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Rizos EC, Tagkas CF, Asimakopoulos AGI, Tsimihodimos V, Anastasiou G, Rizzo M, Agouridis AP, Ntzani EE. The effect of SGLT2 inhibitors and GLP1 receptor agonists on arterial stiffness: A meta-analysis of randomized controlled trials. J Diabetes Complications 2024; 38:108781. [PMID: 38833853 DOI: 10.1016/j.jdiacomp.2024.108781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/18/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Pulse wave velocity (PWV) and augmentation index (AIx) are indices used to assess arterial stiffness. We evaluated the effect of sodium glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) on arterial stiffness indices. METHODS We searched PubMed (up to January 2024) for RCTs assessing the effect of SGLT2i or GLP1-RA on arterial stiffness with reporting outcomes PWV and AIx. Effect sizes of the included studies were expressed as weighted mean difference (WMD) and 95 % confidence interval. Subgroup analyses were performed based on comparator (placebo vs. active comparator), design (RCT vs. crossover), population (diabetic vs. all) and blindness (yes vs. no). RESULTS A total of 19 studies (SGLT2i, 12 studies; GLP1-RA, 5 studies; SGLT2i/GLP1-RA combination, 2 studies) assessing 1212 participants were included. We did not find any statistically significant association between GLP1-RA or SGLT2i and PWV or AIx. None of the subgroup analyses showed any statistically significant result. CONCLUSION No evidence of a favorable change in arterial stiffness indices (PWV, AIx) was found following the administration of SGLT2i or GLP1-RA.
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Affiliation(s)
- Evangelos C Rizos
- School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Christos F Tagkas
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | | | - Georgia Anastasiou
- Department of Internal Medicine, University hospital of Ioannina, Ioannina, Greece
| | - Manfredi Rizzo
- School of Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Palermo, Italy; College of Medicine, Mohammed Bin Rashid University (MBRU), Dubai, United Arab Emirates
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia, Cyprus; Department of Internal Medicine, German Oncology Center, Limassol, Cyprus
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
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Neggazi S, Hamlat N, Berdja S, Boumaza S, Smail L, Beylot M, Aouichat-Bouguerra S. Hypothyroidism increases angiotensinogen gene expression associated with vascular smooth muscle cells cholesterol metabolism dysfunction and aorta remodeling in Psammomys obesus. Sci Rep 2023; 13:19681. [PMID: 37951959 PMCID: PMC10640574 DOI: 10.1038/s41598-023-46899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
It has been previously shown that clinical cardiovascular manifestations can be caused by mild changes in thyroid function. However, the implication of angiotensinogen (Agt) and vascular smooth muscle cells (VSMCs) dysfunction in the pathophysiology of cardiovascular manifestations in hypothyroidism have not yet been investigated. We induced experimental hypothyroidism in Psammomys obesus by administering carbimazole for five months. At the end of the experiment, the animals were sacrificed and histopathological analysis was performed using Masson's trichrome staining of the aorta and thyroid gland. The expression of the Agt gene and the genes implicated in cholesterol metabolism regulation in the liver and VSMCs was determined by qRT-PCR. Histological observations revealed profound remodeling of the aorta structure in animals with hypothyroidism. In addition, Agt gene expression in the liver was significantly increased. In vitro study, showed that VSMCs from hypothyroid animals overexpressed 3-hydroxy-3-methylglutaryl coenzyme A reductase (Hmgcr) and Acyl CoA:cholesterol acyltransferase (Acat) 1, with failure to increase the efflux pathway genes (ATP-binding cassette subfamily G member (Abcg) 1 and 4). These results suggest that hypothyroidism leads to vascular alterations, including structural remodeling, VSMCs cholesterol metabolism dysfunction, and their switch to a synthetic phenotype, together with hepatic Agt gene overexpression.
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Affiliation(s)
- Samia Neggazi
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria.
| | - Nadjiba Hamlat
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria
| | - Sihem Berdja
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria
| | - Saliha Boumaza
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria
| | - Leila Smail
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria
| | - Michel Beylot
- Platform ANIPHY, Faculty of Medicine and Pharmacy, Rockefeller, University Claude Bernard Lyon 1, Lyon, France
| | - Souhila Aouichat-Bouguerra
- Faculty of Biological Sciences, Laboratory of Biology and Physiology of Organisms, Cellular and Molecular Physiopathology team, University of Science and Technology Houari Boumediene, BP 32 El Alia, 16111, Bab Ezzouar, Algiers, Algeria
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Teng Z, Feng J, Lv P. Subclinical Hypothyroidism is Associated with Cognitive Impairment in Patients with Cerebral Small Vessel Disease. Neuropsychiatr Dis Treat 2023; 19:303-310. [PMID: 36761397 PMCID: PMC9904226 DOI: 10.2147/ndt.s401020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the association between subclinical hypothyroidism (SCH) and cognitive function in patients with cerebral small vessel disease (CSVD). METHODS We evaluated 528 patients with CSVD in this retrospective study. SCH was defined as elevated levels of thyroid stimulating hormone with normal concentrations of free thyroxine. Magnetic resonance imaging was performed to assess the total CSVD burden score and the Montreal Cognitive Assessment was used to measure the cognitive function. Participants were grouped based on cognitive function or total CSVD burden score. Multivariate logistic regression and mediation analysis models were used to estimate the association of SCH with cognitive function and CSVD burden. RESULTS SCH was an independent risk factor for cognitive impairment in patients with CSVD after adjustment for potential confounding factors (OR: 1.939; 95% CI: 1.170 to 3.213; P=0.010). Additionally, SCH was independently associated with severe CSVD burden after adjustment for potential confounding factors (OR: 1.668; 95% CI: 1.085 to 2.564; P=0.020). Mediation analysis found a significant moderating effect (P=0.021) of the severe CSVD burden on the relation between SCH and cognitive impairment after adjustment for potential confounding factors. A 30.1% of the total effect between this relation was attributable to the presence of severe CSVD burden. CONCLUSION SCH was associated with an increased risk of cognitive impairment in patients with CSVD. The mediating role of severe CSVD burden suggests that SCH may lead to cognitive impairment through the presence of severe CSVD burden. These findings may suggest strategies for screening for SCH in the context of cognitive impairment in patients with severe CSVD.
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Affiliation(s)
- Zhenjie Teng
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
| | - Jing Feng
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Peiyuan Lv
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
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Rodríguez-Vargas GS, Santos-Moreno P, Rubio-Rubio JA, Bautista-Niño PK, Echeverri D, Gutiérrez-Castañeda LD, Sierra-Matamoros F, Navarrete S, Aparicio A, Saenz L, Rojas-Villarraga A. Vascular Age, Metabolic Panel, Cardiovascular Risk and Inflammaging in Patients With Rheumatoid Arthritis Compared With Patients With Osteoarthritis. Front Cardiovasc Med 2022; 9:894577. [PMID: 35865390 PMCID: PMC9295407 DOI: 10.3389/fcvm.2022.894577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/08/2022] [Indexed: 12/14/2022] Open
Abstract
IntroductionThe risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.Materials and MethodsThis was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.ResultsA total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p < 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.ConclusionsWhen comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.
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Affiliation(s)
- Gabriel-Santiago Rodríguez-Vargas
- Research Institute, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
- Rheumatology, Biomab - Center for Rheumatoid Arthritis, Bogotá, Colombia
- *Correspondence: Gabriel-Santiago Rodríguez-Vargas
| | | | | | | | - Darío Echeverri
- Cardiovascular Prevention Program, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Luz-Dary Gutiérrez-Castañeda
- Research Institute, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
- Basic Sciences Laboratory, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | | | - Stephania Navarrete
- Basic Sciences Laboratory, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | - Anggie Aparicio
- Basic Sciences Laboratory, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | - Luis Saenz
- Cardiovascular Prevention Program, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
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Arterial Stiffness in Thyroid and Parathyroid Disease: A Review of Clinical Studies. J Clin Med 2022; 11:jcm11113146. [PMID: 35683533 PMCID: PMC9180991 DOI: 10.3390/jcm11113146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Growing evidence shows that arterial stiffness measurement provides important prognostic information and improves clinical stratification of cardiovascular risk. Thyroid and parathyroid diseases are endocrine diseases with a relevant cardiovascular burden. The objective of this review was to consider the relationship between arterial stiffness and thyroid and parathyroid diseases in human clinical studies. We performed a systematic literature review of articles published in PubMed/MEDLINE from inception to December 2021, restricted to English languages and to human adults. We selected relevant articles about the relationship between arterial stiffness and thyroid and parathyroid diseases. For each selected article, data on arterial stiffness were extracted and factors that may have an impact on arterial stiffness were identified. We considered 24 papers concerning hypothyroidism, 9 hyperthyroidism and 16 primary hyperparathyroidism and hypoparathyroidism. Most studies evidenced an increase in arterial stiffness biomarkers in hypothyroidism, hyperthyroidism and primary hyperparathyroidism, even in subclinical and mild forms, although heterogeneity of measurement methods and of study designs prevented a definitive conclusion, suggesting that the assessment of arterial stiffness may be considered in the clinical evaluation of cardiovascular risk in these diseases.
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Garcia-Guimaraes M, Masotti M, Sanz-Ruiz R, Macaya F, Roura G, Nogales JM, Tizón-Marcos H, Velázquez-Martin M, Veiga G, Flores-Ríos X, Abdul-Jawad Altisent O, Jimenez-Kockar M, Camacho-Freire S, Moreu J, Ojeda S, Santos-Martinez S, Sanz-Garcia A, Del Val D, Bastante T, Alfonso F. Clinical outcomes in spontaneous coronary artery dissection. Heart 2022; 108:1530-1538. [PMID: 35410894 DOI: 10.1136/heartjnl-2022-320830] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. METHODS The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. RESULTS After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47-60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17-38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. CONCLUSIONS In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. TRIAL REGISTRATION NUMBER NCT03607981.
