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Evaluation of epicardial fat tissue thickness as a marker of cardiovascular risk in patients with subclinical hypothyroidism

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Abstract

Background

Epicardial fat thickness (EFT) has been evaluated as a marker of cardiovascular disease, with good correlation with classical cardiovascular risk factors in the general population. The aim of this study was to evaluate the EFT in subclinical hypothyroidism (SCH), in comparison to a group without thyroid dysfunction.

Methods

A cross-sectional study was performed with 100 participants, including 52 SCH patients and 48 individuals without any thyroid dysfunction (euthyroid group-EU). Transthoracic echocardiography (TE), thyroid hormone levels, lipid profile, and assessment of body composition by bioelectrical impedance (BIA) and anthropometry were measured in all subjects.

Results

The SCH and EU groups were comparable with respect to age, gender, and Framingham risk scores. Serum thyroid-stimulating hormone (TSH) was 6.7 ± 1.4 mIU/L in the SCH group and 2.0 ± 0.84 mIU/L in the control group. EFT was similar in both groups (SCH 3.5 ± 1.3 mm, EU 3.5 ± 1.1 mm, p = 0.43). EFT showed a slight trend for a positive correlation with serum TSH in the SCH group (r s = 0.263, p = 0.05). EFT correlated with the body fat percentage in the SCH group (r s = 0.350, p = 0.03) and EU group (r s = 0.033, p = 0.04). EFT in this cohort was not independently correlated to changes in TSH and Framingham risk score.

Conclusions

EFT determination by TE does not seem to be a good marker of cardiovascular risk in SCH patients with serum TSH <10.0 mIU/L and no pre-existing cardiovascular morbidity.

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References

  1. Cooper DS (2001) Clinical practice. Subclinical hypothyroidism. N Engl J Med 345:260–265

    Article  CAS  PubMed  Google Scholar 

  2. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC (2000) The Colorado thyroid disease prevalence study. Arch Intern Med 160:526–534

    Article  CAS  PubMed  Google Scholar 

  3. Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC (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

    Article  CAS  PubMed  Google Scholar 

  4. Jung CH, Sung KC, Shin HS, Rhee EJ, Lee WY, Kim BS et al (2003) Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, and waist hip ratio in Korea. Korean J Intern Med 18:146–153

    PubMed  Google Scholar 

  5. Asvold BO, Vatten LJ, Nilsen TI, Bjoro T (2007) The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur J Endocrinol 156:181–186

    Article  PubMed  Google Scholar 

  6. Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M et al (2009) Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol 160:785–790

    Article  CAS  PubMed  Google Scholar 

  7. Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL et al (2006) Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 295:1033–1041

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Walsh JP, Bremner AP, Bulsara MK, O’Leary P, Leedman PJ, Feddema P et al (2005) Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 165:2467–2472

    Article  PubMed  Google Scholar 

  9. Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP et al (2010) Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 304:1365–1374

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Rodondi N, Newman AB, Vittinghoff E, de Rekeneire N, Satterfield S, Harris TB 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 

  11. Ferreira MM, Teixeira PF, Mansur VA, Reuters VS, Almeida CP, Vaisman M (2010) Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism. Arq Bras Cardiol 94:806–812

    Article  PubMed  Google Scholar 

  12. Liu D, Jiang F, Shan Z, Wang B, Wang J, Lai Y et al (2010) A cross-sectional survey of relationship between serum TSH level and blood pressure. J Hum Hypertens 24:134–138

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Razvi S, Weaver JU, Vanderpump MP, Pearce SH (2010) The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: reanalysis of the Whickham survey cohort. J Clin Endocrinol Metab 95:1734–1740

    Article  CAS  PubMed  Google Scholar 

  14. Meier C, Staub JJ, Roth CB, Guglielmetti M, Kunz M, Miserez AR et al (2001) TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (basel thyroid study). J Clin Endocrinol Metab 86:4860–4866

    Article  CAS  PubMed  Google Scholar 

  15. Danese MD, Ladenson PW, Meinert CL, Powe NR (2000) Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab 85:2993–3001

    CAS  PubMed  Google Scholar 

  16. Silva N, Santos O, Morais F, Gottlieb I, Hadlich M, Rothstein T et al (2014) Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores. Eur J Endocrinol 171:327–334

