectories by subject to relief from hypothyroid symptoms differed significantly, indicating distinct responses, and denying a single shared outcome. These were formally defined by a high coefficient of the intraclass correlation (ICC1, exceeding 0.60 in all thyroid parameters) during follow-up on multiple visits at the same LT4 dose, when lacking symptoms. The intra-personal clusters were clearly differentiated from random variability by random group resampling. Symptomatic change in these patients was strongly associated with serum FT3, but not with FT4 or TSH concentrations. In 25 patients transitioning from asymptomatic to symptomatically hyperthyroid, FT3 concentrations remained within the reference limits, whilst at the same time marked biochemical differences were apparent between the presentations. Conclusions: Considerable intra-individual clustering occurred in the biochemical and symptomatic responses to LT4 treatment, implying statistically multileveled response groups. Unmasking individual differences in the averaged treatment response hereby highlights clinically distinguishable subgroups within an indiscriminate patient panel. This, through well-designed larger clinical trials will better target the different therapeutic needs of individual patients.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
- *Correspondence: Rudolf Hoermann
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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141
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Zhang S, Feng G, Kang F, Guo Y, Ti H, Hao L, Gao P, Gao J. Hypothyroidism and Adverse Endpoints in Diabetic Patients: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2019; 10:889. [PMID: 31998230 PMCID: PMC6965024 DOI: 10.3389/fendo.2019.00889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: This study investigated the relationship strength between hypothyroidism and cardiovascular and renal outcomes in diabetic patients. Methods: The electronic databases PubMed, EmBase, and Cochrane library were screened for relevant studies published before November 2018. The outcomes included major cardiovascular events (MACEs), all-cause mortality, cardiac death, stroke, diabetic nephropathy (DN), diabetic retinopathy (DR), and chronic kidney disease (CKD). The pooled results for all outcomes were calculated using random-effects models. Results: A total of eight studies met the inclusion criteria. The summary results indicated that hypothyroidism was not associated with the risk of MACEs (OR:1.21; 95%CI:0.68-2.16; P = 0.514), all-cause mortality (OR:1.27; 95%CI:0.93-1.74; P = 0.136), cardiac death (OR:1.16; 95%CI:0.89-1.52; P = 0.271), stroke (OR:0.96; 95%CI: 0.49-1.88; P = 0.915), and DN (OR:1.71; 95%CI:0.37-7.90; P = 0.490). There was a significant association between hypothyroidism and the risk of DR (OR:1.73; 95%CI:1.08-2.77; P = 0.023) and CKD (OR:1.22; 95%CI:1.10-1.36; P < 0.001). Conclusions: These findings indicate that diabetic patients with hypothyroidism have an increased risk of DR and CKD. Additional large-scale prospective studies should be carried out to verify the prognosis of patients with diabetes and hypothyroidism.
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Affiliation(s)
- Shaojun Zhang
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
- Department of Endocrinology, The Sixth Division Hospital of Xinjiang Production and Construction Corps, Wujiaqu, China
- *Correspondence: Shaojun Zhang
| | - Guilong Feng
- Department of Emergency, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Fangfang Kang
- The Department of Endocrinology, The Central Hospital of Linfen City, Linfen, China
| | - Yali Guo
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Hongyan Ti
- The Department of Digestive, Linfen People's Hospital, Linfen, China
| | - Lufang Hao
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Peng Gao
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Jiangqin Gao
- Department of Endocrinology, The Sixth Division Hospital of Xinjiang Production and Construction Corps, Wujiaqu, China
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142
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Li X, Yao Y, Chen Z, Fan S, Hua W, Zhang S, Fan X. Thyroid-stimulating hormone within the normal range and risk of major adverse cardiovascular events in nonischemic dilated cardiomyopathy patients with severe left ventricular dysfunction. Clin Cardiol 2018; 42:120-128. [PMID: 30447088 DOI: 10.1002/clc.23117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The association between thyroid-stimulating-hormone (TSH) and prognosis of nonischemic dilated cardiomyopathy (NIDCM) in patients with normal thyroid function remains unclear. HYPOTHESIS Our aim was to investigate the association between TSH and major adverse cardiovascular events in euthyroid NIDCM patients. METHODS The original cohort consisted of 216 consecutive euthyroid NIDCM patients, with left ventricular ejection fraction (LVEF) ≤35%, who were observed from 2010 to 2013. Patients with persistent ventricular arrhythmia (VA) histories, amiodarone taken for VA prevention, or on heart transplant list within 1 year were excluded. A follow-up evaluation was performed, and VA events, heart failure (HF) exacerbation/heart transplant, cardiac