The Dyslipidemia and Inflammatory markers as the risk predictors for cardiovascular disease in newly diagnosed premenopausal hypothyroid women.

Screening of metabolic derangements in hypothyroidism

  • Vaideki Balamurugan Kasturba Medical College
  • Ravindra Maradi Kasturba Medical College
  • Vivek Joshi Drexel University
  • Vijetha Shenoy Belle Kasturba Medical College
  • BK Manjunatha Goud RAKHS
Keywords: Hypothyroidism, hs-CRP, Dyslipidemia, Atherogenic Indices, Cardiovascular Disease, Framingham Risk Score, Homocysteine

Abstract


Background:

Hypothyroidism can predispose systolic and diastolic cardiac dysfunction, increased peripheral vascular resistance, endothelial dysfunction, altered coagulopathy, and dyslipidaemia resulting in atherosclerosis. Thyroid hormones can influence homocysteine metabolism by regulating the methylenetetrahydrofolate reductase (MTHR). So, this study aimed to compare the markers homocysteine, high sensitive C-reactive protein (hs-CRP), and Atherogenic Indices (AI) between newly diagnosed hypothyroid and euthyroid premenopausal women.

Methods:

80 Female patients aged between 20 and 45 years were enrolled in this study and were equally divided into cases and controls group. Laboratory tests included: i) Serum T3, T4, TSH was measured using electrochemiluminescence, ii) lipid profile, homocysteine, and hs-CRP were measured for all the participants. Atherogenic indices: Castelli risk indices I&II, Atherogenic coefficient (AEC), and Atherogenic Index of Plasma (AIP) were calculated using formulas. A comparison between the study groups was made by using the Independent t-test and Mann-Whitney U test. p-value <0.05 was considered significant.

 

Results:

Atherogenic indices (p<0.001) and homocysteine (p=0.014) were significantly increased in hypothyroid women as compared to euthyroid. 38 % of hypothyroid women and 25 % of euthyroid women had hs-CRP >3 mg/L.

Conclusion:

Premenopausal women with hypothyroidism have a greater predisposition for cardiovascular disease compared to euthyroid

