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Li W, He Q, Zhang H, Shu S, Wang L, Wu Y, Yuan Z, Zhou J. Thyroid-stimulating hormone within the normal reference range has a U-shaped association with the severity of coronary artery disease in nondiabetic patients but is diluted in diabetic patients. J Investig Med 2023; 71:350-360. [PMID: 36680358 DOI: 10.1177/10815589221149187] [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] [Indexed: 01/22/2023]
Abstract
Too high or too low thyroid-stimulating hormone (TSH) has been associated with the progress and prognosis of coronary artery disease (CAD). However, whether TSH within its normal reference range plays a role in the severity of CAD remains unclear. In this observational study, we explored the potential relationship of hypersensitive TSH (hs-TSH) with the severity of CAD in euthyroid patients with or without diabetes mellitus. A total of 7357 CAD patients with euthyroidism were enrolled in this study. Of those, 1997 had diabetes mellitus. The severity of CAD was evaluated through the presence of myocardial infarction (MI) and the severity of coronary lesions, which was calculated using the Gensini score (GS). Logistic regression models treating hs-TSH as a categorical variable and restricted cubic spline analyses treating it as a continuous variable were used to evaluate the associations of hs-TSH with the severity of CAD. The propensity score matching method was used to further validate the differences between diabetic and nondiabetic patients. CAD patients with diabetes mellitus had lower levels of hs-TSH (1.6 (0.97-2.53) vs 1.67 (1.00-2.64)) in serum compared with CAD patients without diabetes mellitus. Meanwhile, hs-TSH was independently related to the severity of CAD. In CAD patients with vs without diabetes mellitus, the U-shaped relationship between hs-TSH and MI was more prominent in patients without diabetes mellitus, and the significant U-shaped association between higher GS and hs-TSH remained only in nondiabetes. Therefore, hs-TSH within the normal reference range has a U-shaped association with the severity of CAD in nondiabetic patients, which is markedly diluted in diabetic patients.
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Affiliation(s)
- Wenyuan Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qingyuan He
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haoxuan Zhang
- Department of Bioengineering, Southwest Jiaotong University, Chengdu, Sichuan, China
- Department of Biological Science, Georgia State University, Atlanta, GA, USA
| | - Shan Shu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lijun Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shannxi Province, Xi'an, Shaanxi, China
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Zhang M, Tang L, Cui X, Yu T, Li Z, Li X, Li G. Shear wave elastography in evaluation of carotid elasticity in the type 2 diabetes mellitus patients with nonalcoholic fatty liver disease. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Artificial Intelligence: A Shifting Paradigm in Cardio-Cerebrovascular Medicine. J Clin Med 2021; 10:jcm10235710. [PMID: 34884412 PMCID: PMC8658222 DOI: 10.3390/jcm10235710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022] Open
Abstract
The future of healthcare is an organic blend of technology, innovation, and human connection. As artificial intelligence (AI) is gradually becoming a go-to technology in healthcare to improve efficiency and outcomes, we must understand our limitations. We should realize that our goal is not only to provide faster and more efficient care, but also to deliver an integrated solution to ensure that the care is fair and not biased to a group of sub-population. In this context, the field of cardio-cerebrovascular diseases, which encompasses a wide range of conditions-from heart failure to stroke-has made some advances to provide assistive tools to care providers. This article aimed to provide an overall thematic review of recent development focusing on various AI applications in cardio-cerebrovascular diseases to identify gaps and potential areas of improvement. If well designed, technological engines have the potential to improve healthcare access and equitability while reducing overall costs, diagnostic errors, and disparity in a system that affects patients and providers and strives for efficiency.
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Zhu Y, Shen J, Xue Y, Xiang Z, Jiang Y, Zhou W, Luo S. The Association between Thyroid-Stimulating Hormone and Long-Term Outcomes in Patients with ST Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. Int J Gen Med 2021; 14:6295-6303. [PMID: 34629894 PMCID: PMC8494999 DOI: 10.2147/ijgm.s333322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Thyroid hormones are closely related to the cardiovascular system. Our study aimed to explore the impact of admission thyroid-stimulating hormone (TSH) levels on long-term outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) by detailed stratifications of TSH. Methods Consecutive STEMI patients admitted to our hospital were divided into four groups: Group 1 (TSH <0.35 mIU/L), Group 2 (TSH 0.35–1.0 mIU/L), Group 3 (TSH 1.0–3.5 mIU/L), and Group 4 (TSH >3.5 mIU/L). The primary endpoint was all-cause mortality during follow-up, and the median follow-up was 2.5 years. Cox proportional hazard regression models were performed to identify the prognostic value of TSH. Results A total of 1186 patients were included. Group 4 was presented with higher systolic and diastolic blood pressure (all P < 0.001), and Group 1 had more patients complicated by heart failure (Killip class >I, P = 0.014). During follow-up, 138 deaths occurred. Patients in Group 4 had the worst long-term outcomes (P < 0.001). The cumulative survival in Group 4 was remarkably lower (Log rank P < 0.001), whereas the other three groups were comparable (Log rank P = 0.365). Through Cox regression analysis, only TSH >3.5 mIU/L was identified as an independent risk factor for long-term mortality after STEMI. Conclusion Only TSH elevation beyond the normal range was associated with worse long-term prognosis in STEMI patients, while high-normal TSH or reduced TSH did not alter long-term prognosis of STEMI patients. TSH >3.5 mIU/L was an independent risk factor for long-term mortality in STEMI.
