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Isailă OM, Stoian VE, Fulga I, Piraianu AI, Hostiuc S. The Relationship between Subclinical Hypothyroidism and Carotid Intima-Media Thickness as a Potential Marker of Cardiovascular Risk: A Systematic Review and a Meta-Analysis. J Cardiovasc Dev Dis 2024; 11:98. [PMID: 38667716 PMCID: PMC11049994 DOI: 10.3390/jcdd11040098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/21/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Thyroid dysfunction is known to have significant consequences on the cardiovascular system. The correlation between carotid intima-media thickness (CIMT) and subclinical hypothyroidism (SCH) has been frequently evaluated in clinical studies in recent years. This study aimed to evaluate the significance of this association through a meta-analysis. METHODS We conducted a systematic search of PubMed, MedLine, Scopus, and Web of Science databases using the keywords 'subclinical hypothyroidism and carotid intima-media thickness', from the beginning of each database until January 2023. We established the inclusion and exclusion criteria and considered studies that met the inclusion criteria. We used Jamovi for statistical analysis of the data. RESULTS We identified 39 observational studies that met the inclusion criteria, with 3430 subjects: 1545 SCH and 1885 EU. Compared to euthyroid subjects (EU), subjects with subclinical hypothyroidism (SCH) had significantly increased carotid intima-media thickness (CIMT) values; the estimated average mean difference was 0.08 (95% CI 0.05 to 0.10), p < 0.01, I2 = 93.82%. After the sensitivity analysis, a total of 19 from the 39 abovementioned studies were analyzed, with most studies showing a positive association between SCH and thickening of the carotid wall; the estimated average mean difference was 0.04 (95% CI 0.02 to 0.07), p = 0.03, I2 = 77.7. In addition, female sex, advanced age, and high cholesterol levels statistically significantly influenced this association. CONCLUSIONS Our meta-analysis indicates a significant positive association between SCH and increased CIMT, but with some limitations.
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Affiliation(s)
- Oana-Maria Isailă
- Department of Legal Medicine and Bioethics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Victor Eduard Stoian
- Department of Legal Medicine, Legal Medicine Service Dâmbovița, 130083 Târgoviște, Romania
| | - Iuliu Fulga
- Department of Legal Medicine, Dunărea de Jos University, 800201 Galați, Romania (A.-I.P.)
| | - Alin-Ionut Piraianu
- Department of Legal Medicine, Dunărea de Jos University, 800201 Galați, Romania (A.-I.P.)
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Zhao S, Zhang B, Han Y, Guan J, Fang W, Zhang H, Wang A. Increased 10-year cardiovascular disease risk in depressed patients with coexisting subclinical hypothyroidism. Front Psychiatry 2023; 14:1185782. [PMID: 37469355 PMCID: PMC10352495 DOI: 10.3389/fpsyt.2023.1185782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/29/2023] [Indexed: 07/21/2023] Open
Abstract
Purpose The prevalence of depressive disorder (DD) and subclinical hypothyroidism (SH) was almost twofold higher in women compared with men, both of which are confirmed to be related to cardiovascular disease (CVD) risk. The current study aimed to identify the prevalence of CVD risk factors and evaluate the 10-year CVD risk in female depressed patients with and without comorbid SH. Methods We recruited 1744 female inpatients with a diagnosis of DD. Venous blood samples were taken from all patients for lipid and thyroid hormones. Framingham Risk Score (FRS) was used to estimate the 10-year CVD risk. Results Female depressed patients with SH had increased BMI, higher Hamilton Anxiety Scale (HAMA) scores, higher LDL-C, TC, UA, and a higher 10-year CVD risk than euthyroid DD groups. Serum TSH levels and HAMA scores were critical predictive variables for 10-year CVD risk in female depressed patients with comorbid SH. Conclusion Our study suggests that female depressed patients with SH have a high 10-year CVD risk. Serum TSH levels and HAMA scores may be helpful to predict cardiovascular risk in female patients with SH. The increased CVD risk in female depressed patients with comorbid SH requires more attention from researchers and clinicians.
