Preclinical Hypothyroidism: A Risk Factor for Coronary Heart-Disease*1

Bastenie, Paul Auguste; Bonnyns, Marc; Vanhaelst, L.; Nève, Pierre; Staquet, Marie‐Jeanne

doi:10.1016/s0140-6736(71)90947-0

Cited by 145 publications

(45 citation statements)

References 4 publications

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“…First, coronary vascular stenosis is induced by local inflammation from the pathological immune reactivity in thyroid autoimmunity that may be found in most patients with SHT. 16,17 However, this suggestion was not confirmed by other studies. 13,15 Second, previous studies have clearly shown that patients with SHT have left ventricular diastolic dysfunction at rest that is reversible with thyroxine therapy 18,19 and systolic dysfunction on effort, which may result in poor physical exercise capacity.…”

Section: Discussionmentioning

confidence: 65%

“…2 Although SHT is often asymptomatic and its treatment remains unclear, previous studies have suggested that there was an association between SHT and coronary artery disease (CAD). 3,4 A recent populationbased study reported that SHT was an independent risk factor for atherosclerosis and myocardial infarction in elderly women. 5 Therefore, we hypothesized that the association of SHT with atherosclerosis and related diseases cannot be entirely attributed to dyslipidemia, and further mechanisms must be taken into consideration.…”

Section: Introductionmentioning

confidence: 99%

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Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Baycan¹,

Erdoğan²,

Çalışkan³

et al. 2007

Clinical Cardiology

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SummaryObjective: Although the cardiovascular system is highly sensitive to thyroid hormones, the cardiovascular effects of subtle thyroid dysfunction such as subclinical hypothyroidism (SHT) remain unclear. Therefore, we investigated coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SHT.Methods: Fifty subjects with SHT and 30 control subjects with normal serum thyroid hormones and TSH levels were included in this study. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity.Results: Age, gender, diastolic and systolic blood pressure, body mass index (BMI), serum lipid parameters, and thyroid hormone levels were similar between the groups. Heart rate was significantly lower in the SHT group. Left ventricular diastolic filling parameters were significantly different in the SHT group while other echocardiographic parameters were similar. CFR values were significantly lower in subjects with SHT than in the control group (2.38 ± 0.44 vs. 2.98 ± 0.47, p<0.0001).Conclusions: These findings suggest that CFR, which reflects coronary microvascular function, is impaired in patients with SHT.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Baycan¹,

Erdoğan²,

Çalışkan³

et al. 2007

Clinical Cardiology

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“…Thyroid hormone deficiency causes hypercholesterolemia and results in excess vascular risk. In patients with primary hypothyroidism, even subclinical hypothyroidism, defined as a normal circulating thyroid hormone concentration with an elevated plasma TSH level, is associated with hyperlipidemia [16]. It is suggested, therefore, that many hypopituitary patients may tend to be under-replaced for thyroid hormone in Japan.…”

Section: Discussionmentioning

confidence: 99%

Hypercholesterolemia and Obesity in Adult Patients with Hypopituitarism: A Report of a Nation-wide Survey in Japan

Murakami

Kato

2003

Endocr J

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Abstract. Dyslipidemia and obesity are common in adult patients with hypopituitarism. Possible contributions of age, sex and hormone deficiencies to hypercholesterolemia and obesity in adult hypopituitary patients were analyzed in 1, 272 Japanese cases based on a database of a national survey on adult hypopituitarism. In patients on routine hormone replacement therapy, 30.5% of male and 40.7% of female subjects were considered hypercholesterolemic. In univariate analysis, hypercholesterolemia was more prevalent in female, aged, untreated Gn-deficient and TSH-deficient groups. In multivariate analysis, sex of female, age older than 40 yr and TSH deficiency were the independent contributing factors to hypercholesterolemia. Obesity (body mass index (BMI) ³25 kg/m 2 ) was more prevalent in male, TSH-deficient and ADH-deficient groups. Severe obesity (BMI ³30) was observed in high prevalence in the youngest group. These findings suggest that hypercholesterolemia and obesity were prevalent in different age and gender groups in Japanese adult patients with hypopituitarism. Insufficient replacement of thyroid hormone and possibly gonadotropin deficiency might contribute to hypercholesterolemia. In contrast, hypothalamic dysfunction as well as hormone deficiencies might play roles in obesity in these patients.

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“…Subclinical hypothyroidism (SH), defined as the clinical status of elevated serum thyrotropin (TSH) levels, with normal levels of thyroxine (T 4 ) and triiodothyronine (T 3 ), is a more common disorder than overt hypothyroidism with a prevalence of 1.4 -7.8% in older populations and even greater percentiles among women (3,4). Some studies have associated this subtle change in thyroid function with increased risk of CAD (1,(4)(5)(6). Lipid abnormalities would offer the most obvious explanation for this phenomenon, but several studies have shown conflicting results concerning not only the degree of lipid changes in SH but also the effect of L-thyroxine substitution therapy (2,4,7).…”

Section: Introductionmentioning

confidence: 99%

Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial?

Efstathiadou¹,

Bitsis²,

Milionis

et al. 2001

European Journal of Endocrinology

115

105

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Objective: The significance of dyslipidemia in subclinical hypothyroidism (SH) and the effect of thyroid substitution on lipids remain controversial. The present study aimed to assess the association of SH with lipid abnormalities and to quantify the effect of L-thyroxine therapy on serum lipid profiles. Design: Serum lipid parameters of 66 patients with SH and 75 age-and sex-matched euthyroid controls were evaluated in a cross-sectional study. Results: Patients with SH had higher total cholesterol (TC) ð222^45 (S.D.) vs 190^32 mg=dlÞ; lowdensity lipoprotein cholesterol (LDL-C) ð139^28 vs 118^39 mg=dlÞ; apolipoprotein B ð149^21 vs 139^18 mg=dlÞ and lipoprotein (a) (Lp(a)) (median 12.5 (0.8-101) mg/dl vs 7 (0.8 -44) mg/dl) levels compared with euthyroid controls (P , 0:05 for all comparisons). In a follow-up study including 37 patients with SH, all measurements were repeated after restoration of a euthyroid state with incremental doses of L-thyroxine. No significant changes in serum lipid profiles were observed except for a decrease in high-density lipoprotein cholesterol ð59^15 to 55^14 mg=dl; P , 0:05Þ: However, patients with high pre-treatment TC ($240 mg/dl) showed a significant reduction in both TC ð278^28 vs 257^36 mg=dl; P , 0:05Þ and LDL-C ð192^23 vs 173^28 mg=dl; P , 0:01Þ levels. Similar but more pronounced changes were observed in a subgroup of patients with pre-treatment levels of TSH $10 mU/ml. Thyroid autoimmunity had no effect on either the baseline or the posttreatment lipid profile. Conclusion: Although patients with subclinical hypothyroidism exhibit increased levels of the atherogenic parameters (mainly LDL-C and Lp(a)), thyroid substitution therapy does not seem to significantly improve dyslipidemia in the whole group of patients.

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Preclinical Hypothyroidism: A Risk Factor for Coronary Heart-Disease*1

Cited by 145 publications

References 4 publications

Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Hypercholesterolemia and Obesity in Adult Patients with Hypopituitarism: A Report of a Nation-wide Survey in Japan

Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial?

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