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Li W, Qiu D, Yin H, Wang Y, Chen Y, Liu Q, Ma H, Geng Q. The Prognostic Value of Thyroid-Stimulating Hormone in Patients with Coronary Artery Disease and Depression. Int J Gen Med 2022; 15:4675-4683. [PMID: 35548588 PMCID: PMC9081036 DOI: 10.2147/ijgm.s364146] [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: 02/26/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with the comorbidity of coronary artery disease (CAD) and depression are very common and always have poor prognosis. The relationship between thyroid-stimulating hormone (TSH) levels and major cardiovascular event (MACE) in these patients is still unknown. We aimed to explore this association. Patients and Methods We enrolled 203 CAD patients proven by coronary angiography (CAG). In the meanwhile, they were all assessed to have depression symptom by professional psycho-cardiologists. After an average follow-up of 23.7 months, patients were divided into two groups (high TSH group with TSH ≥ 1.395μIU/mL and low TSH group with TSH < 1.395μIU/mL) according to the cut-off value of baseline TSH. The impact of two different TSH groups for adverse events in CAD patients with depression was evaluated. Results The average age of these patients was 64.9 years old. The two TSH groups had no significant difference in the comparison of other baseline data. Area under the receiver operating characteristic (ROC) curves (AUC) analysis indicated the well-discriminatory power of TSH levels for the occurrence of MACE (AUC = 0.61, 95% CI: 0.52–0.70, P = 0.03). In the KM survival analysis, high TSH group had a higher risk of MACE (P = 0.029). After multi-factor adjustment, there still existed a higher risk of MACE in high TSH group (HR = 2.05, 95% CI: 1.08–3.88, P = 0.028). Conclusion In patients with the comorbidity of CAD and depression, higher TSH levels are associated with the occurrence of MACE. More researches need to be conducted to prove this association and explore whether the drug-related TSH reduction can decrease the occurrence of adverse events in the future.
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Affiliation(s)
- Weiya Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Di Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Han Yin
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Yu Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Yilin Chen
- School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Quanjun Liu
- School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Qingshan Geng
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
- Correspondence: Qingshan Geng, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China, Tel +86 20 83827812, Email
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Kim H, Kong SH, Moon JH, Kim SY, Park KH, Kim JS, Choh JH, Park YJ, Lim C. Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery. Endocrinol Metab (Seoul) 2020; 35:308-318. [PMID: 32615715 PMCID: PMC7386124 DOI: 10.3803/enm.2020.35.2.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/06/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the associations between subclinical hypothyroidism (SCH) and long-term cardiovascular outcomes after coronary artery bypass grafting (CABG) or heart valve surgery (HVS). METHODS We retrospectively reviewed and compared all-cause mortality, cardiovascular mortality, and cardiovascular events in 461 patients who underwent CABG and 104 patients who underwent HVS. RESULTS During a mean±standard deviation follow-up duration of 7.6±3.8 years, there were 187 all-cause deaths, 97 cardiovascular deaths, 127 major adverse cardiovascular events (MACE), 11 myocardial infarctions, one unstable angina, 70 strokes, 30 hospitalizations due to heart failure, 101 atrial fibrillation, and 33 coronary revascularizations. The incidence of all-cause mortality after CABG was significantly higher in patients with SCH (n=36, 55.4%) than in euthyroid patients (n=120, 30.3%), with a hazard ratio of 1.70 (95% confidence interval, 1.10 to 2.63; P=0.018) after adjustment for age, sex, current smoking status, body mass index, underlying diseases, left ventricular dysfunction, and emergency operation. Interestingly, low total triiodothyronine (T3) levels in euthyroid patients who underwent CABG were significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and MACE, but those associations were not observed in HVS patients. Both free thyroxine and thyroid-stimulating hormone levels in euthyroid patients were not related with any cardiovascular outcomes in either the CABG or HVS group. CONCLUSION SCH or low total T3 might be associated with a poor prognosis after CABG, but not after HVS, implying that preoperative thyroid hormonal status may be important in ischemic heart disease patients.