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Affiliation(s)
- Marcos Garcia-Guimaraes
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Monica Masotti
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Maite Velázquez-Martin
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Xacobe Flores-Ríos
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Omar Abdul-Jawad Altisent
- Department of Cardiology, Hospital Clínic, Barcelona, Spain.,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Jose Moreu
- Department of Cardiology, Hospital General Universitario de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-Garcia
- Data Analysis Unit, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain .,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
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Businge CB, Longo-Mbenza B, Kengne AP. Mildly elevated thyroid-stimulating hormone is associated with endothelial dysfunction and severe preeclampsia among pregnant women with insufficient iodine intake in Eastern Cape province, South Africa. Ann Med 2021; 53:1083-1089. [PMID: 34210226 PMCID: PMC8253179 DOI: 10.1080/07853890.2021.1947520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Preeclampsia and hypothyroidism are associated with endothelial dysfunction. Iodine deficiency is a risk factor for subclinical hypothyroidism in pregnancy. However, there is a paucity of data on the relationship between iodine nutrition state in pregnancy, the degree of endothelial dysfunction, and the risk of preeclampsia. METHODS Ninety-five normotensive pregnant women, 50 women with preeclampsia with no severe features, and 50 women with severe preeclampsia were enrolled into the current study from the maternity units of Nelson Mandela Academic Hospital and Mthatha Regional Hospitals in Eastern Cape Province, South Africa. Urinary iodine concentration (UIC), serum markers of thyroid function, aortic augmentation index, and pulse wave velocity (PWV) were compared. RESULTS Median UIC was 167.5, 127.7, and 88.5 µg/L, respectively for normotensive pregnant women, those with preeclampsia and severe preeclampsia (p = .150). Participants with severe preeclampsia had significantly higher median thyroid-stimulating hormone (TSH) and oxidized LDL than normotensive and preeclamptic women without severe features (respectively 3.0, 2.3, and 2.3 IU/L; 1.2, 1.0, and 1.0 IU/L, p < .05). The median Aortic augmentation index was 7.5, 19.0, and 21.0 (p < .001), and the pulse wave velocity 5.1, 5.7, and 6.3, respectively for normotensive, preeclampsia, and severe preeclampsia participants (both p < .001). In linear regressions, TSH, age, and hypertensive disease were independent predictors of elevated PWV. CONCLUSION Upper normal-range TSH levels in women with severe preeclampsia were associated with markers of endothelial dysfunction. The low UIC and trend towards the elevation of thyroglobulin suggest that inadequate iodine intake may have increased TSH levels and indirectly caused endothelial dysfunction.
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Affiliation(s)
- Charles Bitamazire Businge
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Benjamin Longo-Mbenza
- Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- LOMO University of Research, Kinshasa, Democratic Republic of Congo
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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8
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Carotid Beta Stiffness Association with Thyroid Function. J Clin Med 2021; 10:jcm10030420. [PMID: 33499200 PMCID: PMC7865481 DOI: 10.3390/jcm10030420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Thyroid hormone modulation of cardiovascular function has been associated with cardiovascular disease. Recent evidence suggests that free thyroxine (FT4) levels are associated with an increase in systemic arterial stiffness, but little is known about the effects of FT4 at the local level of the common carotid artery. β-stiffness index is a local elastic parameter usually determined by carotid ultrasound imaging. Methods: We conducted a cross-sectional analysis in the ProgeNIA cohort, including 4846 subjects across a broad age range. For the purpose of this study, we excluded subjects with increased thyrotropin (TSH) levels and those treated with levothyroxine or thyrostatic. We assessed β stiffness, strain, wall–lumen ratio, carotid cross-sectional area (CSA), and stress and flow in the right common carotid artery. We tested whether FT4, heart rate, and their interactions were associated with carotid parameters. Results: FT4 was positively and independently associated with β stiffness index (β = 0.026, p = 0.041), and had a negative association with strain (β = −0.025, p = 0.009). After adding heart rate and the interaction between FT4 and heart rate to the model, FT4 was still associated with the β stiffness index (β = 0.186, p = 0.06), heart rate was positively associated with the stiffness index (β = 0.389, p < 0.001) as well as their interaction (β = 0.271, p = 0.007). Conclusion: This study suggests that higher FT4 levels increase arterial stiffness at the common carotid level, consistent with a detrimental effect on elastic arteries. The effect of FT4 is likely to be primarily attributable to its effect on heart rate.
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Stoica RA, Diaconu CC, Rizzo M, Toth PP, Stefan SD, Serafinceanu C, Nikolic D, Poiana C, Ionescu-Tirgoviste C, Pantea-Stoian A. Weight loss programmes using low carbohydrate diets to control the cardiovascular risk in adolescents (Review). Exp Ther Med 2021; 21:90. [PMID: 33363601 PMCID: PMC7725014 DOI: 10.3892/etm.2020.9522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular risk (CVR) is a broad term that includes traditional factors like hypertension, hyper lipidemia, abdominal obesity, hyperinsulinemia or overt type 2 diabetes mellitus (T2DM), and emerging ones such as hypothyroidism or inflammatory diseases. In epidemiologic studies, all of these factors are associated with atherogenesis and have complex interactions between them. They have in common an increased prevalence in the general population beginning in childhood, and are correlated with endothelial damage as demonstrated by echocardiographic modifications of the left ventricle or carotid intima-media thickness. Adolescence is a transition period where behavioural eating patterns develop and have a major impact on cardiovascular risk. To address these patterns, weight-loss programmes under medical supervision for overweight and obese adolescents are developed. It was observed that those who control the quality and quantity of their carbohydrates, by consuming more fruits and vegetables, associated with increased physical activity reduce their CVR. Some limited studies have shown that low carbohydrate diet (LCD) is safe and effective, but one should take into consideration the limited duration and the structure of the LCD. If there is a proper adherence to this type of nutritional intervention, it results in weight loss, improvement in insulin resistance, lipid profile and subclinical hypothyroidism reversal. We reviewed the literature starting from 2009 by searching all the observational, randomised clinical trials and meta-analyses on MEDLINE and SCOPUS databases regarding obesity and related metabolic diseases (dyslipidemia, type 2 diabetes, hypertension, hypothyroidism, LCD) in adolescents and synthesized the nutritional interventions for this population that could decrease CVR.
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Affiliation(s)
- Roxana Adriana Stoica
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Carol Davila’ University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 014461 Bucharest, Romania
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialities, University of Palermo, I-90139 Palermo, Italy
- Division of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, Charleston, SC 29425, Romania
| | - Peter P. Toth
- Ciccarone' Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196, USA
| | - Simona Diana Stefan
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Carol Davila’ University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Cristian Serafinceanu
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Carol Davila’ University of Medicine and Pharmacy, 020475 Bucharest, Romania
| | - Dragana Nikolic
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, I-90127 Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), I-90139 Palermo, Italy
| | - Catalina Poiana
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 011863 Bucharest, Romania
| | - Constantin Ionescu-Tirgoviste
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Carol Davila’ University of Medicine and Pharmacy, 020475 Bucharest, Romania
- Department of Medical Sciences, Romanian Academy, 050711 Bucharest, Romania
| | - Anca Pantea-Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, ‘Carol Davila’ University of Medicine and Pharmacy, 020475 Bucharest, Romania
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Kwon H, Park B. Borderline-High Mean Corpuscular Volume Levels Are Associated with Arterial Stiffness among the Apparently Healthy Korean Individuals. Korean J Fam Med 2020; 41:387-391. [PMID: 31955550 PMCID: PMC7700835 DOI: 10.4082/kjfm.19.0061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/04/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND High mean corpuscular volume (MCV) has been implicated in various health problems, such as anemia, liver disease, and thyroid disease. However, the clinical significance of borderline-high MCV is poorly understood in the primary care setting. This study aimed to investigate whether borderline-high MCV was related to arterial stiffness in Korean adults as measured by brachial-ankle pulse wave velocity (baPWV). METHODS This cross-sectional study comprised 582 participants aged >30 years who underwent routine health examinations. Borderline-high MCV was defined as over 95.0 fl (>90th percentile) after excluding participants with MCV of ≥100 fl or ≤80 fl, and high baPWV was defined as >1,600 cm/s (>90th percentile). The odds ratios (ORs) and 95% confidence intervals (CIs) for high baPWV according to borderline-high MCV were calculated using multiple logistic regression analyses after adjusting for the confounding variables. RESULTS The mean age of the study population was 47.8±11.7 years, and 56.9% of the participants were male. Compared to that in the control group, the OR (95% CI) of high baPWV in those with a borderline-high MCV was 3.68 (1.39-9.74) after adjusting for age, sex, body mass index, alcohol intake, smoking status, regular exercise, mean blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein cholesterol, C-reactive protein, γ-glutamyltransferase, uric acid, hypertension medication, and diabetes medication. CONCLUSION Borderline-high MCV was independently associated with arterial stiffness among apparently healthy Korean individuals.
