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Costa JP, Meireles P, Meletis E, Kostoulas P, Severo M. Estimates of sensitivity and specificity of serological tests for SARS-CoV-2 specific antibodies using a Bayesian latent class model approach. J Clin Epidemiol 2024; 168:111267. [PMID: 38307216 DOI: 10.1016/j.jclinepi.2024.111267] [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: 09/11/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Assessing the accuracy of serological tests for SARS-CoV-2 was challenging due to the lack of a gold standard. This study aimed to estimate the accuracy of SARS-CoV-2-specific serological tests using Bayesian latent class models (BLCM) and compare methods with and without a gold standard. STUDY DESIGN AND SETTING In this study, we analyzed 356 samples-254 positives, ie, from individuals with a previous SARS-CoV-2 infection diagnosis, and 102 negatives, ie, prepandemic samples-using six different rapid serological tests and one laboratory assay. A BLCM was employed to concurrently estimate the sensitivity and specificity of all serological tests for the immunoglobulin (Ig) M and IgG antibodies specific for SARS-CoV-2. Noninformative priors were used. A sensitivity analysis was conducted considering three methods: 1) reverse transcription-polymerase chain reaction test (RT-PCR) as the gold standard, 2) BLCM with RT-PCR as an imperfect gold standard, and 3) frequentist latent class model (LCM). All analyses used software R version 4.3.0, and BLCM were fitted using package runjags using the software JAGS (Just Another Gibbs Sampler). RESULTS The BLCM-derived sensitivity for IgM varied from 10.7% [95% credibility interval (CrI):1.9-24.6] to 96.9% (95% CrI: 91.0-100.0), with specificities ranging from 48.3% (95% CrI: 39.0-57.6) to 98.9% (95% CrI: 96.2-100.0). Sensitivity for IgG varied between 76.9% (95% CrI: 68.2-84.7) and 99.1% (95% CrI: 96.1-100.0), and specificity ranged from 49.9% (95% CrI: 19.4-95.8) to 99.3% (95% CrI: 97.2-100.0). LCM results were comparable to BLCM. Considering the RT-PCR as a gold standard underestimated the tests' sensitivity, particularly for IgM. CONCLUSION BLCM-derived results deviated from those using a gold standard, which underestimated the tests' characteristics, particularly sensitivity. Although Bayesian and frequentist LCM approaches yielded comparable results, BLCM had the benefit of enabling credibility interval computation even when sample power is limited.
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Affiliation(s)
- Joana P Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.
| | - Paula Meireles
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450, Porto, Portugal
| | - Eleftherios Meletis
- Faculty of Public & One Health, School of Health Science, University of Thessaly, Larissa, Greece
| | - Polychronis Kostoulas
- Faculty of Public & One Health, School of Health Science, University of Thessaly, Larissa, Greece
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
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Sawarthia P, Bhosle D, Kalra R. A Prospective Observational Study to Evaluate Cardiovascular Changes in Patients of Hypothyroidism. Cureus 2023; 15:e40201. [PMID: 37435246 PMCID: PMC10331040 DOI: 10.7759/cureus.40201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Hypothyroidism is a common endocrine disorder in India and is easy to diagnose based on clinical manifestations and signs. Thyroid hormone affects the cardiovascular system. Fatiguability, dyspnea, weight gain, lower limb swelling, and bradycardia are some clinical manifestations. ECG changes in hypothyroidism include sinus bradycardia, prolonged QTc interval, changes in the morphology of the T-wave, QRS duration, and low voltage. Echocardiography changes include diastolic dysfunction, asymmetrical septal hypertrophy, and pericardial effusion. This study aimed to examine the cardiovascular changes in patients with hypothyroidism. Methodology Patients with hypothyroidism and cardiovascular changes were assessed using an electrocardiogram and echocardiography. Results A total of 