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Affiliation(s)
- Hana Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Ilsan Cha Medical Center, Goyang,
Korea
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Sang Yoon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Joong Haeng Choh
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
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de Vries TI, de Valk HW, van der Graaf Y, de Borst GJ, Cramer MJM, Jaap Kappelle L, Visseren FLJ, Westerink J. Normal-range thyroid-stimulating hormone levels and cardiovascular events and mortality in type 2 diabetes. Diabetes Res Clin Pract 2019; 157:107880. [PMID: 31628967 DOI: 10.1016/j.diabres.2019.107880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Abstract
AIMS Thyroid dysfunction is a risk factor for cardiovascular disease. Whether thyroid function within the normal range is a risk factor for cardiovascular disease remains uncertain. The aim of this study is to evaluate whether plasma thyroid-stimulating hormone (TSH) levels in the normal range are a risk factor for cardiovascular disease and mortality in participants with type 2 diabetes mellitus with high cardiovascular risk. METHODS We included 1265 participants with high cardiovascular risk, type 2 diabetes, and TSH within the normal range (0.35-5.00 mIU/L) from the Second Manifestations of ARTerial disease cohort. The primary outcome was major cardiovascular events (MACE; vascular death, stroke and myocardial infarction). Secondary outcomes of interest were the separate vascular outcomes and all-cause mortality. Cox proportional hazard models were used to evaluate the risk of plasma TSH levels on all outcomes. RESULTS A total of 191 MACE occurred during a total follow-up of 8183 years. Plasma TSH levels were not associated with MACE (hazard ratio (HR) per mIU/L TSH increase 0.93; 95% confidence interval (95%CI) 0.80-1.08). With a total of 54 strokes during the study period, plasma TSH was associated with a lower risk of stroke (HR per mIU/L 0.64, 95% CI 0.45-0.89). There was no association between plasma TSH levels and risk of myocardial infarction, vascular death, or all-cause mortality. CONCLUSIONS Higher TSH levels within the normal range are associated with a lower risk of stroke in high-risk patients with type 2 diabetes, but not associated with the risk of other cardiovascular events or mortality.
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Affiliation(s)
- Tamar I de Vries
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Maarten J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
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Chen J, Shi M, Wang N, Yi P, Sun L, Meng Q. TSH inhibits eNOS expression in HMEC-1 cells through the TSHR/PI3K/AKT signaling pathway. ANNALES D'ENDOCRINOLOGIE 2019; 80:273-279. [PMID: 31606200 DOI: 10.1016/j.ando.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effects of thyroid-stimulating hormone (TSH) on the expression of endothelial nitric oxide synthase (eNOS) in human microvascular endothelial cells (HMEC-1) and explore the potential mechanism. MATERIALS AND METHODS Expression of thyroid-stimulating hormone receptor (TSHR) in HMEC-1 cells was determined by immunofluorescence, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting. Cell proliferation and the production of nitric oxide (NO) and superoxide anion (SA) were measured after TSH treatment. eNOS expression and AKT phosphorylation were detected by Western blotting. RESULTS TSHR was expressed in HMEC-1 cells. TSH promoted HMEC-1 cell proliferation and SA production, but inhibited NO generation by dose-dependent blocking of mRNA and protein expression of eNOS. Mechanism studies demonstrated that TSH promoted AKT phosphorylation (P<0.05), and that LY294002 inhibited the reduction of eNOS expression by TSH. Moreover, TSH activated the AKT signaling pathway through binding to TSHR on HMEC-1 cells. CONCLUSIONS TSH inhibits NO production via the TSHR/AKT signaling pathway.
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Affiliation(s)
- Jing Chen
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China
| | - Minmin Shi
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China
| | - Na Wang
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China
| | - Pengfei Yi
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China
| | - Lin Sun
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China
| | - Qiang Meng
- Department of Endocrinology 1, Affiliated Hospital of Jining Medical University, 272029 Jining, Shandong, China.