    Article  CAS  PubMed  Google Scholar 

  17. Momesso DP, Bussade I, Epifanio MA, Schettino CD, Russo LA, Kupfer R (2011) Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome. Diabetes Res Clin Pract 91:47–53

    Article  CAS  PubMed  Google Scholar 

  18. Cooper DS, Biondi B (2012) Subclinical thyroid disease. Lancet 379:1142–1154

    Article  PubMed  Google Scholar 

  19. McQuade C, Skugor M, Brennan DM, Hoar B, Stevenson C, Hoogwerf BJ (2011) Hypothyroidism and moderate subclinical hypothyroidism are associated with increased all-cause mortality independent of coronary heart disease risk factors: a PreCIS database study. Thyroid 21:837–843

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  21. Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U et al (2003) Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 11:304–310

    Article  PubMed  Google Scholar 

  22. Iacobellis G, Willens HJ (2009) Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 22:1311–1319 (quiz 1417–1318)

    Article  PubMed  Google Scholar 

  23. Jeong JW, Jeong MH, Yun KH, Oh SK, Park EM, Kim YK et al (2007) Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 71:536–539

    Article  PubMed  Google Scholar 

  24. Ueno K, Anzai T, Jinzaki M, Yamada M, Jo Y, Maekawa Y et al (2009) Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions. Circ J 73:1927–1933

    Article  PubMed  Google Scholar 

  25. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al (2004) Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291:228–238

    Article  CAS  PubMed  Google Scholar 

  26. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI et al (2012) Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 18:988–1028

    Article  PubMed  Google Scholar 

  27. Braulio VB, Furtado VC, Silveira M, Fonseca MH, Oliveira JE (2010) Comparison of body composition methods in overweight and obese Brazilian women. Arq Bras Endocrinol Metabol 54:398–405

    Article  PubMed  Google Scholar 

  28. Segal KR, Van Loan M, Fitzgerald PI, Hodgdon JA, Van Itallie TB (1988) Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J Clin Nutr 47:7–14

    CAS  PubMed  Google Scholar 

  29. Iacobellis G, Willens HJ, Barbaro G, Sharma AM (2008) Threshold values of high-risk echocardiographic epicardial fat thickness. Obesity (Silver Spring) 16:887–892

    Article  Google Scholar 

  30. de Moura Souza A, Sichieri R (2011) Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol 165:11–15

    Article  Google Scholar 

  31. Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L et al (2005) Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 90:4019–4024

    Article  CAS  PubMed  Google Scholar 

  32. Imaizumi M, Akahoshi M, Ichimaru S, Nakashima E, Hida A, Soda M et al (2004) Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 89:3365–3370

    Article  CAS  PubMed  Google Scholar 

  33. Sgarbi JA, Teixeira PF, Maciel LM, Mazeto GM, Vaisman M, Montenegro Junior RM et al (2013) The Brazilian consensus for the clinical approach and treatment of subclinical hypothyroidism in adults: recommendations of the thyroid Department of the Brazilian Society of Endocrinology and Metabolism. Arq Bras Endocrinol Metabol 57:166–183

    Article  PubMed  Google Scholar 

  34. Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS et al (2006) Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 5:1

    Article  PubMed Central  PubMed  Google Scholar 

  35. Janik M, Hartlage G, Alexopoulos N, Mirzoyev Z, McLean DS, Arepalli CD et al (2010) Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies. J Nucl Cardiol 17:841–847

    Article  PubMed  Google Scholar 

  36. Korkmaz L, Sahin S, Akyuz AR, Ziyrek M, Anaforoglu I, Kose M et al (2013) Epicardial adipose tissue increased in patients with newly diagnosed subclinical hypothyroidism. Med Princ Pract 22:42–46

    Article  PubMed  Google Scholar 

  37. Asik M, Sahin S, Ozkul F, Anaforoglu I, Ayhan S, Karagol S et al (2013) Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis. Clin Endocrinol (Oxf) 79:571–576

    Article  CAS  Google Scholar 

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Santos, O.C., Silva, N.A.O., Vaisman, M. et al. Evaluation of epicardial fat tissue thickness as a marker of cardiovascular risk in patients with subclinical hypothyroidism. J Endocrinol Invest 38, 421–427 (2015). https://doi.org/10.1007/s40618-014-0199-x

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  • DOI: https://doi.org/10.1007/s40618-014-0199-x

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