Minor perturbations of thyroid homeostasis and major cardiovascular endpoints
- It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.
Author: | Patrick MüllerORCiDGND, Melvin Khee-Shing LeowORCiDGND, Johannes Wolfgang Christian DietrichORCiDGND |
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URN: | urn:nbn:de:hbz:294-102450 |
DOI: | https://doi.org/10.3389/fcvm.2022.942971 |
Parent Title (English): | Frontiers in cardiovascular medicine |
Subtitle (English): | physiological mechanisms and clinical evidence |
Publisher: | Frontiers Media |
Place of publication: | Lausanne, Schweiz |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2023/08/29 |
Date of first Publication: | 2022/08/15 |
Publishing Institution: | Ruhr-Universität Bochum, Universitätsbibliothek |
Tag: | Open Access Fonds MACE; cardiac electrophysiology; hypothyroidism; sudden cardiac death; thyroid function; thyrotoxicosis; type 2 allostatic load; ventricular arrhythmia |
Volume: | 9 |
Issue: | Article 942971 |
First Page: | 942971-1 |
Last Page: | 942971-24 |
Note: | Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum. |
Institutes/Facilities: | St. Josef-Hospital Bochum, Abteilung für Diabetologie und Gastrointestinale Endokrinologie |
Katholisches Klinikum Bochum, Innere Medizin | |
Dewey Decimal Classification: | Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit |
open_access (DINI-Set): | open_access |
Licence (English): | Creative Commons - CC BY 4.0 - Attribution 4.0 International |