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Affiliation(s)
- Shuai Zhao
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Boyu Zhang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Yuqin Han
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Jianjun Guan
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Wenmei Fang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Hongqin Zhang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
| | - Anzhen Wang
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Anhui Mental Health Center, Hefei, China
- Anhui Clinical Research Center for Mental Disorders, Hefei, China
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Hou LY, Li X, Zhang GQ, Xi C, Shen CT, Song HJ, Bai WK, Qiu ZL, Luo QY. Transiently impaired endothelial function during thyroid hormone withdrawal in differentiated thyroid cancer patients. Front Endocrinol (Lausanne) 2023; 14:1164789. [PMID: 37424871 PMCID: PMC10327818 DOI: 10.3389/fendo.2023.1164789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Endothelial dysfunction, which was associated with chronic hypothyroidism, was an early event in atherosclerosis. Whether short-term hypothyroidism following thyroxine withdrawal during radioiodine (RAI) therapy was associated with endothelial dysfunction in patients with differentiated thyroid cancer (DTC) was unclear. Aim of the study was to assess whether short-term hypothyroidism could impair endothelial function and the accompanied metabolic changes in the whole process of RAI therapy. Methods We recruited fifty-one patients who underwent total thyroidectomy surgery and would accept RAI therapy for DTC. We analyzed thyroid function, endothelial function and serum lipids levels of the patients at three time points: the day before thyroxine withdrawal(P1), the day before 131I administration(P2) and 4-6 weeks after RAI therapy(P3). A high-resolution ultrasound named flow-mediated dilation (FMD) was used to measure endothelial function of the patients. Results We analyzed the changes of FMD, thyroid function and lipids at three time points. FMD(P2) decreased significantly compared to FMD(P1) (P1vsP2, 8.05 ± 1.55vs 7.26 ± 1.50, p<0.001). There was no significant difference between FMD(P3) and FMD(P1) after restoring TSH (thyroid stimulating hormone) suppression therapy (P1 vs P3, 8.05 ± 1.55 vs 7.79 ± 1.38, p=0.146). Among all parameters, the change of low-density lipoprotein (ΔLDL) was the only factor correlated negatively with the change of FMD (ΔFMD) throughout the RAI therapy process (P1-2, r=-0.326, p=0.020; P2-3, r=-0.306, p=0.029). Conclusion Endothelial function was transiently impaired in DTC patients at short-term hypothyroidism state during the RAI therapy, and immediately returned to the initial state after restoring TSH suppression therapy.
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Affiliation(s)
- Li-ying Hou
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Ultrasound in Medicine, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Guo-qiang Zhang
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuang Xi
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-tian Shen
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-jun Song
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-kun Bai
- Department of Ultrasound in Medicine, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Zhong-ling Qiu
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan-yong Luo
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abu-Awwad A, Tudoran C, Patrascu JM, Faur C, Tudoran M, Mekeres GM, Abu-Awwad SA, Csep AN. Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1640. [PMID: 36837270 PMCID: PMC9966432 DOI: 10.3390/ma16041640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Abu-Awwad
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Ilfov Str. Nr. 3, 030167 Bucuresti, Romania
| | - Jenel Marian Patrascu
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cosmin Faur
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Gabriel Mihai Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Andrei Nicolae Csep
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
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Arterial Stiffness in Thyroid and Parathyroid Disease: A Review of Clinical Studies. J Clin Med 2022; 11:jcm11113146. [PMID: 35683533 PMCID: PMC9180991 DOI: 10.3390/jcm11113146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Growing evidence shows that arterial stiffness measurement provides important prognostic information and improves clinical stratification of cardiovascular risk. Thyroid and parathyroid diseases are endocrine diseases with a relevant cardiovascular burden. The objective of this review was to consider the relationship between arterial stiffness and thyroid and parathyroid diseases in human clinical studies. We performed a systematic literature review of articles published in PubMed/MEDLINE from inception to December 2021, restricted to English languages and to human adults. We selected relevant articles about the relationship between arterial stiffness and thyroid and parathyroid diseases. For each selected article, data on arterial stiffness were extracted and factors that may have an impact on arterial stiffness were identified. We considered 24 papers concerning hypothyroidism, 9 hyperthyroidism and 16 primary hyperparathyroidism and hypoparathyroidism. Most studies evidenced an increase in arterial stiffness biomarkers in hypothyroidism, hyperthyroidism and primary hyperparathyroidism, even in subclinical and mild forms, although heterogeneity of measurement methods and of study designs prevented a definitive conclusion, suggesting that the assessment of arterial stiffness may be considered in the clinical evaluation of cardiovascular risk in these diseases.