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Affiliation(s)
- Haneul Kwon
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
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11
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Mousa S, Hemeda A, Ghorab H, Abdelhamid A, Saif A. ARTERIAL WALL STIFFNESS AND THE RISK OF ATHEROSCLEROSIS IN EGYPTIAN PATIENTS WITH OVERT AND SUBCLINICAL HYPOTHYROIDISM. Endocr Pract 2019; 26:161-166. [PMID: 31557076 DOI: 10.4158/ep-2019-0322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Hypothyroidism is associated with an increased risk of atherosclerosis. Pulse wave velocity (PWV) is an index of arterial wall stiffness widely used for noninvasive assessment of early atherosclerosis. We assessed PWV in Egyptian patients with hypothyroidism. Methods: The study included 100 Egyptian females aged 18 to 55 years. They were classified into three groups: group I, 40 women with overt hypothyroidism; group II, 40 women with subclinical hypothyroidism; and group III, 20 euthyroid women as a control group. The three groups were age matched. Doppler ultrasonography was used to calculate the heart-femoral PWV. Results: PWV was significantly higher in women with overt and subclinical hypothyroidism as compared with the control group (9.55 ± 1.81 m/s and 9.30 ± 1.28 m/s, respectively vs. 7.82 ± 2.14 m/s; P<.001 and <.01, respectively). There was a positive correlation between thyroid-stimulating hormone (TSH) and PWV in women with overt hypothyroidism and in those with subclinical hypothyroidism (P<.05 for both). Multivariate regression analysis showed that age and diastolic blood pressure were independent determinants of PWV in women with overt and subclinical hypothyroidism (P<.01 for all). TSH was also an independent determinant of PWV in both groups (P<.05 for both). Conclusion: PWV is significantly higher in Egyptian women with overt and subclinical hypothyroidism as compared with normal control subjects. This denotes early increase in arterial wall stiffness in patients with hypothyroidism, even in the subclinical phase. The positive correlation between PWV and TSH in both groups of patients suggests that the risk of atherosclerosis is proportionate to the severity of hypothyroidism. Abbreviations: ABI = ankle/brachial index; baPWV = brachial-ankle pulse wave velocity; BP = blood pressure; CIMT = carotid intima-media thickness; ECG = electrocardiogram; FT4 = free thyroxine; HDL = high-density lipoprotein; hfPWV = heart-femoral pulse wave velocity; LDL = low-density lipoprotein; PTT = pulse transit time; PWV = pulse wave velocity; SCH = subclinical hypothyroidism; TSH = thyroid-stimulating hormone.
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12
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Aydoğan Y, Altay M, Ünsal O, Kaplanoğlu V, Çağır Y, Yıldız C, Beyan E, Ramadan SU. An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter. Endocrine 2018; 62:440-447. [PMID: 30084100 DOI: 10.1007/s12020-018-1701-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Publications suggesting that thyroid nodule might be associated with insulin resistance and metabolic syndrome are quite interesting. There is a need for studies assessing the relationship between nodule presence and cardiovascular risk in individuals with non-functioning nodular goiter. The purpose of the present study is to reveal whether or not insulin resistance, nodule presence, and nodule stiffness affect arterial stiffness, which is a reliable and valid cardiovascular risk indicator, in individuals with euthyroid nodular goiter using the pulse wave analysis (PWA). MATERIALS AND METHODS 50 patients with euthyroid nodular goiter and 50 healthy volunteers were included in the study. All participants were examined by B-mode thyroid ultrasound, and the participants in the nodular goiter group were also examined by strain elastography (SE). The strain index of nodules was calculated according to the Rago scoring. Also, fasting plasma glucose (FPG) and insulin levels were measured, and HOMA-IR. Arterial stiffness measurements of the participants were performed using a PWA device which employs a cuff-based oscillometric method from the brachial artery. RESULTS PWV was found to be significantly higher in the euthyroid nodular goiter group (p < 0.001). PWV was found to be positively correlated with FPG and waist circumference. Fasting plasma glucose was found to be higher in the group with nodular goiter (p = 0.03). However, no difference was found between the groups in terms of HOMA-IR and insulin level. HOMA-IR was not correlated with thyroid volume, nodule volume, and nodule count. Also, HOMA-IR was not correlated with strain index value and PWA data. CONCLUSION We found that PWV was significantly higher in patients with euthyroid nodular goiter. This result suggests that these patients may be at risk for cardiovascular disease.
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Affiliation(s)
| | - Mustafa Altay
- Department of Endocrinology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Oktay Ünsal
- Department of Nefrology, Uludağ University Medical Faculty Hospital, Bursa, Turkey
| | - Veysel Kaplanoğlu
- Department of Radiology, Keçiören Training ad Research Hospital, Ankara, Turkey
| | - Yavuz Çağır
- Çankırı Çerkeş State Hospital, Çankırı, Turkey
| | - Canan Yıldız
- Aydın Didim State Hospital, Aydın, Didim, Turkey
| | - Esin Beyan
- Department of Internal Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Selma Uysal Ramadan
- Deparment of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
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13
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Seara FAC, Maciel L, Barbosa RAQ, Rodrigues NC, Silveira ALB, Marassi MP, Carvalho AB, Nascimento JHM, Olivares EL. Cardiac ischemia/reperfusion injury is inversely affected by thyroid hormones excess or deficiency in male Wistar rats. PLoS One 2018; 13:e0190355. [PMID: 29304184 PMCID: PMC5755761 DOI: 10.1371/journal.pone.0190355] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022] Open
Abstract
AIM Thyroid dysfunctions can increase the risk of myocardial ischemia and infarction. However, the repercussions on cardiac ischemia/reperfusion (IR) injury remain unclear so far. We report here the effects of hypothyroidism and thyrotoxicosis in the susceptibility to IR injury in isolated rat hearts compared to euthyroid condition and the potential role of antioxidant enzymes. METHODS Hypothyroidism and thyrotoxicosis were induced by administration of methimazole (MMZ, 300 mg/L) and thyroxine (T4, 12 mg/L), respectively in drinking water for 35 days. Isolated hearts were submitted to IR and evaluated for mechanical dysfunctions and infarct size. Superoxide dismutase types 1 and 2 (SOD1 and SOD2), glutathione peroxidase types 1 and 3 (GPX 1 and GPX3) and catalase mRNA levels were assessed by quantitative RT-PCR to investigate the potential role of antioxidant enzymes. RESULTS Thyrotoxicosis elicited cardiac hypertrophy and increased baseline mechanical performance, including increased left ventricle (LV) systolic pressure, LV developed pressure and derivatives of pressure (dP/dt), whereas in hypothyroid hearts exhibited decreased dP/dt. Post-ischemic recovery of LV end-diastolic pressure (LVEDP), LVDP and dP/dt was impaired in thyrotoxic rat hearts, whereas hypothyroid hearts exhibited improved LVEDP and decreased infarct size. Catalase expression was decreased by thyrotoxicosis. CONCLUSION Thyrotoxicosis was correlated, at least in part, to cardiac remodeling and increased susceptibility to IR injury possibly due to down-regulation of antioxidant enzymes, whereas hypothyroid hearts were less vulnerable to IR injury.
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Affiliation(s)
- Fernando A. C. Seara
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
- Laboratory of Cardiac Electrophysiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro–Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Maciel
- Laboratory of Cardiac Electrophysiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro–Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raiana A. Q. Barbosa
- Laboratory of Cellular and Molecular Cardiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro–Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nayana C. Rodrigues
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
| | - Anderson L. B. Silveira
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
- Laboratory of Physiology and Human Performance, Department of Physical Education and Sports, Institute of Education, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
| | - Michelle P. Marassi
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
| | - Adriana B. Carvalho
- Laboratory of Cellular and Molecular Cardiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro–Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Hamilton M. Nascimento
- Laboratory of Cardiac Electrophysiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro–Rio de Janeiro, Rio de Janeiro, Brazil
| | - Emerson L. Olivares
- Laboratory of Cardiovascular Physiology and Pharmacology, Department of Physiological Sciences, Institute of Biology, Federal Rural University of Rio de Janeiro, Seropedica–RJ, Brazil
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Hashemi MM, Kosari E, Mansourian AR, Marjani A. Serum levels of nitrite/nitrate, lipid profile, and Fasting Plasma Glucose and their associations in subclinical hypothyroid women before and after a two month treatment by levothyroxine. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2017; 55:205-211. [PMID: 28590917 DOI: 10.1515/rjim-2017-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Subclinical hypothyroidism (sHT) is a condition defined by elevated TSH values with normal levels of free thyroid hormones. Altered metabolic status is one of the consequences of sHT which can affect serum levels of FPG, lipid profile, and nitric oxide which propounds cardiovascular consequences per se. The aim of this study was to determine the possible effects of sHT on nitrite/nitrate levels, as a marker of endothelial performance. MATERIALS AND METHODS 50 females were enrolled in this study, 25 women as control group and 25 women as case group (evaluated two times: before and after levothyroxine therapy). Blood samples were collected and levels of FPG, lipid profile components, and nitric oxide were measured spectrophotometrically. The data were analyzed using SPSS version 18 software. RESULTS The levels of lipid profile (except for TG between before and after group, p < 0.05) and nitric oxide did not differ in groups while FPG was significantly higher in case groups in comparison to control group (p < 0.001). Nitric oxide had no correlations with any of variables except for LDL in after treatment group (p < 0.05 and r = 0.397). CONCLUSION Nitric oxide does not have correlation with components of lipid profile (except for LDL) or FPG and has no differences in subclinical hypothyroid patients and control group. Levothyroxine therapy during 2 months cannot alter the levels of nitric oxide in subclinical hypothyroid patients.
