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.

IntroductionIn the emerging health care scenario in developing countries, urbanized lifestyle changes are resulting in increased prevalence of cardiovascular risk factors (diabetes, obesity, hypertension [HTN], and hypercholesterolemia). These in turn result in cardiovascular diseases (CVDs) that include coronary heart disease and stroke. The accuracy of the treadmill stress test (TMT) in predicting significant coronary heart disease is variable, depending Keywords ► coronary artery disease ► coronary angiography ► treadmill stress test AbstractBackground Treadmill stress test (TMT) is the most commonly performed stress test for diagnosis of coronary artery disease (CAD) in outpatient setting. The present study was conducted to find correlation of TMT with coronary angiography (CAG) in males versus female patients. Methods Total 422 patients who had undergone CAG and TMT were enrolled in present study. TMT test was done using Bruce protocol, and results were classified as inconclusive, low, intermediate, and high probability for inducible ischemia. Results Of 422 patients enrolled in the present study, 290 (69%) were males and 132 (31%) were females. Clinical presentation was angina on exertion CCS class II-III in 302 (71.6%) patients and angina equivalent in 124 (29.4%) patients. Out of these, 211 (50.2%) were diabetic and 308 (72.9%) were hypertensive. TMT was inconclusive, low, intermediate, and high probability for inducible ischemia in 35 (8.2%), 40 (9.7%), 19 (4.5%), and 328 (77.7%) patients, respectively. CAGs were normal in 149 (35.4%) patients and abnormal in 273 (64.6%) patients. Out of 328 patients with strongly positive TMT, 104 (31.7%) had normal coronaries, 56 (17%) had mild CAD, while 75 (22.8%) had SVD. LMCA disease, DVD, and TVD were found in 5 (1.5%), 48 (14.6%), and 40 (12.1%) patients, respectively. Of 132 female patients, 70 (53%) were found to have CAD and 62 (47%) had normal coronaries on CAG. Of 290 males, 241(83.1%) were found to have CAD and 49 (16.8%) had normal coronaries on CAG. Positive predictive value (PPV) in females was 53% and in males was 83%. Subgroup analysis showed that if there was high-probability TMT along with older age (p < 0.00), male sex (p < 0.01), and diabetes (p < 0.00), chances of having CAD were more. Conclusion PPV of positive TMT in female is 53% and in male is 83%. High-probability TMT along with the older age, male sex, and presence of diabetes mellitus (DM) makes the probability of having CAD is high.