68 hypothyroid patients were enrolled in the study. The mean age of patients was 41.93 ± 15.36 years, and the mean BMI was 24.64 ± 4.30 kg/m2. Of 68 hypothyroid patients, 57 (83.8%) were females, and 11 (16.2%) were males. The mean thyroid-stimulating hormone (TSH) level in the study population was 11.48 ± 22.02 (mIU/mL). The most common symptoms reported among the study participants were tiredness or weakness (67.6%), followed by dyspnea (42.6%). The mean pulse rate, systolic blood pressure, and diastolic blood pressure were 81.50 ± 16.16, 112.76 ± 7.05, and 70.68 ± 7.46, respectively. Pallor was the most common sign (22.1%) among all the people who participated in the study. The most common findings on the ECG were low voltage complexes (25%) followed by inversion of the T wave (23.5%). Other ECG findings were bradycardia (10.3%), right bundle branch block (7.4%), and QRS prolongation (2.9%). Echocardiography revealed 21 (30.8%) patients with grade 1 left ventricular diastolic dysfunction and pericardial effusion in two patients (2.94%). There was a significantly greater increase in the level of TSH in study participants. Conclusion Patients with abnormal ECG and echocardiography without other cardiovascular changes should be evaluated for hypothyroidism to improve the quality of care.
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Affiliation(s)
- Priyanka Sawarthia
- Internal Medicine, Bharati Vidyapeeth Deemed to be University, Pune, IND
| | - Deepak Bhosle
- Internal Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Ravi Kalra
- Cardiology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
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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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Zhu P, Lao G, Chen C, Luo L, Gu J, Ran J. TSH levels within the normal range and risk of cardiovascular and all-cause mortality among individuals with diabetes. Cardiovasc Diabetol 2022; 21:254. [PMID: 36419168 PMCID: PMC9682658 DOI: 10.1186/s12933-022-01698-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence regarding thyroid-stimulating hormone (TSH) levels within the normal range and mortality in adults with diabetes is scarce. This study aimed to identify the association between TSH levels and cardiovascular disease (CVD) and all-cause mortality among euthyroid patients with diabetes. METHODS This prospective cohort study included 1830 adults with diabetes from the Third National Health and Nutrition Examination Survey III. Mortality outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Participants were categorized by tertiles of TSH levels (low-normal, 0.39-1.30 mIU/L; medium-normal, 1.30-2.09 mIU/L; high-normal, 2.09-4.60 mIU/L). Multivariable Cox proportional hazards models were used to explore the association between TSH levels within the normal range and overall and CVD mortality. Furthermore, restricted cubic spline analyses were used to determine the nonlinear relationship between TSH levels and mortality. RESULTS During a median follow-up of 17.1 years, 1324 all-cause deaths occurred, including 525 deaths from CVD. After multivariate adjustment, a U-shaped relationship was observed between TSH levels in euthyroid status and all-cause or CVD mortality among patients with diabetes (both P < 0.05 for nonlinearity). Compared with participants with medium-normal TSH levels, those with high-normal TSH levels had a significantly higher risk of all-cause (hazard ratio, 1.31; 95% confidence interval, 1.07-1.61) and CVD (1.52; 1.08-2.12) mortality. Similarly, low-normal TSH levels also increased all-cause (1.39; 1.12-1.73) and CVD (1.69; 1.17-2.44) mortality risk. In stratum-specific analyses, we found that high-normal TSH levels were associated with higher mortality risk in younger (< 60 years) patients with diabetes but not in older (≥ 60 years) participants. CONCLUSION Low- and high-normal serum TSH levels were associated with increased all-cause and CVD mortality in euthyroid adults with diabetes. Further studies are needed to confirm the present observation in a wider population.