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15
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Zhang X, Xie Y, Ding C, Xiao J, Tang Y, Jiang X, Shan H, Lin Y, Zhu Y, Li C, Hu D, Ling Z, Xu G, Sheng L. Subclinical hypothyroidism and risk of cerebral small vessel disease: A hospital-based observational study. Clin Endocrinol (Oxf) 2017; 87:581-586. [PMID: 28543314 DOI: 10.1111/cen.13383] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/02/2017] [Accepted: 05/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subclinical hypothyroidism (SCH) has been associated with atherosclerosis and increased risk of ischaemic stroke. However, whether SCH is associated with cerebral small vessel disease (cSVD) remains largely unexplored. This study aimed to investigate the relationship between SCH and total cSVD burden, a composite measurement detected with magnetic resonance imaging (MRI), in patients with minor ischaemic stroke or transient ischaemic attack (TIA). DESIGN This was a prospective observational cohort study conducted in a tertiary referral hospital. METHODS Subclinical hypothyroidism (SCH) was defined as with mildly or moderately increased thyroid-stimulating hormone levels (TSH, 4.5-10.0 mIU/L), but with normal free thyroxine levels. Brain MRI presence of silent lacunar infarcts (LIs), white matter lesions (WMLs), cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVs) were summed to a validated scales ranging from 0 to 4 to represent the load of cSVD. The associations between SCH and cSVD were analysed by logistic regression analyses. RESULTS Subclinical hypothyroidism (SCH) was identified in 43 of 229 (18.8%) patients with minor stroke or TIA. Compared with patients without SCH, those with SCH had higher risks of WMLs, CMBs and total cSVD burden. Adjustment of potential confounders did not change these associations. CONCLUSIONS These findings showed that SCH might be associated with the presence of WMLs, CMBs, as well as cSVD burden in patients with minor stroke or TIA.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Caixia Ding
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jing Xiao
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yinyan Tang
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xuemei Jiang
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Hua Shan
- Department of Radiology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yuankai Lin
- Department of Radiology, Hainan General Hospital, Haikou, Hainan, China
| | - Yujia Zhu
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Chuanyou Li
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Dan Hu
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhixiang Ling
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Lei Sheng
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Smolensky MH, Hermida RC, Portaluppi F. Circadian mechanisms of 24-hour blood pressure regulation and patterning. Sleep Med Rev 2017; 33:4-16. [DOI: 10.1016/j.smrv.2016.02.003] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/18/2016] [Indexed: 11/16/2022]
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17
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Ziganshin BA, Elefteriades JA. Guilt by association: a paradigm for detection of silent aortic disease. Ann Cardiothorac Surg 2016; 5:174-87. [PMID: 27386404 DOI: 10.21037/acs.2016.05.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA.
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Affiliation(s)
- Bulat A Ziganshin
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
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18
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Park BH, Baik SJ, Lee HA, Hong YS, Kim HS, Park H. The association of thyroid hormones and blood pressure in euthyroid preadolescents. J Pediatr Endocrinol Metab 2016; 29:459-64. [PMID: 26812772 DOI: 10.1515/jpem-2015-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 11/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypertension is the leading cause of cardiovascular disease worldwide, and both high and low blood pressures are associated with various chronic diseases. Thyroid hormones have profound effects on cardiovascular function, including on blood pressure. Recent studies have shown that childhood hypertension can lead to adult hypertension. Therefore, adequate blood pressure control is important from early life. Employing a life-course approach, we aimed to investigate the association between thyroid hormones and blood pressure in children. METHODS A total of 290 children from the Ewha Woman's University Hospital birth cohort participated in a preadolescent check-up program. We assessed the levels of serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) and the blood pressure status in these children. Thyroid hormone concentrations were measured using an electro-chemiluminescence immunoassay (ECLIA), and hypertension was defined according to the guideline of the Korea Centers for Disease Control and Prevention. RESULTS The sex-, age-, and height-adjusted prevalence of hypertension was 27.0% in the present study. On regression analysis, serum FT4 showed significantly negative association with diastolic blood pressure (DBP; β=-8.24, 95% CI: -14.19-2.28, p=0.007). However, these relationships were not significant after adjustment for sex, age, and current body mass index. The levels of serum TSH showed no relationship with mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) after adjustment. No significant differences in serum TSH and FT4 levels according to hypertension status were found. CONCLUSIONS These findings suggest that thyroid hormone is not independently associated with increased blood pressure in euthyroid preadolescents.
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Delitala AP, Orrù M, Filigheddu F, Pilia MG, Delitala G, Ganau A, Saba PS, Decandia F, Scuteri A, Marongiu M, Lakatta EG, Strait J, Cucca F. Serum free thyroxine levels are positively associated with arterial stiffness in the SardiNIA study. Clin Endocrinol (Oxf) 2015; 82:592-7. [PMID: 24954304 PMCID: PMC4275408 DOI: 10.1111/cen.12532] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/21/2014] [Accepted: 06/17/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Thyroid dysfunction may accelerate atherosclerosis. Aortic pulse wave velocity (PWV) is an early index of arterial stiffness and an important risk factor for cardiovascular disease and might therefore be linked to changes in thyroid activity. We investigated the relationship between thyroid function and carotid-femoral PWV, as an index of arterial stiffness. DESIGN Cross-sectional cohort study. PATIENTS Participants from the SardiNIA study. Those being treated for thyroid diseases were excluded, yielding a sample of 5875 aged 14-102. MEASUREMENTS Clinical parameters, blood tests including serum TSH and serum FT4, and carotid-femoral PWV were measured. RESULTS After adjusting for confounders, a direct and linear association between FT4 and PWV was shown (multiple regression analysis). The model containing age, mean blood pressure, body mass index, heart rate, FT4, hypertension, diabetes and dyslipidaemia accounted for 55% of the variation in PWV. CONCLUSIONS Like several other known risk factors, serum FT4 levels are associated with carotid-femoral PWV, suggesting that high FT4 levels have a detrimental effect on aortic stiffness and may contribute to ageing process of the vascular system. This finding may help to understand the pathogenesis of cardiovascular disease and contribute to improve prevention therapy.
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Affiliation(s)
- Alessandro P. Delitala
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Marco Orrù
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Cagliari, Italy
| | - Fabiana Filigheddu
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Maria Grazia Pilia
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Cagliari, Italy
| | - Giuseppe Delitala
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Antonello Ganau
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Pier Sergio Saba
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Federica Decandia
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Angelo Scuteri
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Cagliari, Italy
| | - Michele Marongiu
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Cagliari, Italy
| | - Edward G. Lakatta
- Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute of Aging, Baltimore, MD, USA
| | - James Strait
- Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute of Aging, Baltimore, MD, USA
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche, c/o Cittadella Universitaria di Monserrato, Cagliari, Italy
- Department of Biochemical Science, Azienda Ospedaliero-Universitaria di Sassari, Italy
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20
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Hjelt S, Aatola H, Kähönen M, Juonala M, Koivistoinen T, Lehtimäki T, Viikari JSA, Raitakari OT, Laitinen T, Hutri-Kähönen N. Association of thyrotropin with arterial pulse wave velocity in young adults: The Cardiovascular Risk in Young Finns Study. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:716-21. [DOI: 10.3109/00365513.2014.953994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Siiri Hjelt
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital,
Tampere
| | - Heikki Aatola
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital,
Tampere
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital,
Tampere
| | - Markus Juonala
- Department of Medicine, Turku University Hospital and University of Turku,
Turku
- the Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku,
Turku
| | - Teemu Koivistoinen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital,
Tampere
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital, and School of Medicine, University of Tampere,
Tampere
| | - Jorma S. A. Viikari
- Department of Medicine, Turku University Hospital and University of Turku,
Turku
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku,
Turku
- the Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku,
Turku
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, and Kuopio University Hospital,
Kuopio, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital,
Tampere
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Boggio A, Muzio F, Fiscella M, Sommariva D, Branchi A. Is thyroid-stimulating hormone within the normal reference range a risk factor for atherosclerosis in women? Intern Emerg Med 2014; 9:51-7. [PMID: 22203234 DOI: 10.1007/s11739-011-0743-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 11/28/2011] [Indexed: 11/26/2022]
Abstract
The relationship between overt hypothyroidism and cardiovascular risk has been well documented and some data also suggest an association between cardiovascular risk and subclinical hypothyroidism. The aim of our study was to investigate, in a large cohort of euthyroid women, the association of thyroid stimulating hormone (TSH) within the normal reference range with cardiovascular risk factors. The study was carried out on 744 women with normal thyroid function (TSH 0.3-4.9 μU/mL). Women with TSH above the median (≥2.1 μU/mL) were more obese, had greater waist girth, were more hypertensive and had higher levels of total cholesterol (TC), serum triglycerides (TG), blood sugar (BG) and lower levels of HDL-cholesterol (HDL-C) than women with TSH below the median. TSH was significantly correlated with body mass index (BMI), waist circumference, BG, TG, TC, HDL-C and hypertension. Multiple backward stepwise regression analysis with age, waist circumference and TSH as independent variables confirmed the strong association of TSH with BG, TG, HDL-C and hypertension. A total of 205 patients (28%) fulfilled the definition criteria of the metabolic syndrome and the prevalence of metabolic syndrome was significantly greater in patients with TSH above than in patients with TSH below the median. Results of logistic analysis, including age and TSH as predictor variables, confirmed the association of TSH with metabolic syndrome.The results of this study suggest that TSH in the upper limits of the reference range (above 2.1 μU/ml) is associated with a less favourable cardiometabolic profile and consequently with a higher risk of developing cardiovascular diseases.
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Affiliation(s)
- Anna Boggio
- Dietetic and Clinical Nutrition Unit, "Luigi Sacco" University Hospital, Milan, Italy,
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The thyroid and the kidney: a complex interplay in health and disease. Int J Artif Organs 2014; 37:1-12. [PMID: 24634329 DOI: 10.5301/ijao.5000300] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/20/2022]
Abstract
Thyroid hormones may directly affect the kidney and altered kidney function may also contribute to thyroid disorders. The renal manifestations of thyroid disorders are based on hemodynamic alterations or/and to direct effects of thyroid hormones. The renin-angiotensin system plays a crucial role in the cross-talk between the thyroid and the kidney. Hypothyroidism may be accompanied by an increase of serum creatinine and reduction of glomerular filtration rate (GFR), whereas hyperthyroidism may increase GFR. Treatment of thyroid disorders may lead to normalization of GFR. Primary and subclinical hypothyroidism and low triiodothyronine (T3) syndrome are common features in patients with chronic kidney disease (CKD). In addition low levels of thyroid hormones may predict a higher risk of cardiovascular and overall mortality in patients with end-stage renal disease. The causal nature of this correlation remains uncertain. In this review, special emphasis is given to the thyroid pathophysiology, its impact on kidney function and CKD and the interpretation of laboratorial findings of thyroid dysfunction in CKD.