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Kalinowska S, Trześniowska-Drukała B, Safranow K, Pełka-Wysiecka J, Kłoda K, Misiak B, Samochowiec J. Association between thyroid function and metabolic syndrome in male and female schizophrenia patients. Psychiatry Res 2019; 274:167-175. [PMID: 30802688 DOI: 10.1016/j.psychres.2019.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 02/09/2023]
Affiliation(s)
- Sylwia Kalinowska
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewski Street, Szczecin 71-460, Poland.
| | | | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 72 Powstancow Wlkp Street, Szczecin 70-111, Poland
| | - Justyna Pełka-Wysiecka
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewski Street, Szczecin 71-460, Poland
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, 1 Rybacka Street, Szczecin 70-204, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, Wroclaw 50-368, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, 26 Broniewski Street, Szczecin 71-460, Poland
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Altay S, Onat A, Can G, Tusun E, Şimşek B, Kaya A. High-normal thyroid-stimulating hormone in euthyroid subjects is associated with risk of mortality and composite disease endpoint only in women. Arch Med Sci 2018; 14:1394-1403. [PMID: 30393495 PMCID: PMC6209708 DOI: 10.5114/aoms.2016.63264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/17/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events. MATERIAL AND METHODS In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender. RESULTS In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments. CONCLUSIONS The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.
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Affiliation(s)
- Servet Altay
- Department of Cardiology, Trakya University, Edirne, Turkey
| | - Altan Onat
- Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Eyyup Tusun
- Department of Cardiology, Sanliurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Barış Şimşek
- Department of Cardiology, Siyami Ersek Center for Cardiovascular Surgery, Istanbul, Turkey
| | - Adnan Kaya
- Department of Cardiology, Suruç State Hospital, Şanliurfa, Turkey
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7
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Golledge J, Hankey GJ, Almeida OP, Flicker L, Norman PE, Yeap BB. Plasma free thyroxine in the upper quartile is associated with an increased incidence of major cardiovascular events in older men that do not have thyroid dysfunction according to conventional criteria. Int J Cardiol 2018; 254:316-321. [DOI: 10.1016/j.ijcard.2017.10.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 12/29/2022]
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8
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Bano A, Dhana K, Chaker L, Kavousi M, Ikram MA, Mattace-Raso FUS, Peeters RP, Franco OH. Association of Thyroid Function With Life Expectancy With and Without Cardiovascular Disease: The Rotterdam Study. JAMA Intern Med 2017; 177:1650-1657. [PMID: 28975207 PMCID: PMC5710266 DOI: 10.1001/jamainternmed.2017.4836] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Variations in thyroid function within reference ranges are associated with an increased risk of cardiovascular disease (CVD) and mortality. However, the impact of thyroid function on life expectancy (LE) and the number of years lived with and without CVD remains unknown. OBJECTIVE To investigate the association of thyroid function with total LE and LE with and without CVD among euthyroid individuals. DESIGN, SETTING, AND PARTICIPANTS The Rotterdam Study, a population-based, prospective cohort study. We included participants without known thyroid disease and with thyrotropin and free thyroxine (FT4) levels within the reference ranges. MAIN OUTCOMES AND MEASURES Multistate life tables were used to calculate total LE and LE with and without CVD among thyrotropin and FT4 tertiles. Life expectancy estimates in men and women aged 50 years and older were obtained using prevalence, incidence rates, and hazard ratios for 3 transitions (healthy to CVD, healthy to death, and CVD to death), adjusting for sociodemographic and cardiovascular risk factors. RESULTS The mean (SD) age of the 7785 participants was 64.7 (9.8) years, and 52.5% were women. Over a median follow-up of 8.1 (interquartile range, 2.7-9.9) years, we observed 789 incident CVD events and 1357 deaths. Compared with those in the lowest tertile, men and women in the highest thyrotropin tertile lived 2.0 (95% CI, 1.0 to 2.8) and 1.4 (95% CI, 0.2 to 2.4) years longer, respectively, of which, 1.5 (95% CI, 0.2 to 2.6) and 0.9 (95% CI, -0.2 to 2.0) years longer without CVD. Compared with those in the lowest tertile, the difference in life expectancy for men and women in the highest FT4 tertile was -3.2 (95% CI, -5.0 to -1.4) and -3.5 (95% CI, -5.6 to -1.5) years, respectively, of which, -3.1 (95% CI, -4.9 to -1.4) and -2.5 (95% CI, -4.4 to -0.7) years without CVD. CONCLUSIONS AND RELEVANCE At the age of 50 years, participants with low-normal thyroid function live up to 3.5 years longer overall and up to 3.1 years longer without CVD than participants with high-normal thyroid function. These findings provide supporting evidence for a reevaluation of the current reference ranges of thyroid function and can help inform preventive and clinical care.