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Affiliation(s)
- Ping Zhu
- grid.258164.c0000 0004 1790 3548Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220 China
| | - Guojuan Lao
- grid.12981.330000 0001 2360 039XDepartment of Endocrinology and Metabolism, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Chuping Chen
- grid.258164.c0000 0004 1790 3548Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220 China
| | - Lihui Luo
- grid.258164.c0000 0004 1790 3548Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220 China
| | - Jing Gu
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510089 China
| | - Jianmin Ran
- grid.258164.c0000 0004 1790 3548Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220 China
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Yi J, Wang L, Guo J, Sun P, Shuai P, Ma X, Zuo X, Liu Y, Wan Z. Association of nighttime physical activity with all-cause and cardiovascular mortality: Results from the NHANES. Front Cardiovasc Med 2022; 9:918996. [PMID: 35990988 PMCID: PMC9388927 DOI: 10.3389/fcvm.2022.918996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nighttime physical activity (PA) has significant effects on human health. Whether excessive nighttime PA is associated with adverse long-term prognosis remains unknown. Methods Three thousand six hundred ninety adults from the US National Health and Nutrition Examination Survey (NHANES) 2003–2006 with accelerometer monitor recording PA data were included. Nighttime PA was quantified by the nighttime to all-day PA intensity ratio (NAPAIR). Participants with the NAPAIR above the population median (0.17) were defined as the nighttime active population (NAP), otherwise as the daytime active population. All-cause and cardiovascular disease mortality status was acquired from the US National Death Index from their interview and physical examination date through December 31, 2015. Results Among 3690 adults (weighted mean age 48.1 years), 1781 (weighted proportion 48.8%) were females. One thousand eight hundred six (48.9%) were determined as the NAP. During the follow-up period of up to 13.1 years (median, 10.7 years), 639 deaths occurred (heart diseases, 114). Multivariable Cox proportional hazards model showed that the NAP was associated with higher risks of all-cause (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.22–1.75) and cardiovascular disease (HR, 1.58; 95% CI, 1.03–2.41) mortality compared with the daytime active population, and each 0.1 increase in the NAPAIR was associated with 15% increased all-cause mortality risks. Conclusion In this nationally representative prospective cohort study of a sample of United States adults, excessive nighttime PA was associated with a higher risk of death from all causes and cardiovascular disease.
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Affiliation(s)
- Jiayi Yi
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiajun Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Sun
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Ping Shuai
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiaoxiang Ma
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojiao Zuo
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuping Liu
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Yuping Liu
| | - Zhengwei Wan
- Department of Health Management & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Zhengwei Wan
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Economic and Cardiometabolic Risk Factors Are Predictors of Lower Thyroid Stimulating Hormone (TSH) Levels in Hispanic/Latinx Adults with Euthyroidism-A Community-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138142. [PMID: 35805800 PMCID: PMC9265905 DOI: 10.3390/ijerph19138142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Thyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM), and within the euthyroid range they may also impact other outcomes, such as mood disorders. This study aimed to observationally examine the relationship between TSH and social determinants of health and clinical measures in a euthyroid Hispanic/Latinx patient sample with a diagnosis of anxiety and/or depression disorders from a community health clinic. A needs assessment was completed using a random sample of 100 de-identified medical records of individuals who received free medical care, including mental health, at a community-based clinic. Those with low normal TSH (<2 mIU/L) compared with high normal TSH (≥2 mIU/L) had a greater odds of food insecurity (p = 0.016) and being at 100% of the federal poverty level (p = 0.015). The low normal TSH group had significantly higher fasting glucose (p = 0.046), hemoglobin A1c (p = 0.018), and total cholesterol (p = 0.034) compared with the high normal TSH group. In those with T2DM, individuals with low normal TSH had six-times greater odds of having high fasting glucose (p = 0.022) and high hemoglobin A1c (p = 0.029). These relationships warrant further study, to inform future public health policies and follow-up care for underserved and vulnerable communities.
