Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged

Volkan Atmış

doi:10.4274/atfm.galenos.2019.70883

Araştırma Makalesi

Yaşlı Hastalarda Hipotiroidizmin Santral ve Periferik Arter Aterosklerozuna Etkileri

Yıl 2019, Cilt: 72 Sayı: 2, 167 - 173, 02.10.2019

Volkan Atmış

Öz

Amaç: Yaşlanma, tiroid fonksiyon bozukluğu sıklığının artması ile ilişkilidir. Tiroid hormonlarının vasküler hemodinamiği ve arter sertliğini etkilediği gösterilmiştir. Arteriyel sertlik, kardiyovasküler hastalıklar için önemli bir risk faktörü olarak görünmektedir. Hipotiroidizmin periferik arter hastalığının gelişimi üzerindeki uzun vadeli etkisi iyi anlaşılmamıştır. Nabız dalga hızı (NDH), arteriyel sertliği ölçen basit, invazif olmayan bir ateroskleroz belirtecidir. Ayak bileği-brakiyal indeks (ABI) periferik vasküler hastalıkları tespit etmek için yaygın olarak kullanılan invaziv olmayan bir tekniktir. Sınırlı sayıda çalışma yaşlılarda hipotiroidizmi periferik arter hastalığı ve arter sertliği açısından bir risk faktörü olarak değerlendirmiştir. Bu çalışmada yaşlı hastalarda bu ilişkiyi araştırmayı ve daha sonra genç kontrollerle karşılaştırmayı amaçladık.

Gereç ve Yöntem: Kırk Çalışmaya hipotiroidis olan 65 yaş üstü 22 hasta, 65 yaş altı 23 hasta ile cinsiyeti ve vücut kitle indeksi çalışma grubuyla benzer 65 yaş üstü 23 ötiroidik katılımcı alındı.yaşları 65, yaşları 23, hipotiroidizmi olan 23 genç Hipotiroidizmi olan yaşlı hastalar grup I, ötiroidisi olan yaşlılar grup II, hipotiroidizmi olan genç hastalar grup III olarak tanımlandı. Karotis ve femoral arterler arasında PWV ölçüldü. ABI el tipi bir Doppler ile ölçülmüştür.

Bulgular: LDL düzeyleri hipotiroidizmli hastalarda daha yüksek saptandı. Nabız dalga hızı değerleri arasında yaşlı kontrol ve yaşlı hasta grubunda anlamlı fark saptanmadı. En düşük nabız dalga hızları genç hasta grubunda izlendi. Yaşlı gruplarla genç hasta grubu arasındaki fark anlamlıydı (p=0,001). ABI ölçümleri arasında gruplar arasında anlamlı fark saptanmadı (p>0,05). Grupların ABI değerleri periferik arter hastalığı için tanısal olmayan sınırlardaydı (>0,9).

Sonuç: Yaşlı hipotiroidizmli hastalarda santral ve periferik ateroskleroz artışı izlenmedi.Bu konuda daha fazla sayıda kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Hipotiroidizm, Periferik Arter Hastalığı, PWV, ABI, Arteriyel Katılık, İleri Yaş

