Gender-Dependent Association Between Thyroid Hormones and Severity of Coronary Artery Disease by SYNTAX Score
Abstract
Thyroid function has been shown to be associated with cardiovascular diseases. Moreover, sex can influence on the association between thyroid function and other diseases. We aimed to evaluate the relationship between thyroid hormones and the severity of coronary artery disease (CAD) and outcomes. In a prospective study, patients with chest pain undergoing diagnostic coronary angiography were evaluated. Patients were categorized based on the number of involved coronary arteries. Moreover, the severity of CAD was quantitatively calculated using the Syntax score (SS). All patients were also followed up for 3-month duration. The level of TSH in 150 patients was significantly higher in females than males (3.1 [1.7, 5] versus 1.8 [1, 3.3] mU/L; P=0.002). There was significant correlation between THS and the SS among females (ρ=0.477, P<0.001), but not males. Among both sexes, thyroid hormones were comparable between those with or without events during follow-up. The main predictors of high SS values included age (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.018-1.104; P=0.005) and female (OR 2.941, 95% CI 1.198-7.218). The main predictors of multivessel disease were age (OR 1.077, 95% CI 1.026-1.132), female (OR 5.853, 95% CI 1.880-18.222), thyroxin (OR 0.733, 95% CI 0.547-0.981), and thyrotropin (OR 1.333, 95% CI 1.079-1.647). Thyroid hormones are associated with the presence and the severity of CAD, but it might be sex-related. However, thyroid hormone levels could not predict short-term outcomes of patients.
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12. Taylor PN, Razvi S, Pearce SH, Dayan CM. Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab 2013;98:3562-71.
13. Chen HS, Wu TE, Jap TS, Lu RA, Wang ML, Chen RL, et al. Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in Type 2 diabetic patients. Diabet Med 2007;24:1336-44.
14. Meng Z, Liu M, Zhang Q, Liu L, Song K, Tan J, et al. Gender and Age Impact on the Association Between Thyroid-Stimulating Hormone and Serum Lipids. Medicine (Baltimore) 2015;94:e2186.
15. Tognini S, Polini A, Pasqualetti G, Ursino S, Caraccio N, Ferdeghini M, et al. Age and gender substantially influence the relationship between thyroid status and the lipoprotein profile: results from a large cross-sectional study. Thyroid 2012;22:1096-103.
16. Wang X, Wang H, Yan L, Yang L, Xue Y, Yang J, et al. The Positive Association between Subclinical Hypothyroidism and Newly-Diagnosed Hypertension Is More Explicit in Female Individuals Younger than 65. Endocrinol Metab (Seoul) 2021;36:778-89.
17. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2014;130:1749-67.
18. Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009;5:50-6.
19. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269-324.
20. de Miranda EJFP, Bittencourt MS, Staniak HL, Sharovsky R, Pereira AC, Foppa M, et al. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res 2018;51:e7196.
21. Ertaş F, Kaya H, Soydinç MS. Low serum free triiodothyronine levels are associated with the presence and severity of coronary artery disease in the euthyroid patients: an observational study. Anadolu Kardiyol Derg 2012;12:591-6.
22. Ortolani PD, Jr., Romaldini JH, Guerra RA, Portes ES, Meireles GCX, Pimenta J. Association of serum thyrotropin levels with coronary artery disease documented by quantitative coronary angiography: a transversal study. Arch Endocrinol Metab 2018;62:410-5.
23. Yun KH, Jeong MH, Oh SK, Lee EM, Lee J, Rhee SJ, et al. Relationship of thyroid stimulating hormone with coronary atherosclerosis in angina patients. Int J Cardiol 2007;122:56-60.
24. Brzozowski P, Bulak L, Rakotoarison O, Zimoch W, Kosowski M, Tomasiewicz B, et al. Utility of the SYNTAX Score in the risk stratification of patients undergoing rotational atherectomy. Arch Med Sci Atheroscler Dis 2020;5:e313-e9.
25. Yang ZQ, Ma XT, Shao QY, Li QX, Wang YF, Liang J, et al. Predictive Value of Free Triiodothyronine in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Rev Cardiovasc Med 2022;23:230.
26. Iervasi G, Molinaro S, Landi P, Taddei MC, Galli E, Mariani F, et al. Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med 2007;167:1526-32.
27. Bai MF, Gao CY, Yang CK, Wang XP, Liu J, Qi DT, et al. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis. J Cardiol 2014;64:496-500.
28. Li W, Qiu D, Yin H, Wang Y, Chen Y, Liu Q, et al. The Prognostic Value of Thyroid-Stimulating Hormone in Patients with Coronary Artery Disease and Depression. Int J Gen Med 2022;15:4675-83.
29. Fang H, Zhao R, Cui S, Wan W. Sex differences in major cardiovascular outcomes and fractures in patients with subclinical thyroid dysfunction: a systematic review and meta-analysis. Aging (Albany NY) 2022;14:8448-85.
30. Brozaitiene J, Mickuviene N, Podlipskyte A, Burkauskas J, Bunevicius R. Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study. BMC Cardiovasc Disord 2016;16:45
2. Biondi B. The Normal TSH Reference Range: What Has Changed in the Last Decade? J Clin Endocrinol Metab 2013;98:3584-7.
3. Saric MS, Jurasic MJ, Budincevic H, Milosevic M, Kranjcec B, Kovacic S, et al. The role of thyroid hormones in carotid arterial wall remodeling in women. Rom J Intern Med 2022;60:24-33.