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Bernardi S, Grillo A, Antonello RM, Cola MF, Dobrinja C, Fabris B, Giudici F. Meta-analysis on the association between thyroid hormone disorders and arterial stiffness. J Endocr Soc 2022; 6:bvac016. [PMID: 35284772 PMCID: PMC8907416 DOI: 10.1210/jendso/bvac016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Context Aortic stiffness is an emerging predictor of cardiovascular morbidity and mortality. Current data about the effect of subclinical and overt thyroid hormone disorders on aortic stiffness are often conflicting. Objective Primary outcome was to investigate if subclinical and overt thyroid hormone disorders were associated with aortic stiffness. Secondary outcome was to identify disease effect modifiers. Methods Data sources were PubMed, Google Scholar, SCOPUS, Web of Sciences, and the Cochrane Library. Eligible studies included reports of pulse wave velocity (PWV), which is the gold standard method for measuring aortic stiffness, in patients with subclinical and overt thyroid disorders. Two investigators independently identified eligible studies and extracted data. Pooled mean difference was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Univariate meta-regression analysis was used to identify effect modifiers. Results Eleven observational studies were selected, including 1239 patients with subclinical hypothyroidism, 81 patients with overt hypothyroidism, 338 patients with thyrotoxicosis, and 12 715 controls. PWV was significantly higher in subclinical (P < .001) and overt hypothyroidism (P < .001), as well as in patients with thyrotoxicosis (P = .027) compared with controls. Age was an effect modifier in hypothyroid patients. Conclusion This study shows that both overt and subclinical hypothyroidism as well as thyrotoxicosis were associated with an increase of aortic stiffness. The impact of treatment of these conditions on aortic stiffness should be assessed in clinical trials.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Andrea Grillo
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | | | - Marco Fabio Cola
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Chiara Dobrinja
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Chirurgia Generale, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Bruno Fabris
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Operative Unit of Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Hospital, Trieste, Italy
| | - Fabiola Giudici
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Kumari B, Kumar B, Gupta D, Ganju N. FMD and CIMT: Surrogate Markers of Atherosclerosis in Subclinical and Overt Hypothyroidism in Sub Himalyan Region. Indian J Endocrinol Metab 2021; 25:220-225. [PMID: 34760677 PMCID: PMC8547403 DOI: 10.4103/ijem.ijem_247_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypothyroidism increases the risk of atherosclerosis. Carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) have been used as a noninvasive method to detect atherosclerosis. But the literature is scarce on patients with subclinical hypothyroidism. Such a study was not done in our region, so we conducted this study at a tertiary care center to compare CIMT and FMD among subclinical and overt hypothyroid patients and to analyze the risk of atherosclerosis. METHODS We evaluated 68 patients aged 18-50 years, with newly diagnosed hypothyroidism. We divided them into overt and subclinical hypothyroidism groups and compared the findings. All analyses were performed by the computerized SPSS 17.0. The results were noted as means ± SD and percentage. Student's t-test was used to compare continuous variables, and the Chi-square test was used to compare differences. RESULTS The total number of patients with dyslipidemia in the subclinical hypothyroidism (SCH) group was 22 (45.83%) and in the overt hypothyroidism (OH) group was 26 (54.16%) with a P- value of 0.009. The mean FMD% in subclinical hypothyroidism patients was 6.9816 ± 3.4224 and in overt hypothyroidism patients was 5.3670 ± 2.7278 (P = 0.03). The mean CIMT was 0.5009 ± 0.0732, CIMT in the SCH group was 0.5082 ± 0.0672 and in the OH group was 0.5305 ± 0.0799 (P = 0.2). CONCLUSION The outcome of this study specifies that hypothyroidism is associated with endothelial dysfunction as established by impaired FMD, and it may be the first marker of atherosclerosis appearing before any structural evidence like CIMT. We can speculate that there is a link between subclinical hypothyroidism and atherosclerosis, and thyroxine replacement in SCH may help to prevent the progression of atherosclerosis.