death, or death from any cause were separately evaluated. RESULTS A total of 184 patients were enrolled, and 97.8% (180/184) ultimately received follow-up evaluations. During the median 4.6-year follow-up, 24 VA events, 28 cardiac deaths, 30 all-cause deaths, 40 HF exacerbations, and 11 heart transplant events occurred. Serum TSH levels showed good predictive efficacies for VA events (area under the curve [AUC] = 0.702, 95% confidence interval [CI]: 0.629-0.767), and the risk of VA events increased, according to serum TSH quarters, as determined by Kaplan-Meier analysis (2.2% vs 13.4% vs 21.0% vs 30.0%, Q1-Q4, P = 0.011). Multivariable Cox analysis showed that patients at the Q4 level of serum TSH (>2.67 mIU/L) suffered an increased risk of VA events, compared with those at the Q1 level of TSH (hazard ratio [HR] = 15.88, 95% CI: 2.01-65.15) or those at the other three quarters (HR = 3.17, 95% CI: 1.38-7.26). However, the Q4 TSH level was not associated with other adverse cardiac events. CONCLUSION An association between TSH levels and the risk of VA events may exist in euthyroid NIDCM patients.
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Affiliation(s)
- Xiaofei Li
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoran Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyang Fan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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143
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Genome-wide analyses identify a role for SLC17A4 and AADAT in thyroid hormone regulation. Nat Commun 2018; 9:4455. [PMID: 30367059 PMCID: PMC6203810 DOI: 10.1038/s41467-018-06356-1] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
Thyroid dysfunction is an important public health problem, which affects 10% of the general population and increases the risk of cardiovascular morbidity and mortality. Many aspects of thyroid hormone regulation have only partly been elucidated, including its transport, metabolism, and genetic determinants. Here we report a large meta-analysis of genome-wide association studies for thyroid function and dysfunction, testing 8 million genetic variants in up to 72,167 individuals. One-hundred-and-nine independent genetic variants are associated with these traits. A genetic risk score, calculated to assess their combined effects on clinical end points, shows significant associations with increased risk of both overt (Graves’ disease) and subclinical thyroid disease, as well as clinical complications. By functional follow-up on selected signals, we identify a novel thyroid hormone transporter (SLC17A4) and a metabolizing enzyme (AADAT). Together, these results provide new knowledge about thyroid hormone physiology and disease, opening new possibilities for therapeutic targets. Thyroid dysfunction is a common public health problem and associated with cardiovascular co-morbidities. Here, the authors carry out genome-wide meta-analysis for thyroid hormone (TH) levels, hyper- and hypothyroidism and identify SLC17A4 as a TH transporter and AADAT as a TH metabolizing enzyme.
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144
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Wang B, Song R, He W, Yao Q, Li Q, Jia X, Zhang JA. Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults. Front Physiol 2018; 9:1397. [PMID: 30337885 PMCID: PMC6180185 DOI: 10.3389/fphys.2018.01397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
There is an intensive link between obesity and thyroid dysfunction, but this relationship in Asians is still unclear. This study was conducted to define the impact of obesity on risk of hypothyroidism and thyroid autoimmunity among Chinese adults. A population-based, cross-sectional study was carried out, which enrolled a total of 2,808 Chinese adults. To assess the associations of obesity with hypothyroidism and thyroid autoimmunity, odds ratio (ORs) with 95% confidence intervals (95%CIs) were calculated through logistic regression model, and the correlations of body mass index (BMI) with TPOAb and TGAb were also analyzed. Obese females had higher risk of hypothyroidism (22.7 vs. 15.0%; OR = 1.66, 95%CI 1.10–2.53; P = 0.02) and higher risk of subclinical hypothyroidism (22.1 vs. 13.4%; OR = 1.83, 95%CI 1.20–2.80; P = 0.005) than non-obese females. Multivariate logistic regression analysis found significant associations of obesity with hypothyroidism (Adjusted OR = 1.54, 95%CI 1.00–2.38; P = 0.05) and subclinical hypothyroidism (Adjusted OR = 1.69, 95%CI 1.09–2.63; P = 0.02) in females after adjustment for confounding factors. No association between obesity and hypothyroidism was observed in male participants. Spearman's correlation analysis suggested BMI was significantly and positively correlated with TPOAb (Spearman's r = 0.062, P = 0.022) in men but not in women. Linear regression analysis suggested an obviously positive correlation of BMI with TPOAb in men (β = 0.018, P = 0.015) and an obviously negative correlation of BMI with TGAb in women (β = −0.025, P = 0.012), respectively. The study suggests sex differences in the associations of obesity with hypothyroidism and thyroid autoimmunity among Chinese adults. Further studies are needed to better understand the exact mechanism of sex difference in the obesity-thyroid relationship.
