Korean Circ J.  2015 Mar;45(2):125-130. 10.4070/kcj.2015.45.2.125.

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

• Lee SW
• Cho KI
• Kim HS
• Heo JH
• Cha TJ

• KMID: 2297879
• DOI: http://doi.org/10.4070/kcj.2015.45.2.125

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.

Keyword

Hypothyroidism; Autoimmunity; Coronary vasopasm

MeSH Terms

Autoimmunity*
Body Mass Index
Coronary Angiography
Coronary Vasospasm*
Coronary Vessels
Ergonovine
Humans
Hyperthyroidism
Hypothyroidism*
Iodide Peroxidase
Logistic Models
Odds Ratio
Risk Factors*
Spasm
Thyroid Gland*
Ergonovine
Iodide Peroxidase

Figure

• 

  Fig. 1 The proportion of patients with subclinical hypothyroidism among those with positive ergonovine provocation tests was significantly higher than among those patients with negative ergonovine provocation tests. TPO: thyroid peroxidase.

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