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Affiliation(s)
- Bandana Kumari
- Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
| | - Bhupender Kumar
- Medicine Department, AIIMS, Bilaspur, Himachal Pradesh, India
| | - Dalip Gupta
- Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
| | - Neeraj Ganju
- Department of Cardiology, IGMC, Shimla, Himachal Pradesh, India
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Tudoran M, Tudoran C, Ciocarlie T, Giurgi-Oncu C. Aspects of diastolic dysfunction in patients with new and recurrent depression. PLoS One 2020; 15:e0228449. [PMID: 32005035 PMCID: PMC6994243 DOI: 10.1371/journal.pone.0228449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/15/2020] [Indexed: 02/05/2023] Open
Abstract
Objective The main objective of this study was to evidence the potential impact of the intensity, duration and recurrence of depression on the development of arterial stiffness (AS) leading to left ventricular hypertrophy (LVH) and diastolic dysfunction (DD) in patients with new onset depression (NOD) and recurrent depression (RD) in comparison to 33 control subjects without depression. Another aim was to identify potential predictive factors regarding the occurrence of diastolic dysfunction (DD). Methods Our study group included 58 patients diagnosed with NOD and 128 diagnosed with RD, without any previously diagnosed significant heart diseases. The intensity of depression was evaluated by means of the Montgomery-Asberg Depression Rating Scale (MADRS). Assessment of pulse wave velocity (PWV), left ventricular mass index (LVMI) and echocardiographic parameters characterizing DD were performed for each patient. Results The cardiology evaluations suggested an increased prevalence of AS in all patients, of significantly higher rate than in controls (p<0.001), which was statistically correlated with the severity and duration of depression. Another significant finding was an increased prevalence of DD (29.31% and 63.28%, respectively; p<0.001) correlated with the MADRS score, total duration and number of recurrences/relapses. The multivariate logistic regression analysis identified PWV, the intensity and duration of depression as significant predictive factors for the occurrence of DD. Conclusions In our study, diastolic dysfunction was a common finding among patients with RD, but it was also noted, to a lesser extent, in those suffering with NOD. DD was associated with altered AS, and strongly correlated with the intensity and the duration of depressive symptoms. The two latter factors, together with an increased PWV, were strong predictors for the occurrence of DD.
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Affiliation(s)
- Mariana Tudoran
- Department VII Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy ʺVictor Babesʺ, Timisoara, Timis, Romania, County Clinical Emergency Hospital, Timisoara
| | - Cristina Tudoran
- Department VII Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy ʺVictor Babesʺ, Timisoara, Timis, Romania, County Clinical Emergency Hospital, Timisoara
- * E-mail:
| | - Tudor Ciocarlie
- Department VII Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy ʺVictor Babesʺ, Timisoara, Timis, Romania, County Clinical Emergency Hospital, Timisoara
| | - Catalina Giurgi-Oncu
- Neuroscience Department VIII, Discipline of Psychiatry, University of Medicine and Pharmacy ʺVictor Babesʺ, Timisoara, Timis, Romania, County Clinical Emergency Hospital, Timisoara
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Peixoto de Miranda ÉJF, Bittencourt MS, Goulart AC, Santos IS, Mill JG, Schmidt MI, Lotufo PA, Benseñor IJM. Lack of Association Between Subclinical Hypothyroidism and Carotid-Femoral Pulse Wave Velocity in a Cross-Sectional Analysis of the ELSA-Brasil. Am J Hypertens 2017; 30:81-87. [PMID: 27633554 DOI: 10.1093/ajh/hpw117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 07/27/2016] [Accepted: 08/28/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is little available data on carotid-femoral pulse wave velocity (cf-PWV) in subjects with subclinical hypothyroidism (SCH). We aimed to analyze the association between SCH and cf-PWV using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS We included subjects with normal thyroid function (thyrotropin (TSH): 0.4-4.0 mIU/l, and normal free thyroxine (FT4: 0.8-1.9ng/dl) and SCH (TSH > 4.0 mIU/l and normal FT4) evaluated for cf-PWV in a cross-sectional analysis. We excluded individuals using medications that interfere in thyroid function, antihypertensives, or diuretics, and subjects with chronic kidney disease or previous cardiovascular disease. Generalized linear and logistic regression models evaluated cf-PWV as a dependent variable and SCH as an independent variable, adjusted for cardiovascular risk factors. RESULTS Of 8,341 subjects (52.3% women), 7,878 (94.4%) were euthyroid and 463 (5.6%) showed SCH. The median age was 50 years (interquartile range: 44-56). The groups differed by age, sex, body mass index, glomerular filtration rate, and C-reactive protein. SCH was not associated with cf-PWV in the full-adjusted linear model (β = -0.039; P = 0.562) and with cf-PWV >75th percentile in the full-adjusted logistic model (odds ratio = 0.94; 95% confidence interval = 0.72-1.22). CONCLUSION In a large sample, SCH was not associated with increased cf-PWV.