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Affiliation(s)
- Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Ronghua Song
- Department of Endocrinology & Rheumatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Weiwei He
- Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qian Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xi Jia
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
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145
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Feller M, Snel M, Moutzouri E, Bauer DC, de Montmollin M, Aujesky D, Ford I, Gussekloo J, Kearney PM, Mooijaart S, Quinn T, Stott D, Westendorp R, Rodondi N, Dekkers OM. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA 2018; 320:1349-1359. [PMID: 30285179 PMCID: PMC6233842 DOI: 10.1001/jama.2018.13770] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The benefit of thyroid hormone therapy for subclinical hypothyroidism is uncertain. New evidence from recent large randomized clinical trials warrants an update of previous meta-analyses. OBJECTIVE To conduct a meta-analysis of the association of thyroid hormone therapy with quality of life and thyroid-related symptoms in adults with subclinical hypothyroidism. DATA SOURCES PubMed, EMBASE, ClinicalTrials.gov, Web of Science, Cochrane Library, CENTRAL, Emcare, and Academic Search Premier from inception until July 4, 2018. STUDY SELECTION Randomized clinical trials that compared thyroid hormone therapy with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism were eligible. Two reviewers independently evaluated eligibility based on titles and abstracts of all retrieved studies. Studies not excluded in this first step were independently assessed for inclusion after full-text evaluation by 2 reviewers. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, assessed risk of bias (Cochrane risk-of-bias tool), and evaluated the quality of evidence (GRADE tool). For synthesis, differences in clinical scores were transformed (eg, quality of life) into standardized mean differences (SMDs; positive values indicate benefit of thyroid hormone therapy; 0.2, 0.5, and 0.8 correspond to small, moderate, and large effects, respectively). Random-effects models for meta-analyses were applied. MAIN OUTCOMES AND MEASURES General quality of life and thyroid-related symptoms after a minimum follow-up of 3 months. RESULTS Overall, 21 of 3088 initially identified publications met the inclusion criteria, with 2192 adults randomized. After treatment (range, 3-18 months), thyroid hormone therapy was associated with lowering the mean thyrotropin value into the normal reference range compared with placebo (range, 0.5-3.7 mIU/L vs 4.6 to 14.7 mIU/L) but was not associated with benefit regarding general quality of life (n = 796; SMD, -0.11; 95% CI, -0.25 to 0.03; I2=66.7%) or thyroid-related symptoms (n = 858; SMD, 0.01; 95% CI, -0.12 to 0.14; I2=0.0%). Overall, risk of bias was low and the quality of evidence assessed with the GRADE tool was judged moderate to high. CONCLUSIONS AND RELEVANCE Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms. These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
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Affiliation(s)
- Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
| | - Marieke Snel
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | - Maria de Montmollin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Jacobijn Gussekloo
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Center, Leiden, the Netherlands
| | | | - Simon Mooijaart
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Institute for Evidence-based Medicine in Old Age, Leiden University Center, Leiden, the Netherlands
| | - Terry Quinn
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - David Stott
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - Rudi Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Olaf M. Dekkers