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Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor α1. Proc Natl Acad Sci U S A 2013; 110:16241-6. [PMID: 24046370 DOI: 10.1073/pnas.1310300110] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Thyroid hormone is a major regulator of thermogenesis, acting both in peripheral organs and on central autonomic pathways. Mice heterozygous for a point mutation in thyroid hormone receptor α1 display increased thermogenesis as a consequence of high sympathetic brown fat stimulation. Surprisingly, despite the hypermetabolism, their body temperature is not elevated. Here we show, using isolated tail arteries, that defective thyroid hormone receptor α1 signaling impairs acetylcholine-mediated vascular relaxation as well as phenylephrine-induced vasoconstriction. Using infrared thermography on conscious animals, we demonstrate that these defects severely interfere with appropriate peripheral heat conservation and dissipation, which in turn leads to compensatory alterations in brown fat activity. Consequently, when the vasoconstrictive defect in mice heterozygous for a point mutation in thyroid hormone receptor α1 was reversed with the selective α1-adrenergic agonist midodrine, the inappropriate heat loss over their tail surface was reduced, normalizing brown fat activity and energy expenditure. Our analyses demonstrate that thyroid hormone plays a key role in vascular heat conservation and dissipation processes, adding a unique aspect to its well-documented functions in thermoregulation. The data thus facilitate understanding of temperature hypersensitivity in patients with thyroid disorders. Moreover, the previously unrecognized connection between cardiovascular regulation and metabolic activity revealed in this study challenges the interpretation of several experimental paradigms and questions some of the currently derived hypotheses on the role of thyroid hormone in thermogenesis.
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Dusak A, Gokalp G, Erdogan C, Parlak M. Impaired aortic distensibility in hypothyroid patients with negative coronary angiograms: Simultaneous evaluation with 128-slice multiple row detector computed tomography. J Int Med Res 2013; 41:1691-8. [DOI: 10.1177/0300060513489479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the relationship between arterial distensibility and hypothyroidism by simultaneous assessment of coronary angiography and aortic distensibility, measured using 128-slice retrospective electrocardiogram-gated multiple row detector computed tomography (MDCT). Methods Untreated hypothyroid patients and age-matched euthyroid patients, who underwent 128-slice retrospective electrocardiogram-gated MDCT to evaluate the coronary arteries, were assessed. Intraluminal aortic areas in systolic and diastolic phases of the cardiac cycle were measured with multiphase reformation at predefined locations including the ascending aorta, proximal descending aorta and distal descending aorta in the widest axial plane. Results The study included 21 hypothyroid and 21 euthyroid patients. Patients with hypothyroidism exhibited decreased aortic distensibility between each location in the thoracic aorta (ascending aorta, proximal descending aorta and distal descending aorta) compared with euthryoid patients. Conclusions Hypothyroidism was associated with preclinical vascular alteration, characterized by impaired aortic distensibility at each location of the thoracic aorta, which has been shown to be related to increased cardiovascular risk. Monitoring of aortic distensibility is relevant for evaluating coronary artery disease progression and treatment choices.
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Affiliation(s)
| | - Gokhan Gokalp
- Department of Radiology, Uludag University, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, Uludag University, Bursa, Turkey
| | - Mufit Parlak
- Department of Radiology, Uludag University, Bursa, Turkey
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Haribabu A, Reddy VS, Pallavi C, Bitla AR, Sachan A, Pullaiah P, Suresh V, Rao PVLNS, Suchitra MM. Evaluation of protein oxidation and its association with lipid peroxidation and thyrotropin levels in overt and subclinical hypothyroidism. Endocrine 2013; 44:152-7. [PMID: 23224563 DOI: 10.1007/s12020-012-9849-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
Both overt (OHT) and subclinical hypothyroid (SHT) disorders have been found to be associated with increased oxidative stress (OXS). Excess thyrotropin [thyroid stimulating hormone (TSH)] is known to directly produce OXS. Increased lipid peroxidation is known to facilitate protein carbonylation. However, the associations between lipid and protein oxidation and elevated TSH levels have not been studied. Thyroid profile, lipid peroxidation as malondialdehyde (MDA) levels and protein carbonylation as protein carbonyls (PCO) were estimated in OHT and SHT groups consisting of 36 patients each, in comparison to 39 euthyroid controls. We also determined the associations between TSH, MDA, and PCO levels in OHT and SHT groups. Increased oxidative damage was evidenced through significant elevations in the concentrations of MDA and PCO in OHT and SHT groups compared to controls (p < 0.01). Both TSH and MDA levels were positively associated with PCO in OHT group. Partial correlation analysis revealed that both excess TSH and increased MDA levels are mutually influencing elevated PCO. The results indicate that there is a simultaneous oxidative damage to lipids and proteins leading to increased MDA and PCO levels in both patient groups. Either of the excess TSH and increased MDA levels are combinably involved in the elevation of PCO in hypothyroidism.
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Affiliation(s)
- A Haribabu
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, 517507, Andhra Pradesh, India
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Kilic ID, Tanriverdi H, Fenkci S, Akin F, Uslu S, Kaftan A. Noninvasive indicators of atherosclerosis in subclinical hypothyroidism. Indian J Endocrinol Metab 2013; 17:271-275. [PMID: 23776901 PMCID: PMC3683203 DOI: 10.4103/2230-8210.109708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cardiovascular system is rich in thyroid hormone receptors and is one of the major sites of action for thyroid hormones. However, the effect of subclinical hypothyroidism (SCH) on atherosclerosis has not been cleared yet. MATERIALS AND METHODS SCH is defined as high thyroid-stimulating hormone (TSH) levels in the presence of normal serum T4 and T3 levels. A total of 32 patients with SCH and 29 controls were included in the study. Carotid intima-media thickness, flow-mediated dilatation, and aortic distensibility were compared between the groups. RESULTS FMD was lower in patients with SCH than in controls. GTN-induced vasodilatation was similar in the patients with SCH and controls. There was no statistically significant difference between the patients with SCH and controls with respect to CIMT and aortic distensibility. CONCLUSION SCH is associated with endothelial dysfunction as established by FMD. Inconsistent results of CIMT and aortic stiffness can be explained by these parameters being measures of structural changes whereas FMD is a dynamic measure that reflects the impact of both acute and chronic influences on endothelial function.
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Affiliation(s)
- Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Halil Tanriverdi
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Semin Fenkci
- Department of Endocrinology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Fulya Akin
- Department of Endocrinology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Sukriye Uslu
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Asuman Kaftan
- Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey
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Vicinanza R, Coppotelli G, Malacrino C, Nardo T, Buchetti B, Lenti L, Celi FS, Scarpa S. Oxidized low-density lipoproteins impair endothelial function by inhibiting non-genomic action of thyroid hormone-mediated nitric oxide production in human endothelial cells. Thyroid 2013; 23:231-8. [PMID: 23072587 PMCID: PMC3569959 DOI: 10.1089/thy.2011.0524] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thyroid hormone (TH) plays an important role in the modulation of cardiac function, including contractility and systemic vascular resistance (SVR). 3,5,3'-triiodothyronine (T(3)), the active form of TH, induces the activation of endothelial nitric oxide synthase via PI3K/AKT non-genomic signaling. Hypothyroidism is associated with an increase in SVR and serum low-density lipoproteins (LDL) levels, and accumulation of oxidized LDL (oxLDL) may impair endothelial-dependent vascular relaxation. The aim of this study was to investigate the effects of both native LDL (nLDL) and oxLDL on T(3)-mediated AKT phosphorylation, nitric oxide (NO), and cyclic guanosine monophosphate (cGMP) production in human endothelial cells. METHODS Human umbilical vein endothelial cells were exposed to either nLDL or oxLDL for 3 hours and then stimulated with T(3) (10(-7) M) or pretreated with an antioxidant mixture of vitamins E and C for 12 hours before treatment with LDL. An analysis of AKT phosphorylation was performed by Western blot, and NO production was evaluated by using 4,5-diaminofluorescein diacetate. Intracellular production of cGMP was measured by enzymatic immunoassay. LDL oxidation was carried out by incubating LDL with CuSO(4), and α-tocopherol content of LDL was evaluated by high-performance liquid chromatography. RESULTS OxLDL impaired T(3)-mediated AKT phosphorylation at serine 473 and significantly decreased the production of both NO (oxLDL+T(3) vs. T(3), 9.79±0.5 AU vs. 80.75±2.8 AU, mean±standard deviation, p<0.0001) and cGMP. Furthermore, pretreatment with the antioxidant mixture obviated the inhibitory effect of LDL on T(3) action. CONCLUSIONS The results of this study demonstrate that oxLDL may contribute to a blunting of the non-genomic action of T(3) and impair the effect of T(3) on NO and cGMP production in endothelial cells. These data suggest that oxLDL, apart from inducing the atherosclerotic process, may also promote a mechanism of peripheral resistance to T(3,) further amplifying the impact of hypothyroidism on endothelial function by increasing SVR.
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Affiliation(s)
- Roberto Vicinanza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Abstract
Accelerated atherosclerosis and arterial stiffness are the two leading causes of increased cardiovascular disease in patients with chronic kidney disease. Dysfunctional thyroid hormone metabolism has been suggested to play a role in atherosclerosis and arterial stiffness. Changes in cardiac contractility and output, myocardial oxygen demand, systemic and peripheral vascular resistance, blood pressure and lipid profile, increased inflammatory burden and endothelial dysfunction may be responsible for thyroid hormone-related cardiovascular disease. This article focuses on the mechanistic insights of this association and provides a concise review of the current literature.