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Affiliation(s)
- Arjola Bano
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Section of Geriatric Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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Jain RB. Associations between the levels of thyroid hormones and lipid/lipoprotein levels: Data from National Health and Nutrition Examination Survey 2007-2012. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2017; 53:133-144. [PMID: 28549315 DOI: 10.1016/j.etap.2017.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/29/2017] [Accepted: 05/03/2017] [Indexed: 06/07/2023]
Abstract
Data from National Health and Nutrition Examination Survey for the years 2007-2012 were used to investigate associations between thyroid hormones and lipid/lipoprotein levels for a representative sample of general US population aged ≥20 years. There were no statistically significant differences for adjusted high density lipoprotein levels among thyroid function groups, namely, subclinical hyperthyroid (SCHPR), clinical hyperthyroid (CHPR), euthyroid (EU), clinical hypothyroid (CHYP), and subclinical hypothyroid (SCHYP). For the general US population, positive associations for thyroid stimulating hormones (TSH) and negative associations for free thyroxine (FT4) levels were observed with total cholesterol (TC, p<0.01), apolipoprotein B (APOB, p<0.01), and triglycerides (TG, p<0.01). A 10% increase in TC levels was associated with a 2% increase in TSH levels and 0.8% decrease in FT4 levels. Among EU subjects, TG levels were positively correlated with TSH (p<0.01) and negatively correlated with FT4 (p<0.01). For CHYP subjects, TG levels were negatively correlated with TSH (p<0.01). For iodine deficient participants, low density lipoprotein levels (LDL) were lower for SCHPR when compared with EU or CHYP (p<0.01). TC levels were usually lower for SCHPR than for EU, CHYP, and SCHYP but the differences were not necessarily statistically significant. For all participants and for iodine replete participants, TG levels for SCHPR were lower than for CHYP (p<0.01). CHYP and SCHYP had higher levels of TG than other three thyroid function groups. APOB levels were lower for SCHPR than for EU and CHYP for all participants and for iodine replete participants (p<0.01). There was a positive association between the four quartiles of thyroid stimulating hormones and TC, TG, and APOB. There was also an inverse association between the quartiles of free thyroxine levels and LDL, TC, TG, and APOB.
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Affiliation(s)
- Ram B Jain
- 2959 Estate View Ct, Dacula, GA 30019, USA.
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10
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Merke A, Merke J, Silbernagel G, März W. FREE THYROID HORMONES AND MORTALITY IN CAUCASIANS UNDERGOING ANGIOGRAPHY: THE LUDWIGSHAFEN RISK AND CARDIOVASCULAR HEALTH (LURIC) STUDY. Endocr Pract 2016; 23:288-298. [PMID: 27849383 DOI: 10.4158/ep161217.or] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Alterations in thyroid hormone functions are associated with mortality and morbidity. Data on euthyroid individuals are very limited and controversial. We therefore investigated the relationship between circulating thyroid hormones and all-cause and cardiovascular (CV) mortality in participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study and their association with morbidity. METHODS LURIC, a prospective, observational study of a hospital-based cohort of Caucasians, was recruited between June 1997 and May 2001 at the Ludwigshafen General Hospital, Ludwigshafen, Germany. Mortality was recorded for a follow-up period of 10 years. The current investigation includes 2,507 patients without overt thyroid disease who all underwent coronary angiography. Blood was drawn before angiography. We evaluated the association between thyroid hormone concentrations and mortality. RESULTS Low free triiodothyronine (FT3) (hazard ratio [HR], 1.00 versus 0.54; lowest versus highest quartile) and high free thyroxine (FT4) (HR, 1.52 versus 1.00; highest versus lowest quartile) were significant predictors of all-cause and CV mortality, independent of age and sex. Thyroid-stimulating hormone showed no consistent correlation with mortality. CONCLUSION High FT4 and low FT3 concentrations are significantly related to all-cause and CV mortality. These findings suggest that free thyroid hormones should be measured and considered in patients at intermediate to high risk of coronary heart disease. ABBREVIATIONS BMI = body mass index CAD = coronary artery disease CCI = Charlson Comorbidity Index CI = confidence interval CV = cardiovascular eGFR = estimated glomerular filtration rate FT3 = free triiodothyronine FT4 = free thyroxine HR = hazard ratio T3 = triiodothyronine T4 = thyroxine TSH = thyroid-stimulating hormone.
