CAN CARDIOVASCULAR DISEASE BE CAUSED BY THYROID PATHOLOGY?

Abstract

Introduction: Thyroid pathology and cardiovascular disease (CVD) are very prevalent in the general population. Some studies demonstrate an association between thyroid dysfunction and CVD. Taking into account that CVD can increase the risk of events and mortality, it’s important to know modifiable risk factors and act on them.

Objective: The aim of this study is to verify whether thyroid pathology is associated with CVD in the adult population.

Material and Methods: Evidence-based review of systematic reviews (SR), meta-analyses (MA) and randomized clinical trials (RCT), in Portuguese and English, published in the last 10 years, in the PubMed database using the MeSH terms “cardiovascular diseases” and “thyroid diseases”. The Strength of Recommendation Taxonomy (SORT) Scale from the American Family Physician was used to assess the level of evidence and recommendation strength.

Results: 99 articles were found of which 73 were excluded after reading the title, 12 after reading the abstract and 4 after reading the full article, being selected 10 for analysis (4 MA, 2 RS e 4 MA+RS). According to Smedegaard et al., subclinical hyperthyroidism can cause atrial fibrillation (AF) and heart failure (HF), Ding and Gong et al. mentioned an association with metabolic syndrome (increased risk of obesity, hypertension, high level of triglycerides and total and low-density cholesterol, low level of high-density lipoprotein), and Srisawat referred association between hyperthyroidism and venous thromboembolism. Huang mentioned that subclinical hypothyroidism is associated with AF, and Collet stated an association with coronary disease regardless the presence of antibodies. Floriani et al. reported than subclinical hypothyroidism with TSH ≥ 10 mlU/L and subclinical hyperthyroidism with TSH < 0,1 MlU/L increase the risk of mortality so should be treated. Kostopoulos et al. mentioned an association between differentiated thyroid carcinoma and a higher risk of developing AF.

Conclusion: Most studies show an association between thyroid pathology and CVD, as AF and other arrhythmias, HF, increased CV risk and mortality. Therefore, some studies refer to the importance of tracking and treating dysfunction, even if it is subclinical. However, this association remains controversial and it’s important to carry out more studies and more robust ones.