Atherogenic Index of Plasma, Castelli Risk Index and Atherogenic Coefficient in the Assessment of Cardiovascular Disease Risk in Patients with Severe Hypothyroidism

Öz

Objective: In overt hypothyroidism, dyslipidemia occurs due to lipid metabolism changes. We think that changes in lipid metabolism may increase atherogenic changes. Since atherogenicity studies related to severe hypothyroidism are very rare in the literature, we evaluated atherogenicity-related indices in patients with severe hypothyroidism in our study.

Material and Methods: Our retrospective cross-sectional study included 100 subjects, 50 with severe hypothyroidism and 50 healthy controls. Triglyceride glucose index, triglyceride-glucose-body mass index and atherogenic indices such as the Castelli’s Risk Index (CRI), atherogenic index of plasma and atherogenic coefficient were calculated using lipid profile data. Statistical analysis was performed by comparing the lipid profile and atherogenic indexes.

Results: The mean age of the severe hypothyroidism group was 47.1±16.6 and the mean age of the control group was 49.4±6.4 years. In traditional lipid parameters, total cholesterol, triglyceride, low-density lipoprotein, non-high density lipoprotein cholesterol levels were significantly higher in the severe hypothyroidism group (p<0.001, p<0.001, p<0.001, p<0.001). High-density lipoprotein was higher, although not significantly, in the severe hypothyroidism group. Triglyceride glucose index, CRI-I, CRI-II, atherogenic index of plasma and atherogenic coefficient were significantly higher in severe hypothyroidism group (p=0.001, p=0.011, p=0.019, p=0.026, p=0.011). Compared to the control group, elevated triglyceride, total cholesterol, and low-density lipoprotein cholesterol rates were found to be significantly higher in the severe hypothyroidism group (p=0.004, p=0.009, p<0.001, p=0.026). High-risk CRI-I and elevated atherogenic coefficient rates were found to be significantly higher in the severe hypothyroidism group (p=0.012, p=0.003). There was a correlation between fT4 and atherogenic coefficient (r:-0.304, p:0.040), body mass index and triglyceride index (r:0.314, p: 0.002), and atherogenic index of plasma (r: 0.314, p:0.002). (r:0.250, p:0.012).

Conclusion: In severe hypothyroidism, high atherogenic indices are risk factors for cardiovascular complications. We suggest that severe hypothyroidism should be evaluated as cardiovascular disease in treatment and follow-up.

Anahtar Kelimeler

• Severe hypothyroidism
• Atherogenic index of plasma
• Castelli’s Risk Index
• Atherogenic coefficient

AĞIR HİPOTİROİDİZMLİ HASTALARDA KARDİYOVASKÜLER HASTALIK RİSKİNİN DEĞERLENDİRİLMESİNDE PLAZMA ATEROJENİK İNDEKS, CASTELLİ RİSK İNDEKSİ VE ATEROJENİK KATSAYI

Öz

Amaç: Aşikâr hipotiroidide lipid metabolizması değişimine bağlı dislipidemi oluşmaktadır. Lipid metabolizmasındaki değişikliklerin aterojenik değişiklikleri arttırabileceğini düşünmekteyiz. Literatürde ağır hipotiroidi ile ilgili aterojenite çalışmalarının çok nadir olması nedeniyle çalışmamızda ağır hipotiroidili hastalarda aterojenite ile ilişkili indeksleri değerlendirdik.

Gereç ve Yöntemler: Retrospektif kesitsel çalışmamıza, 50 ağır hipotiroidili ve 50 sağlıklı kontrol olmak üzere yüz hasta dahil edildi. Trigliserid glukoz indeksi, Trigliserid glukoz- vücut kitle indeksi, plazma aterojenik indeksi, Castelli risk indeksi ve aterojenik katsayı gibi aterojenik indeksler, lipid profili verileri kullanılarak hesaplandı.

Bulgular: Ağır hipotiroidi grubunun yaş ortalaması 47.1±16.6 yıl ve kontrol grubunun yaş ortalaması 49.4±6.4 yıl olarak saptandı. Geleneksel lipid parametrelerinden total kolesterol, trigliserid, düşük yoğunluklu lipoprotein, yüksek yoğunluklu lipoprotein dışı kolesterol düzeyleri ağır hipotiroidi grubunda anlamlı olarak yüksekti (p<0.001, p<0.001, p<0.001, p<0.001). Yüksek yoğunluklu lipoprotein, ağır hipotiroidi grubunda anlamlı olmasa da daha yüksekti. Ağır hipotiroidi grubunda trigliserid glukoz indeksi, trigliserid glukoz- vücut kitle indeksi, Castelli risk indeksi-I, Castelli risk indeksi-II, plazma aterojenik indeksi ve aterojenik katsayı anlamlı olarak daha yüksekti (p=0.001, p=0.011, p=0.019, p=0.026, p=0.011). Kontrol grubu ile karşılaştırıldığında ağır hipotiroidi grubunda yüksek trigliserid, total kolesterol ve düşük yoğunluklu lipoprotein kolesterol oranları istatistiksel olarak anlamlı düzeyde yüksek bulundu (p=0.004, p=0.009, p<0.001, p=0.026). Yüksek riskli Castelli risk indeksi-I ve yüksek aterojenik katsayı oranları ağır hipotiroidi grubunda anlamlı olarak daha yüksek bulundu (p=0.012, p=0.003). sT4 ile aterojenik katsayı arasında (r:- 0.304, p:0.040), vücut kitle indeksi ile trigliserid indeksi (r: 0.314, p:0.002) ve plazma aterojenik indeksi (r:0.250, p: 0.012) arasında korelasyon saptanmıştır.

