Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

The Impact of Subclinical Hypothyroidism or Thyroid Autoimmunity on Coronary Vasospasm in Patients without Associated Cardiovascular Risk Factors

  • Lee, Sea-Won (Division of Cardiology, Department of Internal Medicine, Busan Veterans Hospital) ;
  • Cho, Kyoung-Im (Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine) ;
  • Kim, Hyun-Su (Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine) ;
  • Heo, Jung-Ho (Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine) ;
  • Cha, Tae-Joon (Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine)
  • Received : 2014.08.14
  • Accepted : 2014.11.14
  • Published : 2015.03.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: Subclinical hypothyroidism is associated with endothelial dysfunction and impaired coronary flow reserve. However, the effect of subclinical hypothyroidism or thyroid autoimmunity on variant angina has yet to be determined. Subjects and Methods: Among 385 consecutive patients without associated cardiovascular risk factors who underwent coronary angiography with the ergonovine provocation test (EPT), 165 had a positive EPT {EPT(+)} and 220 had a negative EPT {EPT(-)}. The relationship between coronary artery spasm and the presence of subclinical thyroid dysfunction as well as serum thyroid peroxidase autoantibody (TPO Ab) was evaluated. Results: The proportion of patients with subclinical hypothyroidism among those who were EPT(+) was significantly higher than that in those who were EPT(-) (18% vs. 11%, p=0.001). However, there was no significant difference in the proportion of patients with subclinical hyperthyroidism between the groups. Moreover, EPT(+) patients showed significantly more positive TPO Ab (33% vs. 14%, p<0.001) than those with EPT(-). There was a positive correlation between EPT(+) and TPO positivity (r=0.226, p<0.001), subclinical hypothyroidism (r=0.112, p=0.033), and body mass index (r=0.123, p=0.018). Binary logistic regression analysis revealed that the significant predictors of EPT(+) were body mass index {adjusted odds ratio (OR)=1.042, 95% confidence interval (CI)=1.005-1.080}, presence of subclinical hypothyroidism (OR=3.047, 95% CI=1.083-8.572), TPO Ab titer (OR=1.028, 95% CI=1.015-1.041), and the presence of TPO Ab (OR=4.904, 95% CI=1.544-15.567). Conclusion: Subclinical hypothyroidism and the presence of TPO Ab are significantly associated with coronary vasospasm in patients without cardiovascular risk factors.