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Affiliation(s)
- Yuansong Zhu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuzhou Xue
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhenxian Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yi Jiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wei Zhou
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Zhang L, Zhai R, Huo Z, Wei Z, Zhang Z, Wei R, Man D. Association of Normal-Range Hemoglobin A1c Value During Midpregnancy with Adverse Birth Outcomes. Int J Gen Med 2021; 14:3049-3057. [PMID: 34234533 PMCID: PMC8256093 DOI: 10.2147/ijgm.s313952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background The midpregnancy normal-range HbA1c value and adverse birth outcomes were controversial. To address this lack of data, we examined the associations between midpregnancy normal-range HbA1c value and adverse birth outcomes. Objective To evaluate whether an association exists between the midpregnancy normal-range HbA1c value and adverse birth outcomes. Materials and Methods A total of 8389 women in their midpregnancy with normal gestational HbA1c value from the Affiliated Hospital of Jining Medical University in China participated in this study from January to December 2019. Subjects were stratified on the basis of their midpregnancy HbA1c value, and multivariate logistic regression was implemented to investigate the association between different HbA1c values and adverse birth outcomes. Results Incidence of preterm birth, macrosomia, and large for gestational age (LGA) for 8389 subjects were 4.8%, 6.3% and 16.5%, respectively. The multivariate logistic regression model demonstrated that the risk of preterm birth (adjusted odds ratio [OR]: 1.71 and 95% confidence interval [CI]: 1.25–2.34), macrosomia (OR: 1.68 and 95% CI: 1.26–2.22), and LGA (OR: 1.53 and 95% CI: 1.28–1.83) increase for every increase of 1% maternal HbA1c. Women with a prepregnancy body mass index (BMI) of < 25 kg/m2 have a stronger correlation with HbA1c values and adverse birth outcomes than women with a prepregnancy BMI of ≥25 kg/m2. Conclusion Our results indicated that the midpregnancy normal-range HbA1c level within the normal range is associated with adverse birth outcomes. Monitoring and controlling HbA1c may reduce the risk of adverse birth outcomes.
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Affiliation(s)
- Lihua Zhang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China.,College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ruixia Zhai
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Zhiyu Huo
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Zhenyan Wei
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ziheng Zhang
- College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ruirui Wei
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Dongmei Man
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China.,College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
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Wu Y, Pan N, An Y, Xu M, Tan L, Zhang L. Diagnostic and Prognostic Biomarkers for Myocardial Infarction. Front Cardiovasc Med 2021; 7:617277. [PMID: 33614740 PMCID: PMC7886815 DOI: 10.3389/fcvm.2020.617277] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/29/2020] [Indexed: 01/12/2023] Open
Abstract
The incidence of myocardial infarction (MI) increases every year worldwide. Better diagnostic and prognostic biomarkers for clinical applications are the consistent pursuit of MI research. In addition to electrocardiogram, echocardiography, coronary angiography, etc., circulating biomarkers are essential for the diagnosis, prognosis, and treatment effect monitoring of MI patients. In this review, we assessed both strength and weakness of MI circulating biomarkers including: (1) originated from damaged myocardial tissues including current golden standard cardiac troponin, (2) released from non-myocardial tissues due to MI-induced systems reactions, and (3) preexisted in blood circulation before the occurrence of MI event. We also summarized newly reported MI biomarkers. We proposed that the biomarkers preexisting in blood circulation before MI incidents should be emphasized in research and development for MI prevention in near future.