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11
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Ndrepepa G, Braun S, Mayer K, Cassese S, Fusaro M, Byrne RA, Hoppmann P, Schunkert H, Laugwitz KL, Kastrati A. Prognostic value of thyroid-stimulating hormone within reference range in patients with coronary artery disease. Metabolism 2015; 64:1308-15. [PMID: 26298467 DOI: 10.1016/j.metabol.2015.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/01/2015] [Accepted: 07/14/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) in the upper part of reference range is associated with cardio-metabolic disorders. The association of TSH within reference range with prognosis of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains poorly investigated. METHODS The study included 8010 consecutive patients with CAD who were treated with PCI. All patients had a TSH level within reference range (0.3 to 4.0 mU/L). The primary outcome was 3-year all-cause mortality. RESULTS TSH tertiles were: 1st tertile (0.3 mU/L to <1.02 mU/L; n=2694), 2nd tertile (1.02 mU/L to <1.67 mU/L; n=2654) and 3rd tertile (1.67 mU/L to 4.00 mU/L; n=2662). The primary outcome (3-year mortality) occurred in 753 patients: 240 deaths in the 1st, 227 deaths in the 2nd and 286 deaths in the 3rd TSH tertile (Kaplan-Meier estimates of mortality 10.2%, 9.8% and 12.3%; adjusted hazard ratio [HR]=1.31, 95% confidence interval [CI] 1.04-1.66 for each tertile increase). TSH level was associated with 30-day mortality (mortality estimates, 1.6% in the 1st, 1.6% in the 2nd and 3.5% in the 3rd TSH tertile; adjusted HR=2.30 [1.33-3.97] for each tertile increase) but not with 30-day to 3-year mortality (mortality estimates, 8.6% in the 1st, 8.2% in the 2nd and 8.8% in the 3rd TSH tertile; P=0.603). The incidence of cardiogenic shock or peri-PCI bleeding was increased in patients in the upper TSH tertile. CONCLUSION In patients with CAD undergoing PCI, TSH level in the upper part of reference range was associated with increased risk of mortality after PCI.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
| | - Siegmund Braun
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | | | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Petra Hoppmann
- 1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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12
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Suh S, Kim DK. Subclinical Hypothyroidism and Cardiovascular Disease. Endocrinol Metab (Seoul) 2015; 30:246-51. [PMID: 26248862 PMCID: PMC4595347 DOI: 10.3803/enm.2015.30.3.246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 01/07/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is a common disorder that is characterized by elevated thyroid-stimulating hormone levels in conjunction with free thyroxine concentrations within the normal reference range. Thyroid hormones are known to affect the heart and vasculature and, as a result, the impact of SCH on the cardiovascular (CV) system has recently become an important topic of research. Strong evidence points to a link between SCH and CV risk factors such as alterations in blood pressure, lipid levels, and atherosclerosis. Additionally, accumulating evidence indicates that SCH is associated with metabolic syndrome and heart failure. The present review proposes that SCH may be a potentially modifiable risk factor of CV disease and mortality. However, large-scale clinical trials with appropriate power investigating the risks and benefits of SCH treatment are required to determine whether these benefits can be achieved with levothyroxine therapy.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Duk Kyu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea.