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Affiliation(s)
| | | | | | - Itamar Souza Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - José Geraldo Mill
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Maria Ines Schmidt
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo Andrade Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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Laugesen E, Moser E, Sikjaer T, Poulsen PL, Rejnmark L. Arterial Stiffness and Central Hemodynamics in Thyroidectomized Patients on Long-Term Substitution Therapy with Levothyroxine. Thyroid 2016; 26:779-84. [PMID: 27029953 DOI: 10.1089/thy.2015.0600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term levothyroxine (LT4) therapy targeting thyrotropin (TSH) suppression in hypothyroid patients treated for thyroid cancer has been associated with increased arterial stiffness and increased cardiovascular mortality. However, most patients with hypothyroidism receive LT4 therapy targeting TSH in the reference range. The long-term vascular effects of this strategy have never been evaluated. METHODS Arterial stiffness and central hemodynamics were studied in 30 thyroidectomized patients (Mage = 54.5 ± 10.2 years; 80% female) on long-term (median = 11 years; range 3-41 years) LT4 replacement therapy targeting TSH in the reference range and 30 sex- and age-matched controls. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV) and central hemodynamics by pulse wave analysis using the SphygmoCor system. RESULTS TSH levels were comparable in patients and controls (median = 1.99 × 10(3) IU/L [range 0.24-5.64 × 10(3) IU/L] vs. median = 2.13 × 10(3) IU/L [range 0.59-5.63 × 10(3) IU/L]; p = 0.69), but patients had higher plasma thyroxine and lower plasma triiodothyronine levels than controls (median = 108 nmol/L [range 84-149 nmol/L] vs. 86 nmol/L [range 59-141 nmol/L]; p < 0.001 and median = 1.49 nmol/L [range 1.00-2.37 nmol/L] vs. 1.62 nmol/L [range 1.18-2.09 nmol/L]; p = 0.04, respectively). PWV was not significantly higher in patients compared to controls (8.2 ± 1.9 vs. 7.9 ± 1.9 m/s, p = 0.69). Similarly, no group differences were observed in central systolic/diastolic blood pressure (120 ± 16 mmHg vs. 119 ± 12 mmHg, p = 0.77; and 80 ± 11 mmHg vs. 80 ± 10 mmHg, p = 0.98, respectively), the augmentation index (28 ± 13% vs. 29 ± 8%, p = 0.72), or the pulse pressure amplification ratio (129 ± 17% vs. 124 ± 13%, p = 0.18). CONCLUSION Despite subtle differences in plasma levels of thyroid hormones, long-term LT4 replacement therapy targeting TSH in the reference range does not seem to cause adverse effects on arterial stiffness and central hemodynamics.
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Affiliation(s)
- Esben Laugesen
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus, Denmark
- 2 Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
- 3 The Danish Diabetes Academy, Odense University Hospital , Odense, Denmark
| | - Emil Moser
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Tanja Sikjaer
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Per Løgstrup Poulsen
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Lars Rejnmark
- 1 Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus, Denmark
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Berezin AE, Kremzer AA, Martovitskaya YV, Samura TA, Berezina TA. Pattern of circulating endothelial-derived microparticles among chronic heart failure patients with dysmetabolic comorbidities: The impact of subclinical hypothyroidism. Diabetes Metab Syndr 2016; 10:29-36. [PMID: 26319410 DOI: 10.1016/j.dsx.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
UNLABELLED The study aim was to evaluate the impact of dysmetabolic comorbidities including subclinical hypothyroidism (SH) on pattern of circulating endothelial-derived microparticles (EMPs) in chronic heart failure (CHF) patients. METHODS It was retrospectively involved a cohort of 388 patients with CHF. Fifty three CHF subjects had SH and 335 patients were free from thyroid dysfunction. Circulating levels of NT-pro brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), thyroid stimulating hormone (TSH), total and free thyroxine (T4) and triiodothyronine (T3) EMPs were measured at baseline. SH was defined per contemporary clinical guideline as state associated with elevated level of serum TSH>10 μU/L and basal normal free T3 and T4 concentration. RESULTS Circulating CD31+/annexin V+ EMPs were higher in SH patients compared with none SH subjects. In contrast, activated CD62E+ EMP numbers were not significantly different between both patient cohorts. Using C-statistics for Models with TSH, New York Heart Association (NYHA) class, dyslipidemia, and circulating biomarkers (hs-CRP, NT-proBNP, serum uric acid) as Continuous Variables we found that adding of NYHA class alone, NT-proBNP alone or their combination to the based model (TSH) improved the relative integrated discrimination improvement (IDI) for increased CD31+/annexin V+ to CD62E+ ratio by 4.9%; 9.2% and 9.6% respectively. NT-proBNP improves significantly predictive model based on TSH for increased CD31+/annexin V+ to CD62E+ ratio. Among patient study population for category-free net reclassification improvement (NRI), 4% of events (P=0.026) and 6% of non-events (P=0.012) were correctly reclassified by the addition of circulating NT-proBNP to the base model (TSH) for Increased CD31+/annexin V+ to CD62E+ ratio. Therefore, 4% of events (P=0.028) and 5% of non-events (P=0.014) were correctly reclassified using category-free NRI for increased CD31+/annexin V+ to CD62E+ ratio. CONCLUSION We found that SH state in CHF patients associates with impaired pattern of circulating EMPs with predominantly increased number of apoptotic-derived microparticles.