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Affiliation(s)
- Yuling Wu
- Systems Biology & Medicine Center for Complex Diseases, Center for Clinical Research, Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nana Pan
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi An
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mengyuan Xu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Tan
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Systems Biology & Medicine Center for Complex Diseases, Center for Clinical Research, Affiliated Hospital of Qingdao University, Qingdao, China
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Hu Y, Yan Z, Pan C. Associations of Thyroid Hormone Levels and Macrovascular Complications in Euthyroid Type 2 Diabetic Patients. Diabetes Metab Syndr Obes 2021; 14:2683-2691. [PMID: 34163196 PMCID: PMC8214540 DOI: 10.2147/dmso.s313803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate whether thyroid hormone in euthyroid patients with type 2 diabetes mellitus (T2DM) is associated with macrovascular complications. PATIENTS AND METHODS The authors examined 311 patients enrolled from February 2019 to December 2019 in Tianjin Medical University Chu Hsien-I Memorial Hospital. A medical record review enabled the collection of demographic and anthropometric information. We classified the patients into two groups based on the echocardiography and vascular ultrasonography results, namely, non-macrovascular complications (n=131) group and macrovascular complications (n=180) group. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for potential confounders, the prevalence of macrovascular complications was determined using multivariate logistic regression. RESULTS A significant association was observed for diabetic macrovascular complications with normal free triiodothyronine (FT3) (OR=0.534, 95% CI 0.358-0.796, p = 0.002) and free thyroxine (FT4) (OR= 0.844, 95% CI 0.760-0.937, p = 0.001). Nevertheless, there was no evidence of any association between thyroid-stimulating hormone (TSH) and the development of diabetic macrovascular complications. When stratified by the body mass index (BMI), a similar relationship existed with the overall results. The positive association remained in restricted analyses involving only patients with HbA1c abnormalities. CONCLUSION Overweight or obese T2DM patients are at high risk due to the implicit association between low but clinically normal thyroid hormone levels and elevated risk of macrovascular complications. However, there were no statistically significant associations between TSH and diabetic macrovascular complications.
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Affiliation(s)
- Yonghui Hu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Zhiyue Yan
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Congqing Pan
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
- Correspondence: Congqing Pan NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of ChinaTel +86-13920423976Fax +86-22-59560475 Email
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Predicting Coronary Atherosclerotic Heart Disease: An Extreme Learning Machine with Improved Salp Swarm Algorithm. Symmetry (Basel) 2020. [DOI: 10.3390/sym12101651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To provide an available diagnostic model for diagnosing coronary atherosclerotic heart disease to provide an auxiliary function for doctors, we proposed a new evolutionary classification model in this paper. The core of the prediction model is a kernel extreme learning machine (KELM) optimized by an improved salp swarm algorithm (SSA). To get a better subset of parameters and features, the space transformation mechanism is introduced in the optimization core to improve SSA for obtaining an optimal KELM model. The KELM model for the diagnosis of coronary atherosclerotic heart disease (STSSA-KELM) is developed based on the optimal parameters and a subset of features. In the experiment, STSSA-KELM is compared with some widely adopted machine learning methods (MLM) in coronary atherosclerotic heart disease prediction. The experimental results show that STSSA-KELM can realize excellent classification performance and more robust stability under four indications. We also compare the convergence of STSSA-KELM with other MLM; the STSSA-KELM model has demonstrated a higher classification performance. Therefore, the STSSA-KELM model can effectively help doctors to diagnose coronary heart disease.
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Bi J, Ji C, Wu Y, Wu M, Liu Y, Song L, Khatiwada SU, Yang S, Li B, Wang Y, Wu L. Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes. J Clin Endocrinol Metab 2020; 105:5804622. [PMID: 32166332 DOI: 10.1210/clinem/dgaa127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/06/2020] [Indexed: 01/25/2023]
Abstract
CONTEXT Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. OBJECTIVE We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. DESIGN AND SETTING The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. PATIENTS A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. MAIN OUTCOME MEASURES The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). RESULTS Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) ≤ 24 kg/m2. CONCLUSIONS Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.