Etik Beyan

Destekleyen Kurum

Proje Numarası

Teşekkür

Kaynakça

1. Mariotti S, Franceschi C, Cossarizza A, et al. The aging thyroid. Endocr Rev. 1995;16:686-715.
2. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160:526-534.
3. Helfand M, Redfern CC. Clinical guideline, part 2. Screening for thyroid disease: an update. American College of Physicians. Ann Intern Med. 1998;129:144-158.
4. Napoli R, Biondi B, Guardasole V, et al. Impact of hyperthyroidism and its correction on vascular reactivity in humans. Circulation. 2001;104:3076- 3080.
5. Sato Y, Nakamura R, Satoh M, et al. Thyroid hormone targets matrix Gla protein gene associated with vascular smooth muscle calcification. Circ Res. 2005;97:550-557.
6. Endo T, Komiya I, Tsukui T, et al. Re-evaluation of a possible high incidence of hypertension in hypothyroid patients. Am Heart J. 1979;98:684-688.
7. Yamashina A, Tomiyama H, Arai T, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res. 2003;26:615-622.
8. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281- 1357.
9. Hamilton PK, Lockhart CJ, Quinn CE, et al. Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci (Lond). 2007;113:157-170.
10. Lane HA, Smith JC, Davies JS. Noninvasive assessment of preclinical atherosclerosis. Vasc Health Risk Manag. 2006;2:19-30.
11. Kelly RP, Millasseau SC, Ritter JM, et al. Vasoactive drugs influence aortic augmentation index independently of pulse-wave velocity in healthy men. Hypertension. 2001;37:1429-1433.
12. Grenon SM, Gagnon J, Hsiang Y. Video in clinical medicine. Anklebrachial index for assessment of peripheral arterial disease. N Engl J Med. 2009;361:e40.
13. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;331:S1-75.
14. Lindeman RD, Romero LJ, Schade DS, et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey. Thyroid. 2003;13:595-600.
15. Kvetny J, Heldgaard PE, Bladbjerg EM, et al. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf). 2004;61:232-238.
16. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295:1033-1041.
17. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004;292:2591-2599.
18. Masaki M, Komamura K, Goda A, et al. Elevated arterial stiffness and diastolic dysfunction in subclinical hypothyroidism. Circ J. 2014;78:1494- 1500.
19. Tudoran M, Tudoran C. Particularities of endothelial dysfunction in hypothyroid patients. Kardiol Pol. 2015;73:337-343.
20. Mazzeffi MA, Lin HM, Flynn BC, et al. Hypothyroidism and the risk of lower extremity arterial disease. Vasc Health Risk Manag. 2010;6:957-962.
21. Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005;165:2460-2466.
22. Mya MM, Aronow WS. Increased prevalence of peripheral arterial disease in older men and women with subclinical hypothyroidism. J Gerontol A Biol Sci Med Sci. 2003;58:68-69.
23. Powell J, Zadeh JA, Carter G, et al. Raised serum thyrotrophin in women with peripheral arterial disease. Br J Surg. 1987;74:1139-1141.
24. Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49-55.
25. Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39:10-15.
26. Zhang YJ, Wu SL, Li HY, et al. [Comparison of arterial stiffness in nonhypertensive and hypertensive population of various age groups]. Zhonghua Xin Xue Guan Bing Za Zhi. 2018;46:56-63.
27. Tanaka H, DeSouza CA, Seals DR. Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol. 1998;18:127-132.
28. Tanaka H, Dinenno FA, Monahan KD, Clevenger CM, DeSouza CA, Seals DR. Aging, habitual exercise, and dynamic arterial compliance. Circulation. 2000;102:1270-1275..

Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged

Yıl 2019, Cilt: 72 Sayı: 2, 167 - 173, 02.10.2019

Volkan Atmış

Öz

Objectives: Aging is associated with an increased incidence of thyroid function abnormalities. Thyroid hormones have been shown to affect vascular hemodynamics and arterial stiffness. Arterial stiffness appears to be an essential risk factor for cardiovascular disease. The long-term effect of hypothyroidism on the development of the peripheral arterial disease is not well understood. Pulse wave velocity (PWV) is a simple, non-invasive marker of atherosclerosis that measures arterial stiffness. Ankle brachial index (ABI) is a non-invasive technique commonly used to detect peripheral vascular diseases. A limited number of studies evaluated hypothyroidism as a risk factor for both peripheral arterial disease and arterial stiffness in the old aged. We aimed to investigate this relationship in older patients and then compared with their younger counterparts.

Materials and Methods: A total of 22 patients ≥65 years of age and 23 younger patients with hypothyroidism and 23 gender-matched, and body mass index-matched old aged individuals with euthyroidism as controls were enrolled in this study. Old aged patients with hypothyroidism were defined as group I, old aged individuals with euthyroidism were defined as group II, and younger patients with hypothyroidism were defined as group III. PWV was measured between the carotid and femoral arteries. ABI was measured by a handheld Doppler.

Results: PWV was similar (0.36) in older groups (groups I and II) and was lower (p < 0.001) in group III. ABI measurements (left and right) were similar in all groups (p > 0.05). More than half of the patients with hypothyroidism had subclinical hypothyroidism, and this condition was similar in all groups (p = 0.26). We also compared patients with hypothyroidism (group I plus III) with older controls with euthyroidism (group II). Median age was higher in group II than that in group I plus III (p < 0.001). PWV was higher in group II than that in group I plus III (p < 0.001). Hypertension was more common in group II than in group I plus III (p < 0.001).

Conclusion: We did not find a relationship between hypothyroidism and atherosclerosis in old aged. PWV and hypertension were higher in older patients with hypothyroidism than in younger. Aging and hypertension increased PWV. Studies with larger series are needed to increase the reliability of these results.

Anahtar Kelimeler

Hypothyroidism, Peripheral Arterial Disease, PWV, ABI, Arterial Stiffness, Old Aged

Etik Beyan

Ethics Committee Approval: This study is ethically approved by local ethics committee with number 15973. Informed Consent: All subjects provided informed consent before entering the study. Peer-review: Externally peer-reviewed. Authorship Contributions Concept: V.A., B.E.Ö., M.F.E., T.A., Design: V.A., B.E.Ö., M.F.E.,T.A., Data Collection or Processing: V.A., B.E.Ö., M.F.E., T.A., Analysis or Interpretation: V.A., B.E.Ö., M.F.E., T.A., LiteratureSearch: V.A., B.E.Ö., M.F.E., T.A., Writing: V.A., B.E.Ö., M.F.E., T.A. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support