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Affiliation(s)
- Alexander E Berezin
- Cardiology Unit, Internal Medicine Department, State Medical University, 26, Mayakovsky av., Zaporozhye, UA-69035, Ukraine.
| | - Alexander A Kremzer
- Clinical Pharmacology Department, State Medical University, Zaporozhye, Ukraine
| | | | - Tatyana A Samura
- Clinical Pharmacology Department, State Medical University, Zaporozhye, Ukraine
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Berezin AE, Kremzer AA, Martovitskaya YV, Samura TA, Berezina TA. The Association of Subclinical Hypothyroidism and Pattern of Circulating Endothelial-Derived Microparticles Among Chronic Heart Failure Patients. Res Cardiovasc Med 2015; 4:e29094. [PMID: 26528453 PMCID: PMC4623383 DOI: 10.5812/cardiovascmed.29094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/09/2015] [Accepted: 06/07/2015] [Indexed: 12/28/2022] Open
Abstract
Background: Subclinical hypothyroidism (SH) is diagnosed biochemically by the presence of normal serum free thyroxine concentration, in conjunction with an elevated serum thyroid-stimulating hormone level. Recent studies have demonstrated the frequent association between SH and cardiovascular diseases and risk factors. Objectives: To evaluate the impact of SH on patterns of circulating endothelial-derived microparticles, (EMPs) among chronic heart failure (CHF) patients Patients and Methods: This is a retrospective study involving a cohort of 388 patients with CHF. Fifty-three CHF subjects had SH and 335 patients were free from thyroid dysfunction. Circulating levels of N-terminal-pro brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), thyroid-stimulating hormone (TSH), total and free thyroxine (T4), and triiodothyronine (T3), and endothelial apoptotic microparticles (EMPs), were measured at baseline. SH was defined, according to contemporary clinical guidelines, as a biochemical state associated with an elevated serum TSH level of greater 10 μU/L and normal basal free T3 and T4 concentrations. Results: Circulating CD31+/annexin V+ EMPs were higher in patients with SH compared to those without SH. In contrast, activated CD62E+ EMP numbers were not significantly different between both patient cohorts. Using uni (bi) variate and multivariate age- and gender-adjusted regression analysis, we found several predictors that affected the increase of the CD31+/annexin V+ to CD62E+ ratio in the patient study population. The independent impact of TSH per 6.5 μU/L (odds ratio [OR] = 1.23, P = 0.001), SH (OR = 1.22, P = 0.001), NT-proBNP (OR = 1.19, P = 0.001), NYHA class (OR = 1.09, P = 0.001), hs-CRP per 4.50 mg/L (OR = 1.05, P = 0.001), dyslipidemia (OR = 1.06, P = 0.001), serum uric acid per 9.5 mmol/L (OR = 1.04, P = 0.022) on the increase in the CD31+/annexin V+ to CD62E+ ratio, was determined. Conclusions: We believe that the SH state in CHF patients may be associated with the impaired pattern of circulating EMPs, with the predominantly increased number of apoptotic-derived microparticles.
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Affiliation(s)
- Alexander E. Berezin
- Consultant of Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine
- Corresponding author: Alexander E. Berezin, Consultant of Therapeutic Unit, Internal Medicine Department, State Medical University, Zaporozhye, Ukraine. Tel: +38-0612894585, E-mail:
| | | | | | - Tatyana A. Samura
- Clinical Pharmacology Department, State Medical University, Zaporozhye, Ukraine
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