The Relationship Between Cardiovascular Diseases and Thyroid Hormones
Review Article
DOI:
https://doi.org/10.5281/zenodo.13309715Keywords:
TSH, TSH and Cardiovascular Diseases, Hypothyroidism and HyperthyroidismAbstract
Among the main targets of thyroid hormone is involvement in the cardiovascular system. Thrombosis associated with the cardiovascular system is associated with hyperthyroidism, while hyperlipidemia is associated with hypothyroidism. This hormone directly affects myocardial contractility. The hormones triiodothyronine [T3, (3,5,3′-triiodothyronine)] and thyroxine [T4 (3,5,3′,3′,5′-tetraiodothyronine] make up the thyroid hormones. They are closely related to metabolic events in the body. They play a role in regulating basal energy utilization through carbohydrate, lipid and protein metabolism. In terms of cardiovascular disease, T3 and T4 have effects on coronary arteries. They increase systolic arterial pressure by modulating vascular smooth muscle cells and vascular tone. Hypothyroidism is a thyroid dysfunction characterized by a decrease in metabolic functions due to insufficient levels of thyroid hormone or its inability to fulfill its function. Hypothyroidism is characterized by high TSH levels and low T4 levels. Clinical hypothyroidism is associated with systolic hypertension and lipid abnormalities. It causes lipid abnormalities, limiting the function of hepatic lipase and lipoprotein lipase in adipose tissue. However, it also causes an increase in cholesterol synthesis. Differences in myocardial remodeling occur in thyroid deficiency. It commonly leads to extracardiac organ dysfunction. Hyperthyroidism is a clinical thyroid dysfunction characterized by elevated thyroid hormones. High levels of T3 and/or T4 are found despite low levels of TSH. Patients with subclinical hyperthyroidism have a higher risk of CVD such as coronary artery disease and heart failure. Excess thyroid hormones increase cardiac output and affect stroke volume and heart rhythm. In this review, we will briefly discuss the relationship between cardiovascular events and thyroid hormones.
References
Gao Y, Zhan T, Xu Y, et al. Causal association of TSH with ischemic heart diseases and heart failure: A 2-sample Mendelian randomization study. Medicine (Baltimore). 2024;103(12):e37539. doi: 10.1097/MD.0000000000037539.
Decandia F. Risk factors for cardiovascular disease in subclinical hypothyroidism. Ir J Med Sci. 2018;187(1):39-43. doi: 10.1007/s11845-017-1617-9.
Ellervik C, Mora S, Kuś A, Åsvold B, Marouli E, Deloukaset P, et al. Effects of thyroid function on hemostasis, coagulation, and fibrinolysis: a mendelian randomization study. Thyroid. 2021;31(9):1305–15. doi: 10.1089/thy.2021.0055.
Türkiye Endokrinoloji ve Metabolizma Derneği, tiroid hastalıkları tanı ve tedavi klavuzu. Subklinik hipotiroidi. 4. Baskı. Tuna matbacılık, Ankara. 2013.S.13-15.
Evron JM, Hummel SL, Reyes-Gastelum D, Haymart MR, Banerjee M, Papaleontiou M. Association of thyroid hormone treatment intensity with cardiovascular mortality among US Veterans. JAMA Netw Open. 2022;5(5):e2211863. doi: 10.1001/jamanetworkopen.2022.11863.
Zhang H, Li X, Zhang N, Tian L. Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14(1):1083171. doi: 10.3389/fendo.2023.1083171.
Tan L, Bogush N, Naqvi E, et al. Thyroid hormone plus dual-specificity phosphatase-5 siRNA increases the number of cardiac muscle cells and improves left ventricular contractile function in chronic doxorubicin-injured hearts. Theranostics. 2021 Mar 4;11(10):4790-4808. doi: 10.7150/thno.57456.
Sinha RA, Singh BK, Yen PM. Direct effects of thyroid hormones on hepatic lipid metabolism. Nat Rev Endocrinol. 2018;14(5):259-269. doi: 10.1038/nrendo.2018.10.
Martinez F. Thyroid hormones and heart failure. Heart Fail Rev. 2016;21(4):361-4. doi: 10.1007/s10741-016-9556-5.
Mariusz W Szkudlinski 1, Valerie Fremont, Catherine Ronin, Bruce D Weintraub. Thyroid-stimulating hormone and thyroid-stimulating hormone receptor structure-function relationships. Physiol Rev. 2002;82(2):473-502. doi: 10.1152/physrev.00031.2001.
Batman A. Atherogenic Index of Plasma, Castelli Risk Index and Atherogenic Coefficient in the Assessment of Cardiovascular Disease Risk in Patients with Severe Hypothyroidism. Journal of KU Faculty of Medicine. 2021;23(3):505–513. doi: 10.4183/aeb.2023.333.