Destekleyen Kurum

Proje Numarası

Teşekkür

Kaynakça

1. Mariotti S, Franceschi C, Cossarizza A, et al. The aging thyroid. Endocr Rev. 1995;16:686-715.
2. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160:526-534.
3. Helfand M, Redfern CC. Clinical guideline, part 2. Screening for thyroid disease: an update. American College of Physicians. Ann Intern Med. 1998;129:144-158.
4. Napoli R, Biondi B, Guardasole V, et al. Impact of hyperthyroidism and its correction on vascular reactivity in humans. Circulation. 2001;104:3076- 3080.
5. Sato Y, Nakamura R, Satoh M, et al. Thyroid hormone targets matrix Gla protein gene associated with vascular smooth muscle calcification. Circ Res. 2005;97:550-557.
6. Endo T, Komiya I, Tsukui T, et al. Re-evaluation of a possible high incidence of hypertension in hypothyroid patients. Am Heart J. 1979;98:684-688.
7. Yamashina A, Tomiyama H, Arai T, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res. 2003;26:615-622.
8. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281- 1357.
9. Hamilton PK, Lockhart CJ, Quinn CE, et al. Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci (Lond). 2007;113:157-170.
10. Lane HA, Smith JC, Davies JS. Noninvasive assessment of preclinical atherosclerosis. Vasc Health Risk Manag. 2006;2:19-30.
11. Kelly RP, Millasseau SC, Ritter JM, et al. Vasoactive drugs influence aortic augmentation index independently of pulse-wave velocity in healthy men. Hypertension. 2001;37:1429-1433.
12. Grenon SM, Gagnon J, Hsiang Y. Video in clinical medicine. Anklebrachial index for assessment of peripheral arterial disease. N Engl J Med. 2009;361:e40.
13. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;331:S1-75.
14. Lindeman RD, Romero LJ, Schade DS, et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey. Thyroid. 2003;13:595-600.
15. Kvetny J, Heldgaard PE, Bladbjerg EM, et al. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf). 2004;61:232-238.
16. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295:1033-1041.
17. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA. 2004;292:2591-2599.
18. Masaki M, Komamura K, Goda A, et al. Elevated arterial stiffness and diastolic dysfunction in subclinical hypothyroidism. Circ J. 2014;78:1494- 1500.
19. Tudoran M, Tudoran C. Particularities of endothelial dysfunction in hypothyroid patients. Kardiol Pol. 2015;73:337-343.
20. Mazzeffi MA, Lin HM, Flynn BC, et al. Hypothyroidism and the risk of lower extremity arterial disease. Vasc Health Risk Manag. 2010;6:957-962.
21. Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005;165:2460-2466.
22. Mya MM, Aronow WS. Increased prevalence of peripheral arterial disease in older men and women with subclinical hypothyroidism. J Gerontol A Biol Sci Med Sci. 2003;58:68-69.
23. Powell J, Zadeh JA, Carter G, et al. Raised serum thyrotrophin in women with peripheral arterial disease. Br J Surg. 1987;74:1139-1141.
24. Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49-55.
25. Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39:10-15.
26. Zhang YJ, Wu SL, Li HY, et al. [Comparison of arterial stiffness in nonhypertensive and hypertensive population of various age groups]. Zhonghua Xin Xue Guan Bing Za Zhi. 2018;46:56-63.
27. Tanaka H, DeSouza CA, Seals DR. Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol. 1998;18:127-132.
28. Tanaka H, Dinenno FA, Monahan KD, Clevenger CM, DeSouza CA, Seals DR. Aging, habitual exercise, and dynamic arterial compliance. Circulation. 2000;102:1270-1275..

Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Geriatri ve Gerontoloji
Bölüm	Makaleler
Yazarlar	Volkan Atmış 0000-0002-0080-6448
Proje Numarası	-
Yayımlanma Tarihi	2 Ekim 2019
Yayımlandığı Sayı	Yıl 2019 Cilt: 72 Sayı: 2

Kaynak Göster

APA	Atmış, V. (2019). Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(2), 167-173. https://doi.org/10.4274/atfm.galenos.2019.70883
AMA	Atmış V. Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2019;72(2):167-173. doi:10.4274/atfm.galenos.2019.70883
Chicago	Atmış, Volkan. “Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, sy. 2 (Ekim 2019): 167-73. https://doi.org/10.4274/atfm.galenos.2019.70883.
EndNote	Atmış V (01 Ekim 2019) Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 2 167–173.
IEEE	V. Atmış, “Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 2, ss. 167–173, 2019, doi: 10.4274/atfm.galenos.2019.70883.
ISNAD	Atmış, Volkan. “Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/2 (Ekim 2019), 167-173. https://doi.org/10.4274/atfm.galenos.2019.70883.
JAMA	Atmış V. Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72:167–173.
MLA	Atmış, Volkan. “Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 2, 2019, ss. 167-73, doi:10.4274/atfm.galenos.2019.70883.
Vancouver	Atmış V. Effects of Hypothyroidism on Central and Peripheral Atherosclerosis in the Old Aged. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72(2):167-73.

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