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Affiliation(s)
- Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cunwei Ji
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yuntao Wu
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yunyun Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shikha Upadhyaya Khatiwada
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Senbei Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bing Li
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Wu
- Institute of Maternal and Child Health, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Wang L, Chen T, Yu J, Yuan H, Deng X, Zhao Z. Clinical Associations of Thyroid Hormone Levels with the Risk of Atherosclerosis in Euthyroid Type 2 Diabetic Patients in Central China. Int J Endocrinol 2020; 2020:2172781. [PMID: 32714391 PMCID: PMC7354656 DOI: 10.1155/2020/2172781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Thyroid function is associated with the etiology and pathogenesis of type 2 diabetes (T2D) and potentially contributes to the development of the complications of T2D. The association of thyroid hormones with atherosclerosis in euthyroid T2D patients is not clear. PURPOSE To investigate the association of thyroid hormone levels with the risk of developing atherosclerosis in euthyroid T2D patients in Central China. METHODS This cross-sectional study recruited 910 euthyroid T2D patients from Henan Provincial People's Hospital, China. Association among hemoglobin A1c (HbA1c), thyroid hormones, and the prevalence of atherosclerosis was assessed by multivariable Cox models after adjusting for covariates including age, BMI, duration of T2D, smoking status, SBP, TC, family history of T2D, and medications on hyperlipidemia. RESULTS Among all 910 subjects, 373 were diagnosed with atherosclerosis. There were 523 females and 387 males included in this study. The mean age was 51.9 years. The average BMI was 25.3 kg/m2. Low-normal serum-free triiodothyronine (FT3) levels (3.50-4.17 pmol/L) were associated with a high prevalence of atherosclerosis. Comparing with low-normal FT3, the prevalence ratio in patients with mid- (4.17-4.83 pmol/L) and high-normal FT3 level (4.83-6.50 pmol/L) is 0.74 (95% CI 0.56 to 0.97, p=0.029) and 0.63 (95% CI 0.46 to 0.87, p=0.005) after adjusting for covariates. High level of free thyroxine (FT4) also had decreased risk for atherosclerosis. Thyroid-stimulating hormone (TSH) and FT3 to FT4 ratio did not show significant association with the development of atherosclerosis. CONCLUSION T2D patients with low but clinically normal FT3 level are more likely to develop macrovascular complications comparing with those with mid- and high-normal FT3 level.
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Affiliation(s)
- Limin Wang
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Tingting Chen
- School of Food Science, State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi 330047, China
| | - Jiawei Yu
- Department of Nephrology, The People's Liberation Army No. 988 Hospital, Zhengzhou, Henan 450003, China
| | - Huijuan Yuan
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Xinru Deng
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Zhigang Zhao
- Department of Endocrinology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
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Gürdoğan M, Altay S, Korkmaz S, Kaya Ç, Zeybey U, Ebik M, Demir M. The Effect of Thyroid Stimulating Hormone Level Within the Reference Range on In-Hospital and Short-Term Prognosis in Acute Coronary Syndrome Patients. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E175. [PMID: 31137601 PMCID: PMC6571699 DOI: 10.3390/medicina55050175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 01/21/2023]
Abstract
Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3-5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and <0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and <1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p < 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p < 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p < 0.001). In multivariate logistic regression analysis, the high-normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%; CI: 1.769-22.480; p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High-normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.
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Affiliation(s)
- Muhammet Gürdoğan
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Servet Altay
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Selçuk Korkmaz
- Department of Biostatistics and Medical Informatics, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Çağlar Kaya
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Utku Zeybey
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Mustafa Ebik
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Melik Demir
- Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
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Su JB, Zhao LH, Zhang XL, Cai HL, Huang HY, Xu F, Chen T, Wang XQ. High-normal serum thyrotropin levels and increased glycemic variability in type 2 diabetic patients. Endocrine 2018; 61:68-75. [PMID: 29651629 DOI: 10.1007/s12020-018-1591-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/31/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE High-normal thyrotropin (TSH) is related to reduced insulin sensitivity and may contribute to glycemic disorders in diabetes. We investigated the relationship between normal serum TSH levels and glycemic variability in euthyroid type 2 diabetic patients. METHODS A total of 432 newly diagnosed type 2 diabetic patients with euthyroid function and normal serum TSH levels were recruited between March 2013 and February 2017. Insulin sensitivity was evaluated by the Matsuda index (ISIMatsuda) following a 75-g oral glucose tolerance test. Multiple glycemic variability indices, including the mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), and standard deviation of glucose (SD), were calculated from glucose data obtained with a continuous glucose monitoring system. Average glucose accessed by 24-h mean glucose (24-h MG) was also calculated. RESULTS A normal serum TSH level was positively correlated with MAGE, MODD, SD, and 24-h MG (r = 0.206, 0.178, 0.186, and 0.132, respectively, p < 0.01). After adjusting for somatometric parameters, lipid profiles, ISIMatsuda, and HbA1c via multiple linear regression analysis, mean differences [B(95% CI)] in MAGE, MODD, SD, and 24-h MG between the patients in the lowest and highest quartiles of TSH levels were 0.128(0.031, 0.226), 0.085(0.022, 0.148), 0.039(0.001, 0.078), and 0.002(-0.264, 0.267) mmol/L, respectively. High-normal TSH was independently associated with MAGE, MODD, and SD, but not 24-h MG. CONCLUSIONS High-normal serum TSH is a significant additional risk factor for increased glycemic variability in type 2 diabetic patients.
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Affiliation(s)
- Jian-Bin Su
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China.
| | - Li-Hua Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Xiu-Lin Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Hong-Li Cai
- Department of Geriatrics, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Hai-Yan Huang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Feng Xu
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Tong Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China
| | - Xue-Qin Wang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People's Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China.
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