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Neves JS, Fontes-Carvalho R, Borges-Canha M, Leite AR, von Hafe M, Vale C, Martins S, Guimarães JT, Carvalho D, Leite-Moreira A, Azevedo A. Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study. Front Endocrinol (Lausanne) 2022; 13:1067801. [PMID: 36518251 PMCID: PMC9742360 DOI: 10.3389/fendo.2022.1067801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Thyroid hormones are important modulators of cardiovascular function. Both hypothyroidism and hyperthyroidism are known to contribute to an increased cardiovascular risk. It remains uncertain whether thyroid hormones level within the euthyroid range are associated with cardiometabolic risk. We aimed to evaluate the association between thyroid function levels within the euthyroid range and cardiovascular risk in a population-based cohort. METHODS Eight hundred thirty-five subjects aged ≥45 years from the EPIPorto population-based cohort were included. We excluded participants with TSH, free T4 (FT4), or free T3 (FT3) outside of the reference range, or with previous cardiovascular or thyroid disease. The associations between thyroid function, cardiovascular risk factors and the 10-year estimated risk of cardiovascular events (using SCORE2 and SCORE2-OP) were evaluated in linear and logistic regression models, crudely and adjusting for age, sex, BMI, diabetes, and smoking. RESULTS The mean age of the participants was 61.5 (SD 10.5) years and 38.9% were men. Eleven percent of the participants had diabetes, 47.8% had dyslipidemia, and 54.8% had hypertension. The mean body mass index (BMI) was 27.4 (SD 4.6) kg/m2, and the median (percentile25-75) 10-year risk of cardiovascular events was 5.46% (2.92, 10.11). Participants with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. Lower FT3/FT4 ratio and higher FT4 levels were associated with higher prevalence of diabetes and more adverse lipid profile. Higher TSH, lower FT3 and lower FT3/FT4 ratio were associated with lower eGFR. Lower FT3, lower FT3/FT4 ratio and higher FT4 were associated with an increased 10-year risk of cardiovascular events. CONCLUSIONS In a population-based study, variations of thyroid function within the euthyroid range were associated with cardiovascular risk factors. On one hand, individuals with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. On the other hand, a decreased conversion of T4 to T3 (lower FT3, lower FT3/FT4 ratio and/or higher FT4) was associated with a higher prevalence of diabetes, a more adverse lipid profile, a lower eGFR and an increased 10-year risk of cardiovascular events.
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Affiliation(s)
- João Sérgio Neves
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: João Sérgio Neves,
| | - Ricardo Fontes-Carvalho
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marta Borges-Canha
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Rita Leite
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Madalena von Hafe
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sandra Martins
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - João Tiago Guimarães
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department of Biomedicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Azevedo
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Giontella A, Lotta LA, Overton JD, Baras A, Sartorio A, Minuz P, Gill D, Melander O, Fava C. Association of Thyroid Function with Blood Pressure and Cardiovascular Disease: A Mendelian Randomization. J Pers Med 2021; 11:jpm11121306. [PMID: 34945778 PMCID: PMC8704995 DOI: 10.3390/jpm11121306] [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: 10/06/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
Thyroid function has a widespread effect on the cardiometabolic system. However, the causal association between either subclinical hyper- or hypothyroidism and the thyroid hormones with blood pressure (BP) and cardiovascular diseases (CVD) is not clear. We aim to investigate this in a two-sample Mendelian randomization (MR) study. Single nucleotide polymorphisms (SNPs) associated with thyroid-stimulating hormone (TSH), free tetraiodothyronine (FT4), hyper- and hypothyroidism, and anti-thyroid peroxidase antibodies (TPOAb), from genome-wide association studies (GWAS), were selected as MR instrumental variables. SNPs-outcome (BP, CVD) associations were evaluated in a large-scale cohort, the Malmö Diet and Cancer Study (n = 29,298). Causal estimates were computed by inverse-variance weighted (IVW), weighted median, and MR-Egger approaches. Genetically increased levels of TSH were associated with decreased systolic BP and with a lower risk of atrial fibrillation. Hyperthyroidism and TPOAb were associated with a lower risk of atrial fibrillation. Our data support a causal association between genetically decreased levels of TSH and both atrial fibrillation and systolic BP. The lack of significance after Bonferroni correction and the sensitivity analyses suggesting pleiotropy, should prompt us to be cautious in their interpretation. Nevertheless, these findings offer mechanistic insight into the etiology of CVD. Further work into the genes involved in thyroid functions and their relation to cardiovascular outcomes may highlight pathways for targeted intervention.