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Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24-hour patterns: circadian rhythm-dependent physiologic and pathophysiologic mechanisms. Chronobiol Int 2012; 30:17-30. [PMID: 23002916 DOI: 10.3109/07420528.2012.715872] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuroendocrine mechanisms are major determinants of the normal 24-h blood pressure (BP) pattern. At the central level, integration of the major driving factors of this temporal variability is mediated by circadian rhythms of monoaminergic systems in conjunction with those of the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, opioid, renin-angiotensin-aldosterone, plus endothelial systems and specific vasoactive peptides. Humoral secretions are typically episodic, coupled either to sleep and/or the circadian endogenous (suprachiasmatic nucleus) central pacemaker clock, but exhibiting also weekly, monthly, seasonal, and annual periodicities. Sleep induction and arousal are influenced also by many hormones and chemical substances that exhibit 24-h variation, e.g., arginine vasopressin, vasoactive intestinal peptide, melatonin, somatotropin, insulin, steroids, serotonin, corticotropin-releasing factor, adrenocorticotropic hormone, thyrotropin-releasing hormone, endogenous opioids, and prostaglandin E2, all with established effects on the cardiovascular system. As a consequence, physical, mental, and pathologic stimuli that activate or inhibit neuroendocrine effectors of biological rhythmicity may also interfere with, or modify, the temporal BP structure. Moreover, immediate adjustment to exogenous components/environment demands by BP rhythms is modulated by the circadian-time-dependent responsiveness of biological oscillators and their neuroendocrine effectors. This knowledge contributes to a better understanding of the pathophysiology of abnormalities of the 24-h BP pattern and level and their correction through circadian rhythm-based chronotherapeutic strategies.
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Affiliation(s)
- Fabio Fabbian
- Section of Clinica Medica, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, Ferrara, Italy
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High normal thyroid-stimulating hormone is associated with arterial stiffness in healthy postmenopausal women. J Hypertens 2012; 30:592-9. [DOI: 10.1097/hjh.0b013e32834f5076] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Chopra S, Cherian D, Jacob JJ. The thyroid hormone, parathyroid hormone and vitamin D associated hypertension. Indian J Endocrinol Metab 2011; 15 Suppl 4:S354-60. [PMID: 22145139 PMCID: PMC3230087 DOI: 10.4103/2230-8210.86979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Thyroid disorders and primary hyperparathyroidism have been known to be associated with increases in blood pressure. The hypertension related to hypothyroidism is a result of increased peripheral resistance, changes in renal hemodynamics, hormonal changes and obesity. Treatment of hypothyroidism with levo-thyroxine replacement causes a decrease in blood pressure and an overall decline in cardiovascular risk. High blood pressure has also been noted in patients with subclinical hypothyroidism. Hyperthyroidism, on the other hand, is associated with systolic hypertension resulting from an expansion of the circulating blood volume and increase in stroke volume. Increased serum calcium levels associated with a primary increase in parathyroid hormone levels have been also associated with high blood pressure recordings. The mechanism for this is not clear but the theories include an increase in the activity of the renin-angiotensin-aldosterone system and vasoconstriction. Treatment of primary hyperparathyroidism by surgery results in a decline in blood pressure and a decrease in the plasma renin activity. Finally, this review also looks at more recent evidence linking hypovitaminosis D with cardiovascular risk factors, particularly hypertension, and the postulated mechanisms linking the two.
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Affiliation(s)
- Sandeep Chopra
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | - Davis Cherian
- Department of Cardiology, Christian Medical College, Ludhiana, India
| | - Jubbin J. Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College, Ludhiana, India
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Mazza A, Beltramello G, Armigliato M, Montemurro D, Zorzan S, Zuin M, Rampin L, Marzola M, Grassetto G, Al-Nahhas A, Rubello D. Arterial hypertension and thyroid disorders: What is important to know in clinical practice? ANNALES D'ENDOCRINOLOGIE 2011; 72:296-303. [DOI: 10.1016/j.ando.2011.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/30/2011] [Accepted: 05/05/2011] [Indexed: 11/27/2022]
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Abstract
Hypothyroidism has been recognized as a cause of secondary hypertension. Previous studies on the prevalence of hypertension in subjects with hypothyroidism have demonstrated elevated blood pressure values. Increased peripheral vascular resistance and low cardiac output has been suggested to be the possible link between hypothyroidism and diastolic hypertension. The hypothyroid population is characterized by significant volume changes, initiating a volume-dependent, low plasma renin activity mechanism of blood pressure elevation. This article summarizes previous studies on the impact of hypothyroidism on blood pressure and early atherosclerotic process.
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Affiliation(s)
- Stella Stabouli
- Pediatric Intensive Care Unit, Hippokration Hospital, Thessaloniki, Greece
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Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J 2011; 5:76-84. [PMID: 21660244 PMCID: PMC3109527 DOI: 10.2174/1874192401105010076] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 12/31/2022] Open
Abstract
Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Hypothyroidism is relatively common and is associated with an unfavorable effect on lipids. Substitution therapy is beneficial for patients with overt hypothyroidism, improving lipid profile. However, whether subclinical hypothyroidism should be treated or not is a matter of debate. On the other hand, hyperthyroidism can be associated with acquired hypocholesterolemia or unexplained improvement of lipid profile. Overall, thyroid dysfunction should be taken into account when evaluating and treating dyslipidemic patients.
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Affiliation(s)
- C V Rizos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Assessment of low-density lipoprotein oxidation, paraoxonase activity, and arterial distensibility in epileptic children who were treated with anti-epileptic drugs. Cardiol Young 2010; 20:547-54. [PMID: 20519057 DOI: 10.1017/s1047951110000697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Studies show that anti-epileptic drugs increase oxidative stress. Thus, low-density lipoprotein oxidation increases and atherogenesis is induced. Paraoxonase-associated high-density lipoprotein protects low-density lipoprotein and high-density lipoprotein oxidation. The effects of anti-epileptic drugs on paraoxonase activity has not been investigated yet. The aim of this study is to investigate the effect of anti-epileptic drugs on paraoxonase activity, lipid profiles, folat, vitamin B12, homocysteine, thyroid hormones, apolipoprotein A-1, total anti-oxidant capacity, malondialdehyd, nitric oxide, and oxidised low-density lipoprotein. The association with carotid-femoral pulse wave velocity and current biochemical parameters had been searched for assessing the effects of anti-epileptic drugs on the vascular system. PATIENTS AND METHODS We recruited 59 epileptic patients treated with anti-epileptic drugs and 23 controls (group IV) at least 6 months ago. The epileptic group was divided into three groups by receiving anti-epileptic drugs as follows: group I: carbamazepine, group II: valproic acid, and group III: carbamazepine and valproic acid. Arterial distensibility was assessed with the Complior device. RESULTS There was no difference between the current biochemical parameters in epileptic children. Serum-free T4 was decreased, when compared with group IV. Thyroid-stimulating hormone was increased in group II, compared with group IV. The carotid-femoral pulse wave velocity was increased in group III, compared with group IV. The carotid-femoral pulse wave velocity was correlated with thyroid-stimulating hormone and valproic acid levels. CONCLUSIONS Anti-epileptic drugs may induce atherogenesis by affecting the thyroid hormones. According to the current data, the effects of thyroid hormones on vascular system may be independent of other biochemical markers. Epileptic patients using anti-epileptic drugs must be followed closely for arterial stiffness, and also for the development and progression of atherosclerosis.
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Kırış A, Erem C, Kırış G, Koçak M, Gedikli O, Nuhoğlu I, Kutlu M, Kaplan T, Gökçe M, Celik S. Intra-left ventricular systolic asynchrony in patients with overt hyperthyroidism. Endocrine 2010; 38:283-8. [PMID: 20972734 DOI: 10.1007/s12020-010-9385-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 08/20/2010] [Indexed: 10/18/2022]
Abstract
Hyperthyroidism causes a variety of adverse effects on the cardiovascular system. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to assess systolic asynchrony in patients with overt hyperthyroidism. Asynchrony was evaluated in 27 patients with overt hyperthyroidism and 21 controls. All the patients and controls were subjected to a tissue synchronization imaging (TSI). The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-mid-segmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. All TSI parameters of LV asynchrony increased in hyperthyroid patients compared to controls: the standard deviation (SD) of the 12 LV segments Ts (35.7±14.4 vs 20.1±10.1, P<0.0001); the maximal difference in Ts between any 2 of the 12 LV segments (111.9±40.7 vs 65.9±30.7, P<0.0001); the SD of the 6 basal LV segments (31.2±18.2 vs 16.8±9.7, P=0.01); and the maximal difference in Ts between any 2 of the 6 basal LV segments (76.6±42.0 vs 44.4±25.7, P=0.005). Patients with overt hyperthyroidism present evidence of LV asynchrony by TSI.