References

1. Ning Y, Cheng YJ, Liu LJ, Sara JDS, Cao ZY, Zheng WP, et al. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med. 2017;15(1):21.
2. Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):55–9.
3. Khan R, Sikanderkhel S, Gui J, Adeniyi A-R, O'Dell K, Erickson M, et al. Thyroid and cardiovascular disease: A focused review on the impact of hyperthyroidism in heart failure. Cardiol Res. 2020;11(2):68–75.
4. Orzechowska-Pawiłojć A, Lewczuk A, Sworczak K. The influence of thyroid hormones on homocysteine and atherosclerotic vascular disease. Endokrynol Pol. 2005;56(2):194–202.
5. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489–99.
6. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F, Galofré JC. The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):923–31
7. Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab. 2013;17(4):647–52.
8. Deokar PG, Nagdeote AN, Lanje MJ, Basutkar DG. Prevalence of Thyroid disorders in a Tertiary Care Center. International Journal of Current Research and Review. 2016 May;8(9):26–30.
9. Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J. 2011;5(1):76–84.
10. Gunduz M, Gunduz E, Kircelli F, Okur N, Ozkaya M. Role of surrogate markers of atherosclerosis in clinical and subclinical thyroidism. Int J Endocrinol. 2012; 2012:109797.
11. Yousuf O, Mohanty BD, Martin SS, Joshi PH, Blaha MJ, Nasir K, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol. 2013;62(5):397–408.
12. Owecki M, Dorszewska J, Sawicka-Gutaj N, Oczkowska A, Owecki MK, Michalak M, et al. Serum homocysteine levels are decreased in levothyroxine-treated women with autoimmune thyroiditis. Endocr Abstr. 2014; Available from: http://dx.doi.org/10.1530/endoabs.35.p202
13. Maradi, R., Joshi, V., Mallick, A.K., Reddy, G.M., Shorey, G., & Tey, R.V. (2011). A correlation study between serum zinc and plasma total cholesterol, high density and low-density lipoprotein cholesterol in thyroid dysfunction. International Journal of Pharmaceutical Sciences Review and Research. 7, 2, p. 122-124 3 p.
14. Bhardwaj S, Jayashree B, Bhatnagar MK, Tyagi S. Atherogenic index of plasma, Castelli risk index and atherogenic coefficient- new parameters in assessing cardiovascular risk. International Journal Of Pharmacy And Biological Sciences. 2013 Jan;3(3):359–64.
15. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe--epidemiological update 2015. Eur Heart J. 2015;36(40):2696–705
16. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007;92(12):4575–82.
17. Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care. 2003;26(5):1380–4.
18. Marzullo P, Mele C, Mai S, Guzzaloni G, Soranna D, Tagliaferri MA, et al. The impact of the metabolic phenotype on thyroid function in obesity. Diabetol Metab Syndr. 2016;8(1):59.
19. Milionis A, Milionis C. Correlation between body mass index and thyroid function in euthyroid individuals in Greece. ISRN Biomark. 2013; 2013:1–7.
20. Aksoy DY, Cinar N, Harmanci A, Karakaya J, Yildiz BO, Usman A, et al. Serum resistin and high sensitive CRP levels in patients with subclinical hypothyroidism before and after L-thyroxine therapy. Med Sci Monit. 2013; 19:210–5.
21. Czarnywojtek A, Owecki M, Zgorzalewicz-Stachowiak M, Woliński K, Szczepanek-Parulska E, Budny B, et al. The role of serum C-reactive protein measured by high-sensitive method in thyroid disease. Arch Immunol Ther Exp (Warsz). 2014;62(6):501–9.
22. Kamath DY, Xavier D, Sigamani A, Pais P. High sensitivity C-reactive protein (hs-CRP) & cardiovascular disease: An Indian perspective. Indian J Med Res. 2015;142(3):261–8.
23. Dong X, Yao Z, Hu Y, Yang N, Gao X, Xu Y, et al. Potential harmful correlation between homocysteine and low-density lipoprotein cholesterol in patients with hypothyroidism. Medicine (Baltimore). 2016;95(29): e4291.
24. Singh S, Dey Sarkar P. Serum lipids, tHcy, hs-CRP, MDA and PON-1 levels in SCH and overt hypothyroidism: effect of treatment. Acta Biomed. 2014;85(2):127–34.
25. Song R-H, Wang B, Yao Q-M, Li Q, Jia X, Zhang J-A. The impact of obesity on thyroid autoimmunity and dysfunction: A systematic review and meta-analysis. Front Immunol. 2019; 10:2349.
26. Tseng F-Y, Lin W-Y, Lin C-C, Lee L-T, Li T-C, Sung P-K, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults. J Am Coll Cardiol. 2012;60(8):730–7.
27. Tamakoshi K, Yatsuya H, Kondo T, Hori Y, Ishikawa M, Zhang H, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in the healthy reference range, a systemic low-grade inflammatory state. Int J Obes Relat Metab Disord. 2003;27(4):443–9.
28. Ranjit PM, Guntuku GS, Pothineni RB. New atherogenic indices: Assessment of cardiovascular risk in post-menopausal dyslipidaemia. Asian J Med Sci. 2015;6(6):25–32.
29. Rodondi N, Locatelli I, Aujesky D, Butler J, Vittinghoff E, Simonsick E, et al. Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS One. 2012;7(3):e34287.
30. Sara JDS, Lennon RJ, Gulati R, Singh M, Holmes DR Jr, Lerman LO, et al. Utility of the Framingham Risk Score in predicting secondary events in patients following percutaneous coronary intervention: A time-trend analysis. Am Heart J. 2016; 172:115–28.
31. Hussain A, Elmahdawi A M, Elzeraidi N, et al. (November 16, 2019) The Effects of Dyslipidaemia in Subclinical Hypothyroidism. Cureus 11(11): e6173. doi:10.7759/cureus.6173
32. B Rajini, R Haragopal. Study on the association between the serum thyroid-stimulating hormone levels and the body mass index. International Journal of Contemporary Medical Research 2018;5(12): L1-L3.
33. William J. Hueston, William S. Pearson. Subclinical Hypothyroidism and the Risk of Hypercholesterolemia. The Annals of Family Medicine Jul 2004, 2 (4) 351-355; DOI: 10.1370/afm.79.
34. Shih, CC., Shih, YL. & Chen, JY. The association between homocysteine levels and cardiovascular disease risk among middle-aged and elderly adults in Taiwan. BMC Cardiovasc Disord 21, 191 (2021). https://doi.org/10.1186/s12872-021-02000.
Published
2022/07/21
Section
Original paper