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Association of serum thyrotropin levels with coronary artery disease documented by quantitative coronary angiography:
Pedro D Ortolani1, João H Romaldini1, Ricardo A Guerra1
1Serviço de Endocrinologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual (HSPE-IAMSPE), São Paulo, SP, Brasil.
Insights
Elevated thyroid-stimulating hormone (TSH) levels are linked to coronary artery disease (CAD) severity. This study suggests high-normal TSH may be a weak CAD risk factor, impacting diagnosis and management.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- The relationship between thyroid function and coronary artery disease (CAD) is debated.
- Thyroid hormones play a crucial role in cardiovascular health.
Purpose of the Study:
- To investigate the association between thyroid function and the presence/severity of CAD.
- To evaluate serum thyroid-stimulating hormone (TSH) levels in relation to coronary artery stenosis.
Main Methods:
- 300 patients undergoing coronary angiography (CA) for CAD diagnosis were assessed.
- Serum TSH, free thyroxine, free triiodothyronine, and thyroid antibody levels were measured.
- Patients were grouped based on the number of coronary arteries with ≥50% stenosis (0, 1, 2, 3).
Main Results:
- Significantly higher TSH levels were observed in patients with more severe CAD (groups 2 and 3) compared to those without obstructive CAD (group 0).
- Group 3 (most severe CAD) also showed higher TSH than group 1.
- Elevated TSH, age, HbA1c, and HOMA-IR were independently associated with CAD presence and severity.
Conclusions:
- Elevated TSH levels, even within the high-normal range, are associated with the presence and severity of coronary artery disease.
- High-normal TSH may serve as a potential, albeit weak, risk factor for CAD.
Objective:
The association between coronary artery disease (CAD) and thyroid function remains controversial. We evaluated the thyroid function and graduated well-defined CAD as confirmed by quantitative coronary angiography (CA).
Subjects And Methods:
We evaluated the serum TSH, free thyroxine, free triiodothyronine and thyroid antibody levels in 300 consecutive patients (age 61.6 ± 9.9 years and 54% were male) undergoing CAD diagnosis as confirmed by CA. Plaques with ≥ 50% stenosis being indicative of obstructive CAD, and patients were divided into groups according to main epicardial coronary arteries with plaques (0, 1, 2, 3). Lipid profiles and a homeostasis model assessment (HOMA-IR) were determined.
Results:
Serum median (25% and 75% percentile) TSH levels in patients with group 2 and 3 (2.25; 1.66-3.12 mU/L and 4.99; 4.38-23.60 mU/L, respectively) had significantly higher TSH concentrations (p < 0.0001) than the group 0 (1.82; 1.35-2.51 mU/L). Furthermore, patients of group 3 had higher TSH concentration (p < 0.0001) than those of group 1 (1.60; 0.89-2.68 mU/L). Group 3 were older (64 ± 8.5 vs. 59 ± 9.5, p = 0.001), had more patients with dyslipidemia (84% versus 58%, p < 0.001), male (54% versus 44%, p = 0.01), hypertension (100% versus 86%, p < 0.001), and smoking (61% versus 33%, p < 0.001) than group 0. Multivariate stepwise logistic analysis showed TSH, age, HbA1c, and HOMA-IR were the CAD associated variables.
Conclusions:
In this cohort, elevated TSH levels in the high normal range or above are associated with the presence and severity of CAD besides may represent a weak CAD risk factor.
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