Delitala AP, Fanciulli G, Maioli M, Delitala G. Subclinical hypothyroidism, lipid metabolism and cardiovascular disease. Eur J Intern Med. 2017;38(1):17-24. doi: 10.1016/j.ejim.2016.12.015.
Rousset B, Dupuy C, Miot F, Dumont J, Feingold KR, Anawalt B. Chapter 2 Thyroid Hormone Synthesis And Secretion. https://www.ncbi.nlm.nih.gov/books/NBK285550/. (Erişim tarihi:01.08.2024).
Turkey Endocrinology and Metabolism Association (TEMD) Thyroid Diseases Diagnosis and Treatment Guide. 2020.S.36–48.
Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J. 2013;2(4): 215-228.https://doi.org/10.1159/000356507.
Gauthier K, Flamant F. Nongenomic, TRβ-Dependent, Thyroid Hormone Response Gets Genetic Support. Endocrinology. 2014;155(9):3206-9. doi: 10.1210/en.2014-1597.
Garber JR, Cobin RH, Gharib H, et al. Woeber; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults., American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr. Pr. Endocr Pract, 2012;18(6):988-1028. doi: 10.4158/EP12280.GL.
Jabbar A, Pingitore A, Pearce SHS, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol. 2017;14(1):39-55. doi: 10.1038/nrcardio.2016.174.
Paschou SA, Bletsa E, Stampouloglou PK, et al. Thyroid disorders and cardiovascular manifestations: an update. Endocrine. 2022;75(3):672-683. https://doi.org/10.1007/s12020-022-02982-4.
Saric MS, Jurasic MJ, Budincevic H, et al. The role of thyroid hormones in carotid arterial wall remodeling in women. Rom J Intern Med. 2022;60(1):24-33. doi: 10.2478/rjim-2021-0028.
Cai P, Peng Y, Chen Y, Wang Y, Wang X. Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure. J Hypertens. 2021;39(3):453-460. doi: 10.1097/HJH.0000000000002655.
Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nature Reviews Endocrinology. 2018;14(5):301–316. doi: 10.1038/nrendo.2018.18.
Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol. 2010;6(8):431-43. doi: 10.1038/nrendo.2010.105.
Ripoli A, Pingitore A, Favilli B, et al. Does subclinical hypothyroidism affect cardiac pump performance?: Evidence from a magnetic resonance imaging study. JACC. 2005;45(3):439–445. doi: 10.1016/j.jacc.2004.10.044.
Sgarbi JA, Villaca FG, Garbeline B, Villar HE, Romaldini JH. The Effects of Early Antithyroid Therapy for Endogenous Subclinical Hyperthyroidism in Clinical and Heart Abnormalities. 2003;88(4):1672-1677. doi: 10.1210/jc.2002-021046.
Biondi B, Palmieri EA, Fazio S, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J. Clin. Endocrinol. Metab. 2000;85(12):4701–4705. doi: 10.1210/jcem.85.12.7085.
Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-509. doi: 10.1056/NEJM200102153440707.
Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD. JACC. 2007;49(1):71–81. oi: 10.1016/j.jacc.2006.08.042.
Iervasi G, Molinaro S, Landi P, et al. Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients. Arch Intern Med. 2007;167(14):1526-1532. doi:10.1001/archinte.167.14.1526.
Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinol Metab. 2003;88(8):3731-7. doi: 10.1210/jc.2003-030039.32.
Nagasaki T, Inaba M, Kumeda Y, et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab. 2006;91(1):154-8. doi: 10.1210/jc.2005-1342.
Dörr M, Empen K, Robinson DM, Wallaschofski H, Felix SB, Völzke H. The association of thyroid function with carotid artery plaque burden and strokes in a population-based sample from a previously iodine-deficient area. European Journal of Endocrinology. 2008;159(2):145–152. https://doi.org/10.1530/EJE-08-0140.
Asvold BO, Vatten LJ, Nilsen TIL, Bjøro T. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. European Journal of Endocrinology. 2007;156(2):181–186. https://doi.org/10.1530/eje.1.02333.
Chen S, Shauer A, Zwas DR, Lotan C, Keren A, Gotsman I. The effect of thyroid function on clinical outcome in patients with heart failure Eur J Heart Fail. 2014;16(2):217-26. doi: 10.1002/ejhf.42
Özcan Çetin EH, Çetin MS, Könte HC, et al. Monitoring of triglyceride/HDL and its role in predicting progressive arterial diseases and plaque morphology. Turkish Clinical and Laboratory Journal. 2019;10(4):467–473.
James SR, Ray L, Ravichandran K, Nanda SK. High atherogenic index of plasma in subclinical hypothyroidism: Implications in assessment of cardiovascular disease risk. Indian J Endocrinol Metab. 2016;20(5):656–661. doi: 10.4103/2230-8210.190550.
