Hypothyroidism as a risk factor for cardiovascular disease |
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Authors: | Biondi Bernadette Klein Irwin |
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Institution: | (1) Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II School of Medicine, Via S. Pansini 5, 80131 Naples, Italy;(2) Division of Endocrinology and Department of Medicine, North Shore University Hospital and Department of Cell Biology, NYU School of Medicine, New York, NY |
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Abstract: | The cardiovascular risk in patients with hypothyroidism is related to an increased risk of functional cardiovascular abnormalities
and to an increased risk of atherosclerosis. The pattern of cardiovascular abnormalities is similar in subclinical and overt
hypothyroidism, suggesting that a lesser degree of thyroid hormone deficiency may also affect the cardiovascular system. Hypothyroid
patients, even those with subclinical hypothyroidism, have impaired endothelial function, normal/depressed systolic function,
left ventricular diastolic dysfunction at rest, and systolic and diastolic dysfunction on effort, which may result in poor
physical exercise capacity. There is also a tendency to increase diastolic blood pressure as a result of increased systemic
vascular resistance. All these abnormalities regress with L-T4 replacement therapy. An increased risk for atherosclerosis is supported by autopsy and epidemiological studies in patients
with thyroid hormone deficiency. The “traditional” risk factors are hypertension in conjunction with an atherogenic lipid
profile; the latter is more often observed in patients with TSH>10 mU/L. More recently, C-reactive protein, homocysteine,
increased arterial stiffness, endothelial dysfunction, and altered coagulation parameters have been recognized as risk factors
for atherosclerosis in patients with thyroid hormone deficiency. This constellation of reversible cardiovascular abnormalities
in patient with TSH levels<10 mU/L indicate that the benefits of treatment of mild thyroid failure with appropriate doses
of l-thyroxine outweigh the risk. |
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Keywords: | Subclinical hypothyroidism mild thyroid failure atherosclerosis hypertension endothelial dysfunction homocysteine C-reactive protein lipid metabolism heart failure |
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