Risk assessment of the subclinical hypothyroidism in non-alcoholic fatty liver disease patients with different levels of cardiovascular risk

Abstract

Objective: To assess the risk of developing subclinical hypothyroidism (SH) in patients with non-alcoholic fatty liver disease (NAFLD) with a different risk of cardiovascular complications, and to identify the link between high risk of developing SH and major cardiovascular factors (CV). Material and methods: A one-stage clinical trial included 298 people with NAFLD with the presence of one or more CV risk factors (arterial hypertension, smoking, hypercholesterolemia) and various levels of CV risk factors on the SCORE scale. All patients were questioned on a standard questionnaire and HRQ, a thyroid status study was conducted.Result: Patients were divided into three groups according to the level of total CV risk for SCORE: 33.9% had low / moderate CV risk, 41.9% -high and 24.2% -very high CV risk. The majority of the subjects were in the age groups 50-59 and 60-69 years. In the age group 40-49 years, 22.2% of patients had high CV risk, 28% of men aged 50-59 years had moderate CV risk, while 49.7% of older patients showed very high CV risk. According to the results of a survey on the HRQ questionnaire, a low risk of developing hypertension was found in 34.9%, a moderate risk in 48.9%, and a high risk was found in 16.1% of patients. Persons with a very high CV risk on the SCORE scale also have a high risk of developing the SH according to the HRQ questionnaire. Among patients with the presence of one or more of the above CV risk factors, early markers of thyroid status disorders should be identified and the risk of developing hypertension should be assessed. Such a tactic contributes to an adequate assessment of the risk of SH in patients with NAFLD and the development of methods for primary prevention.

Low–Normal Thyroid Function Is Not Associated with Either Non-Alcoholic Fatty Liver Disease or with Metabolic Dysfunction-Associated Fatty Liver Disease

“…A total of 3697 patients were included. Among them, 59% (n = 2179) were male, the median age was 48 [43][44][45][46][47][48][49][50][51][52][53][54][55] years, and BMI was 25.9 [23.6-28.5] kg/m 2 . A total of 60% (n = 2238) of patients presented as overweight; according to ATP III criteria, 19.7% (n = 727) had MS. DM was identified in 6.2% (n = 230) of patients.…”

Cardiometabolic Risk Prediction in Patients With Non-Alcoholic Fatty Liver Disease Combined With Subclinical Hypothyroidism

“…Currently, the concept of "cardiometabolic risk" is increasingly used in clinical practice. It involves the risk of developing cardiovascular diseases and/or type 2 diabetes, combining both classical ("traditional") risk factors such as smoking, high levels of low-density lipoprotein cholesterol (LDL-C), arterial hypertension, an increase in glucose level, and factors directly associated with abdominal (especially visceral) obesityinsulin resistance (IR), low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and an increase in proinflammatory markers [8]. The attention of researchers is attracted by the search for early predictors of cardiometabolic changes and vascular markersmarkers of inflammation (C-reactive protein, CRP), dyslipidemia, IR, tumor necrosis factor -α (TNF-α), endothelial dysfunction (ED) indicators such as circulating desquamated endothelial cells (CDECs), vascular endothelial growth factor (VEGF), that could act as a "predictive" [1,7].…”

“…One of the most common diseases of our time is non-alcoholic fatty liver disease (NAFLD)a chronic liver disease that is considered as a component of some diseases associated with IR, such as metabolic syndrome (MS), obesity, and diabetes. The development of NAFLD is very closely associated not only with abdominal obesity, but also has a significant effect on the formation of cardiometabolic risk factors such as hypertriglyceridemia, a decrease in HDL-C level, hypertension, hyperglycemia, thereby increasing the degree of cardiometabolic risk itself and affecting the prognosis and life expectancy of patients [8,18].…”

“…Recently published research results indicate that patients with NAFLD along with traditional risk factors for cardiovascular diseases (CVD) (obesity, diabetes, MS and others) have "new" risk factors such as endothelial dysfunction (ED), carotid intimamedia thickness (CIMT), an increase in the CRP level, as well as risk factors combined into the Framingham scale (age, gender, hypertension, hyperlipidemia, smoking). Also, "traditional" cardiovascular risk factors include: markers of chronic inflammation, hyperhomocysteinemia, impaired blood viscosity, as well as substances that the endothelium secretes (NO, Willebrand factor, P-selectin, adhesion molecule ICAM-1 and VCAM-1, endothelin-1, PAI-1) [7,8].…”

“…According to The Rotterdam Study, 28% of patients with NAFLD have signs of subclinical hypothyroidism (SH) [10,11]. Targher G. et al revealed a link between thyroid hormones and serum liver enzyme activity (levels of thyroid stimulating hormone (TSH), alanine aminotransferase (ALT), γ-Glutamyl Transpeptidase (GGTP)) in a study involving a large cohort of patients [1,8].…”