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Affiliation(s)
- Alice Giontella
- Department of Medicine, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.); (P.M.)
- Clinical Research Center, Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden;
| | - Luca A. Lotta
- Regeneron Genetics Center, Tarrytown, NY 10591, USA; (L.A.L.); (J.D.O.); (A.B.)
| | - John D. Overton
- Regeneron Genetics Center, Tarrytown, NY 10591, USA; (L.A.L.); (J.D.O.); (A.B.)
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, NY 10591, USA; (L.A.L.); (J.D.O.); (A.B.)
| | | | - Andrea Sartorio
- Department of Medicine, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.); (P.M.)
| | - Pietro Minuz
- Department of Medicine, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.); (P.M.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, Imperial College London, London SW7 2AZ, UK;
- Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford OX3 7FZ, UK
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
- Clinical Pharmacology and Therapeutics Section, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Olle Melander
- Clinical Research Center, Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden;
- Department of Emergency and Internal Medicine, Skåne University Hospital, 214 28 Malmö, Sweden
| | - Cristiano Fava
- Department of Medicine, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.); (P.M.)
- Clinical Research Center, Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden;
- Correspondence:
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Jamal MT, Li Q, Li Q, Liang W, Wang L, Wei J, Liang Q, Hu N, Li L. Association of thyroid hormones with blood pressure and arterial stiffness in the general population: The Dali study. J Clin Hypertens (Greenwich) 2021; 23:363-372. [PMID: 33369115 PMCID: PMC8029764 DOI: 10.1111/jch.14154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022]
Abstract
Thyroid dysfunction plays a role in blood pressure (BP) regulation. However, the associations between thyroid function and BP and arterial stiffness in the general Chinese population without thyroid disease are unknown. This population-based cross-sectional study aimed to investigate the association between thyroid function and peripheral and central BP and arterial stiffness in Chinese individuals. After excluding those who had thyroid diseases or incomplete clinical measurements, this study included 691 participants. Of the participants, 444 (64.2%) were women and 215 (31.1%) had hypertension. After adjustment for covariates, serum FT3 was significantly associated with a higher pulse rate in both sexes. In men, each 2.72-fold increase in serum FT4 levels was associated with higher peripheral systolic BP (+10.82 mmHg, p = .005) and pulse pressure (+5.71 mmHg, p = .03). Each 2.72-fold increase in serum FT4 levels was associated with higher central systolic BP (+8.03 mmHg, p = .03) and pulse pressure (+3.89 mmHg, p = .05). In women, serum FT4 was only associated with a higher central pulse pressure (+2.96 mmHg, p = .04). After adjustment for covariates, serum FT4 was significantly associated with a faster cfPWV exclusively in men. Our study showed that serum FT4 is associated with higher peripheral and central BP and faster cfPWV in men, whereas serum FT3 is positively associated with a higher pulse rate in both sexes, indicating that the effects of thyroid function on BP and arterial stiffness are more significant in men than in women.
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Affiliation(s)
- Md Tasneem Jamal
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Qing‐Lu Li
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Qi‐Yan Li
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Wan‐Ying Liang
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Li‐Hong Wang
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Jian‐Hang Wei
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Quan Liang
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Nai‐Qing Hu
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
| | - Li‐Hua Li
- Department of GerontologyThe First Affiliated Hospital of Dali UniversityDaliChina
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