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Affiliation(s)
- Abdulkadir Kırış
- Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, and Department of Internal Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Baek JH, Chung PW, Kim YB, Moon HS, Suh BC, Jin DK, Kim BM, Rhee EJ, Lee YT, Park KY. Favorable influence of subclinical hypothyroidism on the functional outcomes in stroke patients. Endocr J 2010; 57:23-9. [PMID: 19823001 DOI: 10.1507/endocrj.k09e-206] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Subclinical hypothyroidism (SCH) is thought to have an influence on stroke outcomes. However, few reports demonstrate a favorable relationship between the two. We evaluated this association in acute ischemic stroke. From Jan 2005 to June 2008, 756 acute ischemic stroke patients were recruited within seven days of onset. The patients with overt hypothyroidism/hyperthyroidism or other medical conditions that may affect thyroid function were excluded. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured within two days. Patients were divided into two groups: the SCH group (TSH > 5.0 microU/mL and normal FT4 levels) and the control group. Stroke outcomes were assessed using two different criteria. In the first outcome model, favorable outcomes [I] were simply defined by modified Rankin Scale (mRS) scores (<or= 1), while the favorable outcomes [II] were defined as follows: a) a mRS score of 0, if the baseline National Institute of Health Stroke Scale (NIHSS) scores were < 8, b) a mRS score of 0 or 1, if the NIHSS scores were 8-14, c) a mRS score 0-2, if the NIHSS scores were >14. The changes in mRS scores and the proportion of patients with favorable outcomes [I] or [II] at the 30(th) and 90(th) day were compared between the two patient groups. Of the 756 patients, 31 (4.1%) were patients with SCH. More patients from the SCH group showed improvement in NIHSS scores on the 30(th) day compared to the control group (48.4% vs. 25.3%, p=.006). In addition, the proportion of patients who exhibited favorable outcomes [I] was significantly higher in the SCH group on the 90(th) day (74.2% vs. 55.3%, p=.027) and that trend was seen as early as the 30(th) day (p=.102). Similarly, the proportion of the patients with favorable outcomes [II] was significantly greater in the SCH group both on the 30(th) (29.0% vs. 14.6%, p=.039) and 90(th) day (58.0% vs. 31.0%, p=.003). We found that acute ischemic stroke patients with SCH at admission were more likely to show favorable functional outcomes than those without SCH. We can suggest preconditioning before the stroke combined with a reduced response to stress as a possible protective mechanism.
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Affiliation(s)
- Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Adrees M, Gibney J, El-Saeity N, Boran G. Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism. Clin Endocrinol (Oxf) 2009; 71:298-303. [PMID: 19094068 DOI: 10.1111/j.1365-2265.2008.03509.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Some of the cardiovascular and renal abnormalities seen in overt hypothyroidism have also been reported in subclinical hypothyroidism (SCH). Short-term L-T4 replacement in SCH improves cardiovascular risk markers and reduces carotid intima-media thickness (CIMT), a surrogate marker of atherosclerosis. The haemodynamic and renal effects of L-T4 replacement in SCH are poorly understood. OBJECTIVES To compare cardiovascular risk factors and renal variables in women with SCH and normal women. To study the effects of L-T4 replacement in SCH subjects on these variables and on structural and functional changes in common carotid and brachial arteries. DESIGN Fifty-six women with SCH before and after L-T4 replacement for 18 months and 56 normal women of similar age distribution were studied. Blood Pressure (BP), plasma lipids and homocysteine were measured and renal function evaluated [estimation of glomerular filtration rate (eGFR) using standard equations and measurement of serum Cystatin-C] in women with SCH before and after 18 months of l-T4, and in healthy women. CIMT and endothelial function (using brachial artery ultrasound) were studied before and after L-T4 in a subgroup of women with SCH. RESULTS Systolic and diastolic BP, total cholesterol, triglyceride, LDL-cholesterol, lipoprotein(a) and homocysteine were greater in SCH (P < 0.05), and following L-T4 replacement decreased (P < 0.05) to levels that no longer differed from normal subjects. Estimated GFR was reduced and serum Cystatin-C increased (P < 0.05) in SCH. These variables also normalized following L-T4. Following L-T4 replacement the carotid artery baseline diameter increased by 7.1% and CIMT decreased by a mean value of 13%, while brachial artery diameter increased basally by 12.5% and following endothelium-dependent vasodilatation by 17.5% (P < 0.05). However, the increment following reactive hyperaemia did not differ before or following L-T4 replacement. CONCLUSION Normalization of cardiovascular risk factors following L-T4 replacement in SCH potentially explains reduced CIMT. Increased carotid and brachial artery diameters and normalized eGFR indicates a haemodynamic effect of L-T4 replacement, the importance of which requires further investigation.
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Affiliation(s)
- M Adrees
- Department of Clinical Chemistry, Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin 24, Ireland
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Mainenti MRM, Vigário PS, Teixeira PFS, Maia MDL, Oliveira FP, Vaisman M. Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. J Endocrinol Invest 2009; 32:470-3. [PMID: 19468264 DOI: 10.1007/bf03346488] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although muscle metabolism and exercise capacity seem to be affected in patients with subclinical hypothyroidism, there is little evidence indicating improvement of the exercise tolerance due to levothyroxine (L-T(4)) replacement. The aim of the present study was to verify possible cardiopulmonary changes during exercise in patients with subclinical hypothyroidism on L-T(4) replacement with a normal serum TSH for six months. Twenty-three patients with subclinical hypothyroidism were randomized into treated (no.=11) and untreated (no.=12) patients. A cardiopulmonary test was performed with a treadmill, using the modified Balke protocol. Heart rate, oxygen uptake, minute ventilation and other cardiopulmonary parameters were assessed at the 5th minute of exercise. FT4 levels increased while TSH normalized after hormone replacement. Oxygen uptake decreased significantly after hormone replacement (24.1+/-6.3 vs 17.1+/-4.2 ml x kg x min(-1); p=0.03).Minute ventilation also showed an enhanced performance in treated patients (28.0+/-8.1 vs 23.5+/-5.6 l x min(-1); p=0.03), as did the heart rate (128+/-17 vs 121+/-17 bpm; p=0.03). There were no changes in the untreated group. The results demonstrate that submaximal cardiopulmonary exercise performance improved after six months of TSH normalization and this improvement can help enhance the ability to carry out daily life activities in patients with subclinical hypothyroidism.
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Affiliation(s)
- M R M Mainenti
- Endocrine Clinic, University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil.
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Mainenti MRM, Teixeira PFS, Oliveira FP, Vaisman M. [Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery]. ACTA ACUST UNITED AC 2009; 51:1485-92. [PMID: 18209891 DOI: 10.1590/s0004-27302007000900011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 08/06/2007] [Indexed: 11/22/2022]
Abstract
In order to identify the characteristics of subclinical hypothyroidism (SH) during physical stress and its recovery, 15 SH patients and 16 healthy women were compared by a treadmill cardiopulmonary test. Means of variables were analyzed by the Mann-Whitney U test. Patients obtained lower values for peak expired fraction of O2 (14.90+/-1.05 x 16+/-1.14%; p = 0.014); systolic blood pressure variation (34.33+/-17.92 x 52.50+/-17.22; p = 0.009); exercise duration (8.83+/-2.91 x 14.5+/-5.63 min; p = 0.0005), maximal test load (11.6+/-4.22 x 18.94+/-5.45%; p = 0.0004), as well as tendencies in gas exchange ratio and peak heart rate. Between the first and the third recovery minutes, there was a reduction of only 0.71 mmHg in the diastolic blood pressure, whereas there was a 5.33-mmHg reduction to control group (p = 0.0009) (slower recovery of patients). It is presumable that SH may cause cardiopulmonary dysfunctions, with higher sensibility to the parameters previously cited.
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Affiliation(s)
- Míriam R M Mainenti
- Programa de Pós-Graduação em Endocrinologia, Escola de Educação Física e Desportos (Laboratório de Fisiologia do Exercício), Universidade Federal do Rio de Janeiro, RJ.
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Association of thyroid function with arterial pressure in normotensive and hypertensive euthyroid individuals: A cross-sectional study. Thyroid Res 2008; 1:3. [PMID: 19014646 PMCID: PMC2583982 DOI: 10.1186/1756-6614-1-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 09/29/2008] [Indexed: 11/24/2022] Open
Abstract
Background Overt hypothyroidism has been associated with arterial hypertension and increased arterial stiffness. Results in euthyroid individuals have been conflicting. We investigated associations of thyroid function with systolic (SAP) and diastolic (DAP) arterial pressure in euthyroid subjects. Methods 311 euthyroid individuals (185 women, mean age 43.9 ± 9) without a history of diabetes attending a preventive medicine program were examined. Subjects receiving thyroxine (10.6%) were excluded; 19.3% had hypertension, 43% had a family history for hypertension. TSH, fT4, thyroid autoantibodies, insulin, glucose were measured. The "fT4.TSH product", which has been suggested as a T4 resistance-index, was calculated. Results TSH range was 0.1–8, median 1.4 mU/L, fT4 range was 11.5–25.2 pmol/L, median 17.4. TSH and the "fT4.TSH product" were positively associated with DAP (p < 0.03, for both associations). In the subgroup of individuals with TSH levels 0.36–2.5 mU/L, both TSH and the "fT4.TSH product" were positively correlated with SAP (r = +0.133 p = 0.044, r = +0.152 p = 0.026) and DAP (r = +0.243 p < 0.001, r = +0.252 p < 0.001 respectively); in multivariate analysis the "fT4.TSH product" was a significant predictor of DAP independently of HOMA-IR and BMI (p < 0.001). Similar associations were found when only the non-hypertensive subjects were analysed (p = 0.004). Hypertensive patients had higher TSH levels (p = 0.02) and belonged more frequently to the subgroup with TSH > 2 mU/L (35.3% vs 21.3%, p = 0.045). Conclusion In euthyroid individuals the association of thyroid function with diastolic arterial pressure remains significant even when a stricter "normal range" for TSH levels is considered. The "freeT4.TSH" product appears to be an even stronger predictor of DAP, independently of HOMA insulin resistance index and obesity.