Iqbal A, Jorde R, Figenschau Y. Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromsø Study. J Intern Med. 2006;260(1):53–61. doi: 10.1111/j.1365-2796.2006.01652.x.
Delitala AP, Pilia MG, Ferreli L, et al. Prevalence of unknown thyroid disorders in a Sardinian cohort. Eur J Endocrinol. 2014;171(1):143-9. doi: 10.1530/EJE-14-0182.
40. Konstam MA. Progress in heart failure management? Lessons from the real world. Circulation. 2000;102(10):1076-8. doi: 10.1161/01.cir.102.10.1076.
Kannan L, Shaw PA, Morley MP, et al Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes. Circ Heart Fail. 2018;11(12):e005266. doi: 10.1161/CIRCHEARTFAILURE.118.005266.
Chaker L, Heeringa J, Dehghan A, et al. Normal Thyroid Function and the Risk of Atrial Fibrillation: the Rotterdam Study. J Clin Endocrinol Metab. 2015;100(10):3718-24. doi: 10.1210/jc.2015-2480.
Xu Y, Derakhshan A, Hysaj O, et al. The optimal healthy ranges of thyroid function defined by the risk of cardiovascular disease and mortality: systematic review and individual participant data meta-analysis. Lancet Diabetes Endocrinol. 2023;11(10):743–754. doi: 10.1016/S2213-8587(23)00227-9.
Kim D, Vazquez-Montesino LM, Escober JA, et al. Low thyroid function in nonalcoholic fatty liver disease is an independent predictor of all-cause and cardiovascular mortality. Am J Gastroenterol. 2020;115(9):1496–504. doi: 10.14309/ajg.0000000000000654.
Siu CW, Yeung CY, Lau CP, Kung AWC, Tse HF. Incidence, clinical characteristics, and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart. 2007;93(4):483-7. doi: 10.1136/hrt.2006.100628.
Rivas M, Dennis J, Pena C, Kopel J, Nugent K. The association of hypertension and hyperthyroidism in a subspecialty clinic and a national data base. South Med J. 2020;113(12):607-611. doi: 10.14423/SMJ.0000000000001186.
Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix T.H, Hegedüs L. Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk. Thyroid. 2019;29(3):332-340. doi: 10.1089/thy.2018.0320.
Yamakawa H, Kato TS, Noh JY, et al. Thyroid hormone plays an important role in cardiac function: From bench to bedside. Front Physiol. 2021;12(1):606931. doi: 10.3389/fphys.2021.606931.
Pingitore A, Nicolini G, Kusmic C, Iervasi G, Grigolini P, Forini F. Cardioprotection and thyroid hormones. Heart Fail Rev. 2016;21(4):391-9. doi: 10.1007/s10741-016-9545-8.
Rajagopalan V, Zhang Y, Ojamaa K, et al. Safe Oral Triiodo-L-Thyronine Therapy Protects from Post-Infarct Cardiac Dysfunction and Arrhythmias without Cardiovascular Adverse Effects. PLoS One. 2016;11(3):e0151413. doi: 10.1371/journal.pone.0151413.
Jung KY, Ahn HY, Han SK, Park YJ, Cho BY, Moon MK. Association between thyroid function and lipid profiles, apolipoproteins, and high density lipoprotein function. J Clin Lipidol. 2017;11(6):1347-1353. doi: 10.1016/j.jacl.2017.08.015.
Mourouzis I, Mantzouratou P, Galanopoulos G, et al. Dose-dependent effects of thyroid hormone on post-ischemic cardiac performance: potential involvement of Akt and ERK signalingsMol Cell Biochem. 2012;363(1-2):235-43. doi: 10.1007/s11010-011-1175-9.
Chen YF, Weltman NY, Li X, Youmans S, Krause D, Gerdes AM. Improvement of left ventricular remodeling after myocardial infarction with eight weeks l-thyroxine treatment in rats. J Transl Med. 2013;11(1):40. doi: 10.1186/1479-5876-11-40.
Fitzgerald SP, Bean NG, Falhammar H, Tuke J. Clinical parameters are more likely to be associated with thyroid hormone levels than with thyrotropin levels: a systematic review and meta-analysis. Thyroid. 2020;30(12):1695–1709. doi: 10.1089/thy.2019.0535.
Hyland KA, Arnold AM, Lee JS, Cappola AR. Persistent subclinical hypothyroidism and cardiovascular risk in the elderly: the cardiovascular health study. J Clin Endocrinol Metab. 2013;98(2):533-40. doi: 10.1210/jc.2012-2180.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Anatolia Cor
This work is licensed under a Creative Commons Attribution 4.0 International License.