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13
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Zhang Y, Chang Y, Ryu S, Cho J, Lee WY, Rhee EJ, Kwon MJ, Pastor-Barriuso R, Rampal S, Han WK, Shin H, Guallar E. Thyroid hormones and mortality risk in euthyroid individuals: the Kangbuk Samsung health study. J Clin Endocrinol Metab 2014; 99:2467-76. [PMID: 24708095 DOI: 10.1210/jc.2013-3832] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear. OBJECTIVE To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints. SETTING AND DESIGN A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records. RESULTS After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95, comparing the highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints. CONCLUSIONS In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.
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Affiliation(s)
- Yiyi Zhang
- Departments of Epidemiology and Medicine (Y.Z., Y.C., S.R., J.C., S.R., E.G.), and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205; Department of Occupational Medicine (Y.C., S.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Seoul 110-746, South Korea; Center for Cohort Studies (Y.C., S.R., J.C.), Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea; Department of Health Sciences and Technology (J.C.), Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 135-710, South Korea; Department of Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea; Department of Laboratory Medicine (M.J.K.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea; National Center for Epidemiology (R.P.-B.), Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; Department of Social and Preventive Medicine (S.R.), Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Surgery (W.K.H.), Kangbuk Samsung Hospital and Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea; and Department of Family Medicine (H.S.), Kangbuk Samsung Hospital and Sungkyunkwan University School of Medicine. Seoul 110-746, South Korea
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14
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Anagnostis P, Efstathiadou ZA, Slavakis A, Selalmatzidou D, Poulasouchidou M, Katergari S, Karathanasi E, Dogramatzi F, Kita M. The effect of L-thyroxine substitution on lipid profile, glucose homeostasis, inflammation and coagulation in patients with subclinical hypothyroidism. Int J Clin Pract 2014; 68:857-63. [PMID: 24548294 DOI: 10.1111/ijcp.12394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIMS Subclinical hypothyroidism (SH) is associated with increased risk for atherosclerosis, mainly attributable to dyslipidaemia and hypercoagulability. However, conflicting data exist regarding the effect of L-thyroxine substitution on these parameters. The purpose of this study was to assess the effect of L-thyroxine therapy on lipidaemic profile, coagulation markers, high-sensitivity C-reactive protein (hsCRP) and glucose homoeostasis in SH patients. METHODS It was a prospective open-label study. The following parameters were measured before and 6 months after intervention: anthropometric data, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), apolipoproteins B (apoB) and A1 (apoA1), lipoprotein (a) [Lp(a)], fasting plasma glucose and insulin, homoeostasis model assessment-insulin resistance (HOMA-IR), hsCRP, antithrombin III (AT-III), protein C (PC), protein S (PS), fibrinogen and homocysteine. RESULTS Thirty-two patients (30 women) aged 52.1 ± 13.9 years with SH completed the study. Baseline mean TSH levels were 6.79 ± 2.58 mIU/ml. Achievement of euthyroidism significantly reduced systolic blood pressure (BP) in patients with SH (from 135.2 ± 18.5 to 129.7 ± 15.8 mmHg, p = 0.03) and diastolic BP only in those with baseline TSH levels > 7 mIU/ml (from 79.5 ± 9.8 to 72.1 ± 7.3 mmHg, p = 0.03). No significant changes in body weight, TC, LDL-C, HDL-C, TG, apoB, glucose, insulin, HOMA-IR, hsCRP, AT-III, PC, PS, fibrinogen or homocysteine levels were noticed after restoration of euthyroidism, except for a decrease in apoA1 (p = 0.04) and an increase in Lp(a) levels (p = 0.02). CONCLUSIONS Except for a reduction in systolic and diastolic BP, thyroid substitution therapy does not affect lipidaemic profile, systematic inflammation, glucose homoeostasis or coagulation in patients with SH.
