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Risk factors for cardiovascular disease in subclinical hypothyroidism

Irish Journal of Medical Science (1971 -) volume 187, pages 39–43 (2018)Cite this article

Abstract

Subclinical hypothyroidism (SH), defined as an increased serum thyrotropin (TSH) level and normal plasma-free thyroid hormones’ concentrations, is common in the general population, in particular, among elderly women. Its prevalence ranges from 4 to 15% and up to 20% among females aged > 60 year. Although SH has been associated with atherosclerotic cardiovascular disease (CVD), it is acknowledged that the high prevalence of dyslipidemia in elderly people is considered a common biochemical condition. Therefore, whether SH is associated with a higher risk for CVD is still controversial. At the moment, no consensus exists on the clinical significance and treatment of the mild form of thyroid failure, although available data suggest that only patients with plasma TSH levels above 10 mU/L may have an increased risk of CVD. However, treatment of SH in older individual requires special consideration with regard to thyroid hormone replacement therapy and expected clinical outcomes, since the increase of TSH observed in this population may represent a physiological process. It is likely that age affects TSH levels, and some studies suggest that modified reference limits for elderly populations should be considered in the diagnosis of mild thyroid failure.

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References

  1. Becker C (1985) Hypothyroidism and atherosclerotic heart disease: pathogenesis, medical management, and the role of coronary artery bypass surgery. Endocr Rev 6:432–440

    CAS  Article  PubMed  Google Scholar 

  2. Nedrebo BG, Ericsson UB, Nygard O et al (1998) Plasma total homocysteine levels in hyperthyroid and hypothyroid patients. Metabolism 47:89–93

    CAS  Article  PubMed  Google Scholar 

  3. Medici M, Porcu E, Pistis G et al (2014) Identification of novel genetic loci associated with thyroid peroxidase antibodies and clinical thyroid disease. PLoS Genet 10:e1004123

    Article  PubMed  PubMed Central  Google Scholar 

  4. Walsh JP, Bremner AP, Feddema P et al (2010) Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab 95:1095–1104

    CAS  Article  PubMed  Google Scholar 

  5. Rugge B, Balshem H, Sehgal R et al (2011) Screening and treatment of subclinical hypothyroidism or hyperthyroidism. AHRQ Comparative Effectiveness Reviews, Rockville

    Google Scholar 

  6. Hak AE, Pols HA, Visser TJ et al (2000) Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam study. Ann Intern Med 132:270–278

    CAS  Article  PubMed  Google Scholar 

  7. Biondi B, Cooper DS (2008) The clinical significance of subclinical thyroid dysfunction. Endocr Rev 29:76–131

    CAS  Article  PubMed  Google Scholar 

  8. Shin DJ, Osborne TF (2003) Thyroid hormone regulation and cholesterol metabolism are connected through sterol regulatory element-binding protein-2 (SREBP-2). J Biol Chem 278:34114–34118

    CAS  Article  PubMed  Google Scholar 

  9. Pearce EN (2004) Hypothyroidism and dyslipidemia: modern concepts and approaches. Curr Cardiol Rep 6:451–456

    Article  PubMed  Google Scholar 

  10. Delitala AP, Fanciulli G, Maioli M et al (2017) Subclinical hypothyroidism, lipid metabolism and cardiovascular disease. Eur J Intern Med 38:17–24

    CAS  Article  PubMed  Google Scholar 

  11. Cappola AR, Ladenson PW (2003) Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 88:2438–2444

    CAS  Article  PubMed  Google Scholar 

  12. Pearce EN (2012) Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab 97:326–333

    CAS  Article  PubMed  Google Scholar 

  13. Nilsson G, Nordlander S, Levin K (1976) Studies on subclinical hypothyroidism with special reference to the serum lipid pattern. Acta Med Scand 200:63–67

    CAS  Article  PubMed  Google Scholar 

  14. Lithell H, Boberg J, Hellsing K et al (1981) Serum lipoprotein and apolipoprotein concentrations and tissue lipoprotein-lipase activity in overt and subclinical hypothyroidism: the effect of substitution therapy. Eur J Clin Investig 11:3–10

    CAS  Article  Google Scholar 

  15. Hueston WJ, Pearson WS (2004) Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2:351–355

    Article  PubMed  PubMed Central  Google Scholar 

  16. Teixeira Pde F, Reuters VS, Ferreira MM et al (2008) Lipid profile in different degrees of hypothyroidism and effects of levothyroxine replacement in mild thyroid failure. Transl Res 151:224–231

