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Impact of hormone-replacement therapy on vascular wall function in patients with heart failure and sub-clinical hypothyroidism

Blankova Z. N., Seredinina E. M., Kulev B. D., Ryabtseva O. Y., Svirida O. N, Zhubrina E. S., Barinova I. V., Ageev F. T.
Federal State Budgetary Institution, “Russian Cardiology Research and Production Complex” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: hypotheriosis, vessels, therapy, CHF

DOI: 10.18087/rhfj.2012.3.1655

Relevance. Currently researchers pay great attention to endothelial dysfunction and vascular stiffness in CHF patients. Subclinical hypotheriosis is associated with similar vascular lesion whereas the necessity of its hormone replacement therapy (HRT) is discussed by experts. Objective. To evaluate effect of HRT by Levothyroxin on arterial pressure, vascular rigidity, endothelial function in CHF patients with preserved ejection f unction (CHF-PEF) in a combination with subclinical hypotheriosis. Materials and methods. 43 patients with CHF in a combination with subclinical hypotheriosis, with diastolic dysfunction according to data of Doppler EchoCG in a stable state (NYHA II), taking standard CHF therapy, were randomized in two groups. Patients of Group I received standard CHF therapy and Levothyroxin (average dosage 60 mcg) and completed study on achevement of euthyreosis (thyreotropic hormone – 2.3±1 mU per l) in 6–10 months. Group I patients received only standard CHF therapy and completed study in 6 months. At the initial point and at the final visit arterial pressure, brachial-ankle and carotid-femoral speeds of pulse wave and endothelial function were evaluated for each patient. Results. Levothyroxin hormone replacement therapy led to statistically reliable reduction of systolic pressure (132±15 / 121±13 mm Hg, p<0.01), diastolic pressure (81±10 / 75±9 mm Hg, p<0.01) and brachial-ankle SPW (14.3±2.2 / 13.5±1.4 m per sec, p<0.01) and improvement of endothelial f unction (flow-dependent vasodilatation 7.8±4.1,%, p<0.001). No reliable changes of studied parameters in Group II were observed. Conclusion. In CHF – PEF patients combined with subclinical hypotheriosis, Levothyroxin HRT increases arterial stiffness, endothelial function and reduces arterial pressure.
  1. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado Thyroid disease prevalence study. Arch Intern Med. 2000;160 (4):526–534.
  2. Wilson S, Parle JV, Roberts LM et al.; Birmingham Elderly Thyroid Study Team. Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey. J Clin Endocrinol Metab. 2006;91 (12):4809–4816.
  3. Ringel MD, Mazzaferri EL. Subclinical thyroid dysfunction – can there be a consensus about the consensus? J Clin Endocrinol Metab. 2005;90 (1):588–590.
  4. Дедов И. И., Мельниченко Г. А., Герасимов Г. А. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению аутоиммунного тиреоидита у взрослых. Проблемы эндокринологии. 2003;49 (6):50.
  5. Duntas LH. Thyroid disease and lipids. Thyroid. 2002;12 (4):287–293.
  6. Iqbal A, Figenschau Y, Jorde R. Blood pressure in relation to serum thyrotropin: the Tromso study. J Hum Hypertens. 2006;20 (12):932–936.
  7. Lekakis J, Papamichael C, Alevizaki M et al. Flow-mediated, endothelium dependent vasodilatation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and highnormal serum thyrotropin (TSH) values. Thyroid. 1997;7 (3):411–414.
  8. Owen PJ, Rajiv C, Vinereanu D et al. Subclinical hypothyroidism, arterial stiffness and myocardial reserve. J Clin Endocrinol Metab. 2006;91 (6):2126–2132.
  9. Biondi B, Fazio S, Palmieri EA et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin Endocrinol Metab. 1999;84 (6):2064–2067.
  10. Rodondi N, den Elzen WP, Bauer DC et al. Thyroid Studies Collaboration Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010;304 (12):1365–1374.
  11. Dillmann WH. Cellular action of thyroid hormone on the heart. Thyroid. 2002;12 (6):447–452.
  12. Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116 (15):1725–1735.
  13. 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 (21):2460–2466.
  14. Iacoviello M, Guida P, Guastamacchia E et al. Prognostic role of sub-cli­nical hypothyroidism in chronic heart failure outpatients. Curr Pharm Des. 2008;14 (26):2686–2692.
  15. Mancia G, Laurent S, Agabiti-Rosei E et al. Reapprasial of European guidelines on hypertension management: a European Society of Hypertenion Task Force document. J Hypertens. 2009;27 (11):2121–2158.
  16. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов «Диагностика и лечение артериальной гипертензии». Доступно на: www.cardiosite.ru / recommendations / 2008.
  17. 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 (8):3731–3737.
  18. Nagasaki T, Inaba M, Yamada S et al. Decrease of brachial-ankle pulse wave velocity in female subclinical hypothyroid patients during norma­lization of thyroid function: a double-blind, placebo-controlled study. Eur J Endocrinol. 2009;160 (3):409–415.
  19. Monzani F, Di Bello V, Caraccio N et al. Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study. J Clin Endocrinol Metab. 2001;86 (3):1110–1115.
  20. Villar HC, Saconato H, Valente O, Atallah AN. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev. 2007; (3):CD003419.
  21. Агеев Ф. Т., Даниелян М. О., Мареев В. Ю., Беленков Ю. Н. Больные с хронической сердечной недостаточностью в российской амбулаторной практике: особенности контингента, диагностики и лечения (по материалам исследования ЭПОХА–О–ХСН). Журнал Сердечная Недостаточность. 2004;5 (1):4–7.
  22. Asvold BO, Bjoro 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 Mar;92 (3):841–845.
  23. Blacher J, Asmar R, Djane S et al. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999;33 (5):1111–1117.
  24. Imanishi R, Seto S, Toda G et al. High brachial-ankle pulse wave velo­city is an independent predictor of the presence of coronary artery disease in men. Hypertens Res. 2004;27 (2):71–78.
  25. Faber J, Petersen L, Wiinberg N et al. Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism. Thyroid. 2002;12 (4):319–324.
  26. Luboshitzky R, Aviv A, Herer P, Lavie L. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid. 2002;12 (5):421–425.
Blankova Z. N., Seredinina E. M., Kulev B. D. et al. Impact of hormone-replacement therapy on vascular wall function in patients with heart failure and sub-clinical hypothyroidism. Russian Heart Failure Journal. 2012;13(3):167-171

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