Keywords

References

  1. Yasue H, Horio Y, Nakamura N, et al. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation 1986;74:955-63. https://doi.org/10.1161/01.CIR.74.5.955
  2. Akasaka T, Yoshida K, Hozumi T, et al. Comparison of coronary flow reserve between focal and diffuse vasoconstriction induced by ergonovine in patients with vasospastic angina. Am J Cardiol 1997;80:705-10. https://doi.org/10.1016/S0002-9149(97)00499-2
  3. Kugiyama K, Ohgushi M, Motoyama T, et al. Nitric oxide-mediated flow-dependent dilation is impaired in coronary arteries in patients with coronary spastic angina. J Am Coll Cardiol 1997;30:920-6. https://doi.org/10.1016/S0735-1097(97)00236-2
  4. Selwyn AP, Kinlay S, Creager M, Libby P, Ganz P. Cell dysfunction in atherosclerosis and the ischemic manifestations of coronary artery disease. Am J Cardiol 1997;79(5A):17-23.
  5. Owen PJ, Sabit R, Lazarus JH. Thyroid disease and vascular function. Thyroid 2007;17:519-24. https://doi.org/10.1089/thy.2007.0051
  6. Lekakis J, Papamichael C, Alevizaki M, et al. Flow-mediated, endothelium-dependent vasodilation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and high-normal serum thyrotropin (TSH) values. Thyroid 1997;7:411-4. https://doi.org/10.1089/thy.1997.7.411
  7. Cikim AS, Oflaz H, Ozbey N, et al. Evaluation of endothelial function in subclinical hypothyroidism and subclinical hyperthyroidism. Thyroid 2004;14:605-9. https://doi.org/10.1089/1050725041692891
  8. 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;88:3731-7. https://doi.org/10.1210/jc.2003-030039
  9. Schultz M, Kistorp C, Raymond I, et al. Cardiovascular events in thyroid disease: a population based, prospective study. Horm Metab Res 2011;43:653-9. https://doi.org/10.1055/s-0031-1283162
  10. Sharma R, Sharma TK, Kaushik GG, Sharma S, Vardey SK, Sinha M. Subclinical hypothyroidism and its association with cardiovascular risk factors. Clin Lab 2011;57:719-24.
  11. Stamatelopoulos KS, Kyrkou K, Chrysochoou E, et al. Arterial stiffness but not intima-media thickness is increased in euthyroid patients with Hashimoto's thyroiditis: the effect of menopausal status. Thyroid 2009;19:857-62. https://doi.org/10.1089/thy.2008.0326
  12. Ciccone MM, De Pergola G, Porcelli MT, et al. Increased carotid IMT in overweight and obese women affected by Hashimoto's thyroiditis: an adiposity and autoimmune linkage? BMC Cardiovasc Disord 2010;10:22. https://doi.org/10.1186/1471-2261-10-22
  13. Cho KI, Lee JH. The impact of thyroid autoimmunity on arterial stiffness in postmenopausal patients with fibromyalgia. Int J Rheum Dis 2014 Jan 11 [Epub]. http://dx.doi.org/10.1111/1756-185X.12257.
  14. Zaya M, Mehta PK, Merz CN. Provocative testing for coronary reactivity and spasm. J Am Coll Cardiol 2014;63:103-9. https://doi.org/10.1016/j.jacc.2013.10.038
  15. JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008):digest version. Circ J 2010;74:1745-62. https://doi.org/10.1253/circj.CJ-10-74-0802
  16. Bory M, Panagides D, Desfossez L. Coronary artery spasm in myocardial infarction. Lancet 1993;342:436.
  17. Yasue H, Kugiyama K. Coronary spasm: clinical features and pathogenesis. Intern Med 1997;36:760-5. https://doi.org/10.2169/internalmedicine.36.760
  18. Kahaly GJ. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid 2000;10:665-79. https://doi.org/10.1089/10507250050137743
  19. Wei JY, Genecin A, Greene HL, Achuff SC. Coronary spasm with ventricular fibrillation during thyrotoxicosis: response to attaining euthyroid state. Am J Cardiol 1979;43:335-9. https://doi.org/10.1016/S0002-9149(79)80023-5
  20. Cooper DS. Clinical practice. Subclinical hypothyroidism. N Engl J Med 2001;345:260-5. https://doi.org/10.1056/NEJM200107263450406
  21. Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002;137:904-14. https://doi.org/10.7326/0003-4819-137-11-200212030-00011
  22. Pirich C, Müllner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol 2000;53:623-9. https://doi.org/10.1016/S0895-4356(99)00187-0
  23. Cai Y, Ren Y, Shi J. Blood pressure levels in patients with subclinical thyroid dysfunction: a meta-analysis of cross-sectional data. Hypertens Res 2011;34:1098-105. https://doi.org/10.1038/hr.2011.91
  24. Canturk Z, Cetinarslan B, Tarkun I, Canturk NZ, Ozden M, Duman C. Hemostatic system as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Thyroid 2003;13:971-7. https://doi.org/10.1089/105072503322511382
  25. Mizuma H, Murakami M, Mori M. Thyroid hormone activation in human vascular smooth muscle cells: expression of type II iodothyronine deiodinase. Circ Res 2001;88:313-8. https://doi.org/10.1161/01.RES.88.3.313
  26. Taddei S, Caraccio N, Virdis A, et al. Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto’s thyroiditis. J Clin Endocrinol Metab 2006;91:5076-82. https://doi.org/10.1210/jc.2006-1075
  27. Obuobie K, Smith J, Evans LM, John R, Davies JS, Lazarus JH. Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab 2002;87:4662-6. https://doi.org/10.1210/jc.2002-020493
  28. Nagasaki T, Inaba M, Kumeda Y, et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab 2006;91:154-8. https://doi.org/10.1210/jc.2005-1342
  29. Kashiwagi Y, Harada E, Mizuno Y, et al. Coronary spastic angina is associated with insulin resistance-possible involvement of endothelial dysfunction. Coron Artery Dis 2013;24:559-65. https://doi.org/10.1097/MCA.0000000000000024
  30. Al Suwaidi J, Higano ST, Holmes DR Jr, Lennon R, Lerman A. Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries. J Am Coll Cardiol 2001;37:1523-8. https://doi.org/10.1016/S0735-1097(01)01212-8

Cited by

  1. The Association of Subclinical Hypothyroidism and Pattern of Circulating Endothelial-Derived Microparticles Among Chronic Heart Failure Patients vol.4, pp.4, 2015, https://doi.org/10.5812/cardiovascmed.29094
  2. Subclinical hypothyroidism and the development of heart failure: an overview of risk and effects on cardiac function vol.108, pp.3, 2015, https://doi.org/10.1007/s00392-018-1340-1
  3. Relationship of thyroid dysfunction with cardiovascular diseases: updated review on heart failure progression vol.19, pp.3, 2020, https://doi.org/10.1007/s42000-020-00208-8