    Article  PubMed  Google Scholar 

  17. Caraccio N, Ferrannini E, Monzani F (2002) Lipoprotein profile in subclinical hypothyroidism: response to levothyroxine replacement, a randomized placebo-controlled study. J Clin Endocrinol Metab 87:1533–1538

    CAS  Article  PubMed  Google Scholar 

  18. Efstathiadou Z, Bitsis S, Milionis HJ et al (2001) Lipid profile in subclinical hypothyroidism: is L-thyroxine substitution beneficial? Eur J Endocrinol 145:705–710

    CAS  Article  PubMed  Google Scholar 

  19. Adrees M, Gibney J, El-Saeity N et al (2009) Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism. Clin Endocrinol 71:298–303

    CAS  Article  Google Scholar 

  20. Tzotzas T, Krassas GE, Konstantinidis T et al (2000) Changes in lipoprotein(a) levels in overt and subclinical hypothyroidism before and during treatment. Thyroid 10:803–808

    CAS  Article  PubMed  Google Scholar 

  21. Brenta G, Berg G, Arias P et al (2007) Lipoprotein alterations, hepatic lipase activity, and insulin sensitivity in subclinical hypothyroidism: response to L-T(4) treatment. Thyroid 17:453–460

    CAS  Article  PubMed  Google Scholar 

  22. Ito M, Takamatsu J, Sasaki I et al (2004) Disturbed metabolism of remnant lipoproteins in patients with subclinical hypothyroidism. Am J Med 117:696–699

    CAS  Article  PubMed  Google Scholar 

  23. Meisinger C, Ittermann T, Tiller D et al (2014) Sex-specific associations between thyrotropin and serum lipid profiles. Thyroid 24:424–432

    CAS  Article  PubMed  Google Scholar 

  24. Delitala AP, Steri M, Pilia MG et al (2016) Menopause modulates the association between thyrotropin levels and lipid parameters: the SardiNIA study. Maturitas 92:30–34

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Villar HC, Saconato H, Valente O et al (2007) Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev:CD003419

  26. Scuteri A, Morrell CH, Orru M et al (2014) Longitudinal perspective on the conundrum of central arterial stiffness, blood pressure, and aging. Hypertension 64:1219–1227

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Dillmann WH (1996) Editorial: thyroid hormone action and cardiac contractility-a complex affair. Endocrinology 137:799–801

    CAS  Article  PubMed  Google Scholar 

  28. Danzi S, Klein I (2012) Thyroid hormone and the cardiovascular system. Med Clin North Am 96:257–268

    CAS  Article  PubMed  Google Scholar 

  29. Christ-Crain M, Meier C, Guglielmetti M et al (2003) Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebo-controlled trial. Atherosclerosis 166:379–386

    CAS  Article  PubMed  Google Scholar 

  30. Chadarevian R, Bruckert E, Leenhardt L et al (2001) Components of the fibrinolytic system are differently altered in moderate and severe hypothyroidism. J Clin Endocrinol Metab 86:732–737

    CAS  Article  PubMed  Google Scholar 

  31. Kahaly GJ (2000) Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid 10:665–679

    CAS  Article  PubMed  Google Scholar 

  32. Kahaly GJ, Nieswandt J, Mohr-Kahaly S (1998) Cardiac risks of hyperthyroidism in the elderly. Thyroid 8:1165–1169

    CAS  Article  PubMed  Google Scholar 

  33. Ladenson PW, Sherman SI, Baughman KL et al (1992) Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism. Proc Natl Acad Sci U S A 89:5251–5255

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Mariotti S, Franceschi C, Cossarizza A et al (1995) The aging thyroid. Endocr Rev 16:686–715

    CAS  Article  PubMed  Google Scholar 

  35. Cappola AR, Fried LP, Arnold AM et al (2006) Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 295:1033–1041

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. Delitala AP, Orru M, Filigheddu F et al (2015) Serum free thyroxine levels are positively associated with arterial stiffness in the SardiNIA study. Clin Endocrinol 82:592–597

    CAS  Article  Google Scholar 

  37. Delitala AP, Filigheddu F, Orru M et al (2015) No evidence of association between subclinical thyroid disorders and common carotid intima medial thickness or atherosclerotic plaque. Nutr Metab Cardiovasc Dis 25:1104–1110