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Affiliation(s)
- P Anagnostis
- Department of Endocrinology, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
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15
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Viswanathan G, Balasubramaniam K, Hardy R, Marshall S, Zaman A, Razvi S. Blood thrombogenicity is independently associated with serum TSH levels in post-non-ST elevation acute coronary syndrome. J Clin Endocrinol Metab 2014; 99:E1050-4. [PMID: 24628547 DOI: 10.1210/jc.2013-3062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Higher serum TSH levels, both within the reference range and in those with subclinical hypothyroidism (SCH), have been associated with increased risk of atherosclerosis and cardiovascular (CV) events in a number of cross-sectional and longitudinal studies. OBJECTIVE Our objective was to evaluate blood thrombogenicity in patients post-non-ST elevation acute coronary syndrome (NSTE-ACS) in relation to their thyroid function. DESIGN, PATIENTS, AND OUTCOME MEASURE: At 1 week after troponin-positive NSTE-ACS, 70 patients who had been treated with optimal antiplatelet and secondary prevention therapy were studied. Patients with known thyroid disease or on medications affecting thyroid function were excluded. Blood thrombogenicity was assessed using the ex vivo Badimon perfusion chamber. RESULTS Serum TSH was associated with higher thrombus burden (β = .30; P = .01) independent of other well-established CV risk factors. Patients with SCH (n = 12; 17%) had a higher thrombus burden than euthyroid individuals as evidenced by the area of the thrombus: mean (SD) 23 608 (10 498) vs 16 661 (10 902) μm(2)/mm (P = .02). However, this association was not evident when the analysis was limited to patients with serum TSH within the reference range. In addition, neither serum free T4 nor free T3 had any significant association with thrombus area. CONCLUSION Serum TSH levels, particularly in the SCH range, are associated with higher thrombus burden despite optimal recommended secondary prevention therapy after NSTE-ACS. This may explain the higher CV risk seen in SCH patients. Future trials to assess the effect of individualized antithrombotic as well as thyroid hormone replacement therapy to reduce atherothrombotic risk in this population are needed.
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Affiliation(s)
- Girish Viswanathan
- Institutes of Cellular Medicine (G.V., K.B., S.M., A.Z.) and Institute of Genetic Medicine (S.R.), Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom; Department of Cardiology (A.Z.), Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; and Gateshead Health National Health Service Foundation Trust (R.H., S.R.), Gateshead NE9 6SX, United Kingdom
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16
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Roef GL, Rietzschel ER, Van Daele CM, Taes YE, De Buyzere ML, Gillebert TC, Kaufman JM. Triiodothyronine and free thyroxine levels are differentially associated with metabolic profile and adiposity-related cardiovascular risk markers in euthyroid middle-aged subjects. Thyroid 2014; 24:223-31. [PMID: 24032604 PMCID: PMC3926145 DOI: 10.1089/thy.2013.0314] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We have previously shown that in healthy young men, a less favorable body composition is associated with higher free triiodothyronine (fT3) levels within the euthyroid range. Besides, a higher free-triiodothyronine-to-free-thyroxin (fT3-to-fT4) ratio has been related to a less favorable metabolic phenotype and more placental growth in pregnant women. In the present study, we therefore investigated whether serum thyrotropin (TSH), thyroid hormone levels, and the fT3-to-fT4 ratio are associated with metabolic and adiposity-related cardiovascular risk markers in a healthy population of middle-aged euthyroid men and women. METHODS Thyroid parameters were measured in 2524 generally healthy subjects from the Asklepios Study (35-55 years, mean age 46 years). Analyses were restricted to 2315 subjects (1138 women and 1177 men), not using thyroid medication, not having anti-TPO levels above clinical cutoff values or TSH levels outside the reference range (0.27-4.2 mU/L). Twenty-seven percent of the women and 47.5% of the men were overweight, while 13% of women and 17% of men were obese. Twenty percent of the subjects were active smokers. Serum thyroid function parameters were determined by electrochemiluminescence. RESULTS fT3 and the fT3-to-fT4 ratio were positively related to body mass index (BMI), waist circumference, and components of metabolic syndrome, that is, triglycerides, systolic and diastolic blood pressure, and fasting plasma glucose, and negatively with HDL-cholesterol levels, whereas fT4 was negatively associated with BMI, waist circumference, and triglycerides (p<0.001). TSH related positively with total cholesterol levels (p<0.01), triglycerides, and systolic and diastolic blood pressure (p<0.001). The fT3-to-fT4 ratio was further positively associated with the adiposity-related inflammation markers interleukin-6 and high-sensitivity C-reactive protein and to pulse wave velocity. All associations were adjusted for sex, age, height, and smoking, and most associations persisted after additional adjustment for weight or waist circumference. CONCLUSION In healthy euthyroid middle-aged men and women, higher fT3 levels, lower fT4 levels, and thus a higher fT3-to-fT4 ratio are consistently associated with various markers of unfavorable metabolic profile and cardiovascular risk.