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Ravera S, Carrasco N, Gelernter J, Polimanti R. Phenomic Impact of Genetically-Determined Euthyroid Function and Molecular Differences between Thyroid Disorders. J Clin Med 2018; 7:E296. [PMID: 30248900 PMCID: PMC6210201 DOI: 10.3390/jcm7100296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The thyroid plays a key role in development and homeostasis, but it has been difficult to establish causality with diseases and phenotypic traits because of several potential confounders. METHODS To determine the causal effect of euthyroid function, we conducted a two-sample Mendelian randomization study of euthyroid thyrotropin (TSH) and free thyroxine (FT4) levels with respect to 2419 traits assessed in 337,199 individuals from UK Biobank. Additionally, we investigated the molecular differences between hypothyroidism and hyperthyroidism using genome-wide data. RESULTS After multiple testing correction, sixteen traits appear to be affected by genetically-determined euthyroid TSH, including multiple thyroid-related traits, e.g., hypothyroidism (p = 2.39 × 10-17), height (p = 2.76 × 10-10), body fat distribution (impedance of whole body, p = 4.43 × 10-8), pulse rate (p = 2.84 × 10-8), female infertility (p = 4.91 × 10-6), and hearing aid use (p = 7.10 × 10-5). Moreover, we found a consistent genetic correlation between hypothyroidism and hyperthyroidism (rg = 0.45, p = 5.45 × 10-6) with several immune pathways shared between these diseases. Two molecular pathways survived multiple testing correction for specificity to hyperthyroidism, JAK/STAT signaling (p = 1.02 × 10-6) and Rac guanyl-nucleotide exchange factor activity (p = 4.39 × 10-6). CONCLUSION Our data shed new light on the inter-individual variability of euthyroid function and the molecular mechanisms of the two thyroid disorders investigated.
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Affiliation(s)
- Silvia Ravera
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Nancy Carrasco
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
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147
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High-sensitivity cardiac troponin I and risk of incident atrial fibrillation hospitalisation in an Australian community-based cohort: The Busselton health study. Clin Biochem 2018; 58:20-25. [DOI: 10.1016/j.clinbiochem.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/17/2018] [Accepted: 05/06/2018] [Indexed: 01/13/2023]
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Lessons from Randomised Clinical Trials for Triiodothyronine Treatment of Hypothyroidism: Have They Achieved Their Objectives? J Thyroid Res 2018; 2018:3239197. [PMID: 30174821 PMCID: PMC6098896 DOI: 10.1155/2018/3239197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 12/28/2022] Open
Abstract
Randomised controlled trials are deemed to be the strongest class of evidence in evidence-based medicine. Failure of trials to prove superiority of T3/T4 combination therapy over standard LT4 monotherapy has greatly influenced guidelines, while not resolving the ongoing debate. Novel studies have recently produced more evidence from the examination of homeostatic equilibria in humans and experimental treatment protocols in animals. This has exacerbated a serious disagreement with evidence from the clinical trials. We contrasted the weight of statistical evidence against strong physiological counterarguments. Revisiting this controversy, we identify areas of improvement for trial design related to validation and sensitivity of QoL instruments, patient selection, statistical power, collider stratification bias, and response heterogeneity to treatment. Given the high individuality expressed by thyroid hormones, their interrelationships, and shifted comfort zones, the response to LT4 treatment produces a statistical amalgamation bias (Simpson's paradox), which has a key influence on interpretation. In addition to drug efficacy, as tested by RCTs, efficiency in clinical practice and safety profiles requires reevaluation. Accordingly, results from RCTs remain ambiguous and should therefore not prevail over physiologically based counterarguments. In giving more weight to other forms of valid evidence which contradict key assumptions of historic trials, current treatment options should remain open and rely on personalised biochemical treatment targets. Optimal treatment choices should be guided by strict requirements of organizations such as the FDA, demanding treatment effects to be estimated under actual conditions of use. Various improvements in design and analysis are recommended for future randomised controlled T3/T4 combination trials.