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. Volzke H, Robinson DM, Schminke U et al (2004) Thyroid function and carotid wall thickness. J Clin Endocrinol Metab 89:2145–2149

    Article  PubMed  Google Scholar 

  39. Peixoto de Miranda EJ, Bittencourt MS, Goulart AC et al (2017) Lack of association between subclinical hypothyroidism and carotid-femoral pulse wave velocity in a cross-sectional analysis of the ELSA-Brasil. Am J Hypertens 30:81–87

    Article  PubMed  Google Scholar 

  40. Wang J, Zheng X, Sun M et al (2015) Low serum free thyroxine concentrations associate with increased arterial stiffness in euthyroid subjects: a population-based cross-sectional study. Endocrine 50:465–473

    CAS  Article  PubMed  Google Scholar 

  41. Biondi B (2012) Mechanisms in endocrinology: heart failure and thyroid dysfunction. Eur J Endocrinol 167:609–618

    CAS  Article  PubMed  Google Scholar 

  42. Suh S, Kim DK (2015) Subclinical hypothyroidism and cardiovascular disease. Endocrinol Metab (Seoul) 30:246–251

    CAS  Article  Google Scholar 

  43. Pasqualetti G, Tognini S, Polini A et al (2013) Subclinical hypothyroidism and heart failure risk in older people. Endocr Metab Immune Disord Drug Targets 13:13–21

    CAS  Article  PubMed  Google Scholar 

  44. Razvi S, Shakoor A, Vanderpump M et al (2008) The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a metaanalysis. J Clin Endocrinol Metab 93:2998–3007

    CAS  Article  PubMed  Google Scholar 

  45. Kvetny J, Heldgaard PE, Bladbjerg EM et al (2004) Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol 61:232–238

    CAS  Article  Google Scholar 

  46. Walsh JP, Bremner AP, Bulsara MK et al (2005) Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 165:2467–2472

    Article  PubMed  Google Scholar 

  47. Rodondi N, Newman AB, Vittinghoff E et al (2005) Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 165:2460–2466

    Article  PubMed  Google Scholar 

  48. Hyland KA, Arnold AM, Lee JS et al (2013) Persistent subclinical hypothyroidism and cardiovascular risk in the elderly: the cardiovascular health study. J Clin Endocrinol Metab 98:533–540

    CAS  Article  PubMed  Google Scholar 

  49. LeGrys VA, Funk MJ, Lorenz CE et al (2013) Subclinical hypothyroidism and risk for incident myocardial infarction among postmenopausal women. J Clin Endocrinol Metab 98:2308–2317

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  50. Ochs N, Auer R, Bauer DC et al (2008) Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med 148:832–845

    Article  PubMed  Google Scholar 

  51. Rodondi N, den Elzen WP, Bauer DC et al (2010) Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304:1365–1374

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  52. Zhao M, Yang T, Chen L et al (2015) Subclinical hypothyroidism might worsen the effects of aging on serum lipid profiles: a population-based case-control study. Thyroid 25:485–493

    CAS  Article  PubMed  Google Scholar 

  53. Pasqualetti G, Tognini S, Polini A et al (2013) Is subclinical hypothyroidism a cardiovascular risk factor in the elderly? J Clin Endocrinol Metab 98:2256–2266

    CAS  Article  PubMed  Google Scholar 

  54. Pearce SH, Brabant G, Duntas LH et al (2013) 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J 2:215–228

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  55. Volzke H, Ludemann J, Robinson DM et al (2003) The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 13:803–810

    Article  PubMed  Google Scholar 

  56. Delitala AP, Pilia MG, Ferreli L et al (2014) Prevalence of unknown thyroid disorders in a Sardinian cohort. Eur J Endocrinol 171:143–149

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  57. Lucas A, Julian MT, Canton A et al (2010) Undiagnosed thyroid dysfunction, thyroid antibodies, and iodine excretion in a Mediterranean population. Endocrine 38:391–396

    CAS  Article  PubMed  Google Scholar 

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  1. Cardiology Unit, Ospedale San Francesco, Via Nonnis, 17, 08100, Nuoro, Italy

    F. Decandia

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Decandia, F. Risk factors for cardiovascular disease in subclinical hypothyroidism. Ir J Med Sci 187, 39–43 (2018). https://doi.org/10.1007/s11845-017-1617-9

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Keywords

  • Cardiovascular disease
  • Elderly
  • Lipids
  • Subclinical hypothyroidism
  • Thyroid disorders