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Affiliation(s)
- Greet L. Roef
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ernst R. Rietzschel
- Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium
| | | | - Youri E. Taes
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Thierry C. Gillebert
- Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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17
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Abete P, Adlbrecht C, Assimakopoulos SF, Côté N, Dullaart RP, Evsyukova HV, Fang TC, Goswami N, Hinghofer-Szalkay H, Ho YL, Hoebaus C, Hülsmann M, Indridason OS, Kholová I, Lin YH, Maniscalco M, Mathieu P, Mizukami H, Ndrepepa G, Roessler A, Sánchez-Ramón S, Santamaria F, Schernthaner GH, Scopa CD, Sharp KM, Skuladottir GV, Steichen O, Stenvinkel P, Tejera-Alhambra M, Testa G, Visseren FL, Westerink J, Witasp A, Yagihashi S, Ylä-Herttuala S. Research update for articles published in EJCI in 2011. Eur J Clin Invest 2013. [DOI: 10.1111/eci.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Pasquale Abete
- Dipartimento di Scienze Mediche Traslazionali; Università degli Studi di Napoli “Federico II”; Naples Italy
| | - Christopher Adlbrecht
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Nancy Côté
- Department of Surgery; Laboratoire d'Études Moléculaires des Valvulopathies (LEMV); Institut Universitaire de Cardiologie et de Pneumologie de Québec/Research Center; Laval University; Québec Canada
| | - Robin P.F. Dullaart
- Department of Endocrinology; University of Groningen and University Medical Centre Groningen; Groningen The Netherlands
| | - Helen V. Evsyukova
- Department of Hospital Therapy; Medical Faculty; St Petersburg State University; St. Petersburg Russia
| | - Te-Chao Fang
- Division of Nephrology; Department of Internal Medicine; Buddhist Tzu Chi General Hospital; Hualien Taiwan
| | - Nandu Goswami
- Institute of Physiology; Medical University of Graz; Austria
| | | | - Yi-Lwun Ho
- Department of Internal Medicine; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Clemens Hoebaus
- Department of Medicine II; Angiology, Medical University and General Hospital of Vienna; Vienna Austria
| | - Martin Hülsmann
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - Olafur S. Indridason
- Internal Medicine Services; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Ivana Kholová
- Pathology; Fimlab Laboratories; Tampere University Hospital; Tampere Finland
| | - Yen-Hung Lin
- Department of Internal Medicine; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Mauro Maniscalco
- Section of Respiratory Diseases; Hospital “S. Maria della Pietà”; Casoria Naples Italy
| | - Patrick Mathieu
- Department of Surgery; Laboratoire d'Études Moléculaires des Valvulopathies (LEMV); Institut Universitaire de Cardiologie et de Pneumologie de Québec/Research Center; Laval University; Québec Canada
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Gjin Ndrepepa
- Herz- und Kreislauferkrankungen; Deutsches Herzzentrum München; Technische Universität; Munich Germany
| | | | | | - Francesca Santamaria
- Department of Translational Medical Sciences; Federico II University; Naples Italy
| | | | | | | | - Gudrun V. Skuladottir
- Department of Physiology; Faculty of Medicine; School of Health Sciences; University of Iceland; Reykjavik Iceland
| | - Olivier Steichen
- Internal Medicine Department; Assistance Publique-Hôpitaux de Paris; Tenon Hospital; Paris France
- Faculty of Medicine; Université Pierre et Marie Curie-Paris 6; Paris France
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Marta Tejera-Alhambra
- Laboratory of Neuroimmunology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Gianluca Testa
- Dipartimento di Medicina e Scienze della Salute; Università del Molise; Campobasso Italy
| | - Frank L.J. Visseren
- Department of Vascular Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Anna Witasp
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Seppo Ylä-Herttuala
- A.I.Virtanen Institute for Molecular Sciences; University of Eastern Finland; Kuopio Finland
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