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Peleg RK, Efrati S, Benbassat C, Fygenzo M, Golik A. The effect of levothyroxine on arterial stiffness and lipid profile in patients with subclinical hypothyroidism. Thyroid 2008; 18:825-30. [PMID: 18651824 DOI: 10.1089/thy.2007.0359] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The influence of treatment for subclinical hypothyroidism (SCH) on cardiovascular morbidity and mortality, arterial stiffness, and lipid profile has not been elucidated yet. The aim of this study was to evaluate the effect of levothyroxine on arterial stiffness, lipid profile, and inflammation. METHODS The study included 30 patients with SCH. Patients were treated with levothyroxine and were assessed at baseline and at 1, 4, and 7 months. Blood samples were taken for lipid profile and highly sensitive C-reactive protein (hs-CRP). Arterial stiffness was evaluated by augmentation index (AIx). In conditions that cause arterial stiffness, the pulse wave traveling from the periphery to the heart reaches the heart during systole, resulting in augmentation of the central pressure. This increase, calculated as the AIx, is a good expression of central aortic pressure. RESULTS After accomplishing euthyroidism, the AIx decreased from 17.2 +/- 8.3 to 14.3 +/- 6.5 (p < 0.01) and AIx percentage decreased from 36.2 +/- 11.5 to 33.2 +/- 9.1 (p = 0.03). Systolic blood pressure (SBP) decreased from 134.7 +/- 20 to 127.6 +/- 13.7 mmHg (p < 0.01). In those patients whose AIx decreased, low-density lipoprotein (LDL) levels decreased by 0.4 +/- 0.96 mmol/L compared to the patients whose AIx did not decrease and LDL increased by 0.62 +/- 1.48 mmol/L (p = 0.057). Total cholesterol decreased by 0.72 +/- 1.64 mmol/L in the patients whose AIx decreased and increased by 1 +/- 2.53 mg/dL in the patients whose AIx did not improve (p = 0.06). CONCLUSIONS In patients with SCH, treatment with levothyroxine had a significant beneficial effect on arterial stiffness and SBP, and no effect on lipid profile or hs-CRP.
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Affiliation(s)
- Ronit Koren Peleg
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel.
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Abbas JMK, Chakraborty J, Akanji AO, Doi SAR. Hypothyroidism results in small dense LDL independent of IRS traits and hypertriglyceridemia. Endocr J 2008; 55:381-9. [PMID: 18385530 DOI: 10.1507/endocrj.k07e-065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is evidence of an association between hypothyroidism and coronary heart disease. We decided to look at the relationship between hypothyroidism and LDL subclasses' pattern including small, dense LDL to define a biochemical basis for better management of the CHD risk of these patients. We utilized a case-control design to evaluate differences in lipid parameters between cases and controls. Univariate analysis revealed that many factors were associated with LDL particle size. Binary logistic regression however revealed that only thyroid status and serum triglyceride (TG) levels were independently associated with LDL particle size. Results from this study support an independent association between LDL particle size phenotype and both plasma TG concentrations and thyroid status. After adjusting for TG levels, other insulin resistance syndrome (IRS) traits were not associated with LDL size phenotype, suggesting that the IRS related sdLDL is linked most strongly to alterations in TG levels.
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Affiliation(s)
- Jasem M K Abbas
- Division of Clinical Biochemistry, Mubarak Al-Kabeer Hospital, Kuwait
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Abstract
Subclinical thyroid disease (SCTD) is defined as serum free T(4) and free T(3) levels within their respective reference ranges in the presence of abnormal serum TSH levels. SCTD is being diagnosed more frequently in clinical practice in young and middle-aged people as well as in the elderly. However, the clinical significance of subclinical thyroid dysfunction is much debated. Subclinical hyper- and hypothyroidism can have repercussions on the cardiovascular system and bone, as well as on other organs and systems. However, the treatment and management of SCTD and population screening are controversial despite the potential risk of progression to overt disease, and there is no consensus on the thyroid hormone and thyrotropin cutoff values at which treatment should be contemplated. Opinions differ regarding tissue effects, symptoms, signs, and cardiovascular risk. Here, we critically review the data on the prevalence and progression of SCTD, its tissue effects, and its prognostic implications. We also examine the mechanisms underlying tissue alterations in SCTD and the effects of replacement therapy on progression and tissue parameters. Lastly, we address the issue of the need to treat slight thyroid hormone deficiency or excess in relation to the patient's age.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
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Oflaz H, Kurt R, Cimen A, Elitok A, Onur I, Golcuk E, Demirturk M, Batmaz S, Kasikcioglu E. Coronary flow reserve is also impaired in patients with subclinical hypothyroidism. Int J Cardiol 2007; 120:414-6. [PMID: 17092581 DOI: 10.1016/j.ijcard.2006.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 08/01/2006] [Indexed: 10/23/2022]
Abstract
The diagnosis of subclinical hypothyroidism and detection of its effects on cardiovascular system is important. Also, the patients with subclinical hypothyroidism even at the very early stage are at increased risk for developing atherosclerosis. We evaluated coronary microvascular circulation and endothelial dysfunction of epicardial coronary arteries by the measurement of coronary flow velocity reserve via a non invasive technique, transthoracic Doppler echocardiography in subclinical hypothyroidism. Coronary flow reserve in patients with subclinical hypothyroidism such as in overt hypothyroidism was lower than that of euthyroid subject. As a conclusion, endothelial and microvascular dysfunction, which are early harbingers of atherosclerosis, are shown in overt and subclinical hypothyroidism.
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Papaioannou TG, Karatzis EN, Karatzi KN, Gialafos EJ, Protogerou AD, Stamatelopoulos KS, Papamichael CM, Lekakis JP, Stefanadis CI. Hour-to-hour and week-to-week variability and reproducibility of wave reflection indices derived by aortic pulse wave analysis: implications for studies with repeated measurements. J Hypertens 2007; 25:1678-86. [PMID: 17620966 DOI: 10.1097/hjh.0b013e3281ab6c58] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Wave reflections are implicated increasingly in clinical research. AIMS The purpose of the present study was to investigate whether wave reflection indices are reproducible when measured repeatedly (more than twice) at longer time intervals, namely hour-to-hour and week-to-week, in healthy subjects; something that has not yet been examined. METHODS Bland-Altman plots, the interclass correlation coefficients (ICC) and coefficient of variation were used for this purpose. Two series, with measurements repeated in triplicate, were performed in 22 healthy subjects: the first at intervals of 1 h and the second at 1-week time intervals. Augmentation index (AIx), heart rate-corrected AIx (AI@75) and arrival time of reflected waves at the central aorta (tr) were calculated by aortic pulse wave analysis. RESULTS AIx and AI@75 presented very good to excellent reproducibility (ICC = 0.86) for hour-to-hour repeated measurements, while tr was also highly reproducible (ICC = 0.79). AIx, AI@75 and tr were substantially reproducible when measured repeatedly with 1-week intervals, providing ICCs greater than 0.70. Bland-Altman plots confirmed these results, indicating that more than 90% of AIx, AI@75 and tr measurements fell within two standard deviations of the mean difference. CONCLUSIONS Wave reflections are substantially reproducible even when measurements repeated in triplicate are performed at longer time intervals (hours and weeks). A quantifiable amount of variation was reported, which should be taken carefully into consideration in interventional studies with repeated measurements and in observational studies investigating differences or correlations of these indices.
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Affiliation(s)
- Theodore G Papaioannou
- Unit of Biomedical Engineering, First Department of Cardiology, Hippokration Hospital, Medical School, Greece.
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Abstract
Hypothyroidism is often associated with adverse cardiovascular risk factors such as high cholesterol together with hypertension, endothelial dysfunction, and other atherosclerotic cardiovascular risk factors. The changed hemodynamic characteristics result in reduced cardiac index, and the renal perfusion is impaired with hyponatremia, and low renin and aldosterone production. The ischemic abnormalities are probably related to long-term consequences of a slow development of hypothyroidism, while the hemodynamic changes can develop in very short-term hypothyroidism. Replacement of hypothyroidism with levothyroxine is associated with a normalization of basal metabolic rate. Most patients with preexisting angina experience a gradual amelioration of symptoms, but in some cases the initial therapy may precipitate an unrecognized ischemic state, worsen a preexisting angina, or even result in myocardial infarction. It is therefore advisable to start replacement slowly and if needed perform a stress test and/or coronary angiography before. It may also in some cases be necessary to monitor the patients closely in a hospital setting during initiation of levothyroxine. Elderly hypothyroid patients with unstable angina pose a particular challenging problem, especially if coronary vascular surgery is indicated. No increased risk of peri- or postoperative death has been noted in small studies, although more complications have been described. It may be relevant to treat the cardiac vascular occlusion before starting replacement with levothyroxine in some cases, after careful weighting of pros and cons in each individual case.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
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Abstract
Altered cardiac function in thyroid disease is well recognized and has been extensively investigated, vascular function has however been less well studied in those with thyroid dysfunction. Thyroid hormones, thyroxine (T(4)) and triiodothyronine (T(3)) are important regulators of cardiac function and cardiovascular hemodynamics. The cardiovascular system responds to minimal but persistent changes in circulating thyroid hormone levels producing changes in vascular reactivity and endothelial function. The detection of endothelial dysfunction and/or arterial stiffness allows early identification of individuals at risk as these occur in both patients with risk factors for coronary artery disease and in those with established disease. This may allow treatment to be targeted at high risk individuals with the aim of slowing the progression of vascular disease. The various methods used to assess arterial function are reviewed and the changes demonstrated in human and animal models of thyroid dysfunction.
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Affiliation(s)
- Penelope J D Owen
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, United Kingdom.
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Kanbay M, Turgut F, Karakurt F, Isik B, Alkan R, Akcay A, Yigitoglu R, Covic A. Relation between Serum Thyroid Hormone and ‘Nondipper’ Circadian Blood Pressure Variability. Kidney Blood Press Res 2007; 30:416-20. [DOI: 10.1159/000110082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2007] [Indexed: 11/19/2022] Open
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