4. Asvold BO, Bjøro T, Nilsen TI, Vatten LJ. Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: a population-based study. J Clin Endocrinol Metab 2007;92:841-5.
5. Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur J Endocrinol 2007;156:181-6.
6. Auer J, Berent R, Weber T, Lassnig E, Eber B. Thyroid function is associated with presence and severity of coronary atherosclerosis. Clin Cardiol 2003;26:569-73.
7. Yang L, Zou J, Zhang M, Xu H, Qi W, Gao L, et al. The relationship between thyroid stimulating hormone within the reference range and coronary artery disease: impact of age. Endocr J 2013;60:773-9.
8. Ndrepepa G, Braun S, Mayer K, Cassese S, Fusaro M, Byrne RA, et al. Prognostic value of thyroid-stimulating hormone within reference range in patients with coronary artery disease. Metabolism 2015;64:1308-15.
9. Neves JS, Fontes-Carvalho R, Borges-Canha M, Leite AR, von Hafe M, Vale C, et al. Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study. Front Endocrinol (Lausanne) 2022;13:1067801.
10. Sheehan MT. Biochemical Testing of the Thyroid: TSH is the Best and, Oftentimes, Only Test Needed - A Review for Primary Care. Clin Med Res 2016;14:83-92.
11. Mitchell JE, Hellkamp AS, Mark DB, Anderson J, Johnson GW, Poole JE, et al. Thyroid Function in Heart Failure and Impact on Mortality. JACC Heart Fail 2013;1:48-55.
12. Taylor PN, Razvi S, Pearce SH, Dayan CM. Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab 2013;98:3562-71.
13. Chen HS, Wu TE, Jap TS, Lu RA, Wang ML, Chen RL, et al. Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in Type 2 diabetic patients. Diabet Med 2007;24:1336-44.
14. Meng Z, Liu M, Zhang Q, Liu L, Song K, Tan J, et al. Gender and Age Impact on the Association Between Thyroid-Stimulating Hormone and Serum Lipids. Medicine (Baltimore) 2015;94:e2186.
15. Tognini S, Polini A, Pasqualetti G, Ursino S, Caraccio N, Ferdeghini M, et al. Age and gender substantially influence the relationship between thyroid status and the lipoprotein profile: results from a large cross-sectional study. Thyroid 2012;22:1096-103.
16. Wang X, Wang H, Yan L, Yang L, Xue Y, Yang J, et al. The Positive Association between Subclinical Hypothyroidism and Newly-Diagnosed Hypertension Is More Explicit in Female Individuals Younger than 65. Endocrinol Metab (Seoul) 2021;36:778-89.
17. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2014;130:1749-67.
18. Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009;5:50-6.
19. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269-324.
20. de Miranda EJFP, Bittencourt MS, Staniak HL, Sharovsky R, Pereira AC, Foppa M, et al. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res 2018;51:e7196.
21. Ertaş F, Kaya H, Soydinç MS. Low serum free triiodothyronine levels are associated with the presence and severity of coronary artery disease in the euthyroid patients: an observational study. Anadolu Kardiyol Derg 2012;12:591-6.
22. Ortolani PD, Jr., Romaldini JH, Guerra RA, Portes ES, Meireles GCX, Pimenta J. Association of serum thyrotropin levels with coronary artery disease documented by quantitative coronary angiography: a transversal study. Arch Endocrinol Metab 2018;62:410-5.
23. Yun KH, Jeong MH, Oh SK, Lee EM, Lee J, Rhee SJ, et al. Relationship of thyroid stimulating hormone with coronary atherosclerosis in angina patients. Int J Cardiol 2007;122:56-60.
24. Brzozowski P, Bulak L, Rakotoarison O, Zimoch W, Kosowski M, Tomasiewicz B, et al. Utility of the SYNTAX Score in the risk stratification of patients undergoing rotational atherectomy. Arch Med Sci Atheroscler Dis 2020;5:e313-e9.
25. Yang ZQ, Ma XT, Shao QY, Li QX, Wang YF, Liang J, et al. Predictive Value of Free Triiodothyronine in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Rev Cardiovasc Med 2022;23:230.
26. Iervasi G, Molinaro S, Landi P, Taddei MC, Galli E, Mariani F, et al. Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med 2007;167:1526-32.
27. Bai MF, Gao CY, Yang CK, Wang XP, Liu J, Qi DT, et al. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis. J Cardiol 2014;64:496-500.
28. Li W, Qiu D, Yin H, Wang Y, Chen Y, Liu Q, et al. The Prognostic Value of Thyroid-Stimulating Hormone in Patients with Coronary Artery Disease and Depression. Int J Gen Med 2022;15:4675-83.
29. Fang H, Zhao R, Cui S, Wan W. Sex differences in major cardiovascular outcomes and fractures in patients with subclinical thyroid dysfunction: a systematic review and meta-analysis. Aging (Albany NY) 2022;14:8448-85.
30. Brozaitiene J, Mickuviene N, Podlipskyte A, Burkauskas J, Bunevicius R. Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study. BMC Cardiovasc Disord 2016;16:45
| Files | ||
| Issue | Vol 62 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v62i1.16883 | |
| Keywords | ||
| Coronary artery disease SYNTAX score Thyroid hormone Sex Prognosis | ||
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How to Cite
1.
Eskandari R, Vatandoost M, Nourian S, Rezaei Y. Gender-Dependent Association Between Thyroid Hormones and Severity of Coronary Artery Disease by SYNTAX Score. Acta Med Iran. 2024;62(1):27-34.