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149
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Morishima I, Okumura K, Morita Y, Kanzaki Y, Takagi K, Yoshida R, Nagai H, Ikai Y, Furui K, Yoshioka N, Tsuboi H, Murohara T. High-Normal Thyroid-Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation. J Am Heart Assoc 2018; 7:JAHA.118.009158. [PMID: 30005553 PMCID: PMC6064838 DOI: 10.1161/jaha.118.009158] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Hypothyroidism has been shown to contribute to enhanced atrial arrhythmogenesis, resulting in atrial fibrillation (AF) development in animal models and clinical populations. We aimed to elucidate whether high thyroid‐stimulating hormone (TSH) levels are related to outcomes of catheter ablation of AF. Methods and Results Of 477 consecutive patients who underwent first‐time pulmonary vein isolation–based radiofrequency catheter ablation of AF, 456 with TSH above the lower limit of the normal range (age, 65.5±9.9 years; men, 73.9%; paroxysmal AF, 56.8%) were analyzed for this study. Atrial tachyarrhythmia recurrence for 3 years was compared across groups with hypothyroidism (n=23) and TSH quartile groups with euthyroidism (normal‐range TSH levels, n=433). Atrial tachyarrhythmia recurrence occurred in 179 patients (39%) after the first session. Patients with hypothyroidism had increased recurrence compared with patients with normal TSH levels (crude hazard ratio, 3.14 after the last session; P=0.001). When focusing on patients with normal TSH levels, recurrence‐free survivals after both the first and last sessions were significantly reduced in euthyroid patients with the highest quartile of TSH levels (quartile 4) compared with others (quartiles 1–3). Cox regression analysis identified high TSH levels as an independent predictor of atrial tachyarrhythmia recurrence after both the first (adjusted hazard ratio, 1.51; P=0.018) and last (adjusted hazard ratio, 1.86; P=0.023) sessions. The difference was more pronounced in patients with paroxysmal AF than in those with nonparoxysmal AF. Conclusions Not only hypothyroidism but also high‐normal TSH levels may be an independent predictor of atrial tachyarrhythmia recurrence after catheter ablation of AF.
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Affiliation(s)
- Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kenji Okumura
- Department of Cardiology, Tohno Kosei Hospital, Mizunami, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ruka Yoshida
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshihiro Ikai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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150
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Lange T, Budde K, Homuth G, Kastenmüller G, Artati A, Krumsiek J, Völzke H, Adamski J, Petersmann A, Völker U, Nauck M, Friedrich N, Pietzner M. Comprehensive Metabolic Profiling Reveals a Lipid-Rich Fingerprint of Free Thyroxine Far Beyond Classic Parameters. J Clin Endocrinol Metab 2018; 103:2050-2060. [PMID: 29546278 DOI: 10.1210/jc.2018-00183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/07/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Thyroid hormones are ubiquitously involved in human metabolism. However, the precise molecular patterns associated with alterations in thyroid hormones levels remain to be explored in detail. A number of recent studies took great advantage of metabolomics profiling to outline the metabolic actions of thyroid hormones in humans. METHODS Among 952 participants in the Study of Health in Pomerania, data on serum free thyroxine (FT4) and thyrotropin and comprehensive nontargeted metabolomics data from plasma and urine samples were available. Linear regression analyses were performed to assess the association between FT4 or thyrotropin and metabolite levels. RESULTS AND CONCLUSION After accounting for major confounders, 106 of 613 plasma metabolites were significantly associated with FT4. The associations in urine were minor (12 of 587). Most of the plasma metabolites consisted of lipid species, and subsequent analysis of highly resolved lipoprotein subclasses measured by proton nuclear magnetic resonance spectroscopy revealed a consistent decrease in several of these species (e.g., phospholipids) and large low-density lipoprotein and small high-density lipoprotein particles. The latter was unique to men. Several polyunsaturated and saturated fatty acids displayed an association with FT4 in women only. A random forest-based variable selection approach using phenotypic characteristics revealed higher alcohol intake in men and an adverse thyroid state and menopause in women as the putative mediating factors. In general, our observations have confirmed the lipolytic and lipogenic effect of thyroid hormones even in the physiological range and revealed different phenotypic characteristics (e.g., lifestyle differences) as possible confounders for sex-specific findings.
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Affiliation(s)
- Thomas Lange
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst-Moritz Arndt-University Greifswald, Greifswald, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anna Artati
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Krumsiek
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Diabetes Research, Partner Site Greifswald, Greifswald, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, München-Neuherberg, Germany
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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