Sonuç: Ağır hipotiroidide aterojenik indekslerin yüksekliği kardiyovasküler komplikasyonlar açısından risk faktörüdür. Ağır hipotiroidi tedavi ve takibinde kardiyovasküler hastalık gibi yaklaşılmasını öneriyoruz.

Anahtar Kelimeler

• Ciddi hipotiroidizm
• Plazma aterojenik indeksi
• Castelli risk indeksi
• Aterojenik katsayı

Kaynakça

1. 1. Najeeb HA, Al-Timimi, DJ, Qasim BA, Mohammed AA. Parental history of coronary artery disease among adults with hypothyroidism: Case controlled study. Ann Med Surg. 2020;60(10):92-101.
2. 2. Pearce EN. Hypothyroidism and dyslipidemia: Modern concepts and approaches. Curr Cardiol Rep. 2004;6(6):451-6.
3. 3. Fruchart JC, Nierman MC, Stroes ESG, Kastelein JJP, Duriez P. New risk factors for atherosclerosis and patient risk assessment. Circulation. 2004;109(23):15-9.
4. 4. Bhardwaj S, Pharm IJ, Sci B, Bhardwaj S, Bhattacharjee J, Bhatnagar MK et al. Atherogenic Index of Plasma, Castelli Risk Index and Atherogenic Coefficient-New Parameters in assessing cardiovascular risk. Int J Pharm Biol Sci. 2013;3(3):359-64.
5. 5. Sasikala T, Kalyan G. Castelli risk index-1 and atherogenic coefficient are better predictors of cardiometabolic risk in patients with hypothyroidism. Int J Clin Bio Res. 2020;7(2):254-9.
6. 6. Kamoru AA, Japhet OM, Adetunji AD, Musa MA, Hammed OO, Akinlawon AA et al. Castelli risk index, atherogenic index of plasma, and atherogenic coefficient: Emerging risk predictors of cardiovascular disease in HIV-treated patients. Saudi J Med Pharm Sci. 2017;(12):1101-10.
7. 7. Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Mänttäri M, Heinonen OP et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study: Implications for treatment. Circulation. 1992;85(1):37-45.
8. 8. Grais IM. Bedside skills: A 50-Year personal retrospective. Texas Hear Inst J. 2010;37(6):629-32.

9. 9. Arambam P, Kaul U, Ranjan P, Janardhanan R. Prognostic implications of thyroid hormone alterations in acute coronary syndrome-A systematic review. Indian Heart J. 2021;73(2):143-8.
10. 10. Kuusi T, Taskinen MR, Nikkilä EA. Lipoproteins, lipolytic enzymes, and hormonal status in hypothyroid women at different levels of substitution. J Clin Endocrinol Metab. 1988;66(1):51-6.
11. 11. Baliarsingh S, Sharma N, Mukherjee R. Serum uric acid: Marker for atherosclerosis as it is positively associated with “atherogenic index of plasma”. Arch Physiol Biochem. 2013;119(1):27-31.
12. 12. Cnop M, Havel PJ, Utzschneider KM, Carr DB, Sinha MK, Boyko EJ et al. Relationship of adiponectin to body fat distribution, insulin sensitivity and plasma lipoproteins: Evidence for independent roles of age and sex. Diabetologia. 2003;46(4):459-69.
13. 13. Lu L, Wang B, Shan Z, Jiang F, Teng X, Chen Y et al. The correlation between thyrotropin and dyslipidemia in a population-based study. J Korean Med Sci. 2011;26(2):243-9.
14. 14. Jian S, Su-Mei N, Xue C, Jie Z, Xue-Sen W. Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults. Clin Exp Hypertens. 2017;39(8):732-9.
15. 15. Assmann G, Cullen P, Schulte H. The Münster Heart Study (PROCAM). Results of follow-up at 8 years. Eur Heart J. 1998;19:A2-11.
16. 16. Wu TT, Gao Y, Zheng YY, Ma YT, Xie X. Atherogenic index of plasma (AIP): A novel predictive indicator for the coronary artery disease in postmenopausal women. Lipids Health Dis. 2018;17(1):1-7.
17. 17. Yildiz G, Duman A, Aydin H, Yilmaz A, Hur E, Magden K et al. Evaluation of association between atherogenic index of plasma and intima-media thickness of the carotid artery for subclinic atherosclerosis in patients on maintenance hemodialysis. Hemodial Int. 2013;17(3):397-405.
18. 18. Marwaha RK, Tandon N, Garg MK, Kanwar R, Sastry A, Narang A et al. Dyslipidemia in subclinical hypothyroidism in an Indian population. Clin Biochem. 2011;44(14-15):1214-17.
19. 19. Sigal GA, Tavoni TM, Silva BMO, Kalil FR, Brandão LG, Maranhão RC. Effects of short-term hypothyroidism on the lipid transfer to high-density lipoprotein and other parameters related to lipoprotein metabolism in patients submitted to thyroidectomy for thyroid cancer. Thyroid. 2019;29(1):53-8.
20. 20. Van Der Boom T, Jia C, Lefrandt JD, Connelly MA, Links TP, Tietge UJF et al. HDL Cholesterol efflux capacity is impaired in severe short-term hypothyroidism despite increased HDL cholesterol. J Clin Endocrinol Metab. 2020;105(9):1-8.