Association of thyroid function with arterial pressure in normotensive and hypertensive euthyroid individuals: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Overt hypothyroidism has been associated with arterial hypertension and increased arterial stiffness. Results in euthyroid individuals have been conflicting. We investigated associations of thyroid function with systolic (SAP) and diastolic (DAP) arterial pressure in euthyroid subjects.</p> <p>Methods</p> <p>311 euthyroid individuals (185 women, mean age 43.9 ± 9) without a history of diabetes attending a preventive medicine program were examined. Subjects receiving thyroxine (10.6%) were excluded; 19.3% had hypertension, 43% had a family history for hypertension. TSH, fT4, thyroid autoantibodies, insulin, glucose were measured. The "fT4.TSH product", which has been suggested as a T4 resistance-index, was calculated.</p> <p>Results</p> <p>TSH range was 0.1–8, median 1.4 mU/L, fT4 range was 11.5–25.2 pmol/L, median 17.4. TSH and the "fT4.TSH product" were positively associated with DAP (p < 0.03, for both associations). In the subgroup of individuals with TSH levels 0.36–2.5 mU/L, both TSH and the "fT4.TSH product" were positively correlated with SAP (r = +0.133 p = 0.044, r = +0.152 p = 0.026) and DAP (r = +0.243 p < 0.001, r = +0.252 p < 0.001 respectively); in multivariate analysis the "fT4.TSH product" was a significant predictor of DAP independently of HOMA-IR and BMI (p < 0.001). Similar associations were found when only the non-hypertensive subjects were analysed (p = 0.004). Hypertensive patients had higher TSH levels (p = 0.02) and belonged more frequently to the subgroup with TSH > 2 mU/L (35.3% vs 21.3%, p = 0.045).</p> <p>Conclusion</p> <p>In euthyroid individuals the association of thyroid function with diastolic arterial pressure remains significant even when a stricter "normal range" for TSH levels is considered. The "freeT4.TSH" product appears to be an even stronger predictor of DAP, independently of HOMA insulin resistance index and obesity.</p

Free thyroxine is an independent predictor of subcutaneous fat in euthyroid individuals

Objective: Thyroid function parameters have been associated with obesity, but associations with the type of adiposity have not been examined. We used ultrasound (US) to assess regional adiposity and investigated associations of thyroid function with parameters of central obesity. Design: Cross-sectional study. Methods: A total of 303 apparently healthy individuals (age 42.9+/-8.8, body mass index (BMI) 19.0-43.3, median 26.2 kg/m(2), 181 women) were examined for indices of the metabolic syndrome. BMI, waist and hip circumference, abdominal subcutaneous fat (SF), and preperitoneal fat (PF) layer was estimated. TSH, free thyroxine (fT(4)), triiodothyronine (T-3), thyroid autoantibodies, insulin, glucose, and lipid levels were measured. Subjects receiving T-4 (9.2%) were excluded. Results: SF and SF/PF ratio were inversely correlated with fT(4) levels (r=-0.169. P=0.023, r=-0.193, P=0.009 respectively). In multivariate analysis, fT(4) was a predictor of SF and SF/PF, independently of age, sex, and smoking. SF correlated with TSH levels (r=0.149, P=0.037). PF and SF were positively associated with T-3 levels (r=0.245, P=0.004 and r=0.189, P=0.019 respectively). T-3 levels were positively associated with BMI (r=0.257, P=0.0004). waist perimeter (r=0.324, P&lt;0.0001), and waist-to-hip ratio (WHR; r=0.363, P&lt;0.0001). The T-3/fT(4) ratio was positively correlated with SF (r=0.182, P=0.028), WHR (r=0.267, P=0.0003), and BMI (r=0.146, P=0.043). Conclusions: Increasing SI, accumulation as assessed by US is associated with lower fT(4) and higher TSH levels among euthyroid slightly overweight individuals. These associations indicate that subtle variation in thyroid function may participate in regional adiposity

Paraneoplastic humorally mediated hypercalcemia induced by parathyroid hormone-related protein in gynecologic malignancies: a systematic review

Humoral hypercalcemia of malignancy (HHM) is a metabolic phenomenon that is mediated by the paraneoplastic secretion of parathyroid hormone-related peptide (PTH-rP). Gynecologic malignant neoplasms complicated by HHM have been reported for organs such as the uterus, cervix, ovary, vulva and the vagina. The purpose of our study was to perform a review of the published cases in the literature and, further, to identify parameters with effect on outcome. Among 34 women with gynecologic neoplasms, 22 suffered from ovarian and 6 from uterine malignancies, while 3 had vulvar and another 3 cervical cancer. Furthermore, clear cell carcinoma was the predominant histology associated with PTH-rP expression. A significant correlation was found between serum calcium and PTH-rP levels. Treatment of hypercalcemia was successful in all cases; pamidronate was utilized in 8 patients. Ovarian cancer patients with severe hypercalcemia and high PTH-rP serum levels had shorter survival compared to their counterparts with mild hypercalcemia or moderately elevated PTH-rP serum levels, but the differences were not statistically significant

Paraneoplastic Humorally Mediated Hypercalcemia Induced by Parathyroid Hormone-Related Protein in Gynecologic Malignancies: A Systematic Review

Humoral hypercalcemia of malignancy (HHM) is a metabolic phenomenon that is mediated by the paraneoplastic secretion of parathyroid hormone-related peptide (PTH-rP). Gynecologic malignant neoplasms complicated by HHM have been reported for organs such as the uterus, cervix, ovary, vulva and the vagina. The purpose of our study was to perform a review of the published cases in the literature and, further, to identify parameters with effect on outcome. Among 34 women with gynecologic neoplasms, 22 suffered from ovarian and 6 from uterine malignancies, while 3 had vulvar and another 3 cervical cancer. Furthermore, clear cell carcinoma was the predominant histology associated with PTH-rP expression. A significant correlation was found between serum calcium and PTH-rP levels. Treatment of hypercalcemia was successful in all cases; pamidronate was utilized in 8 patients. Ovarian cancer patients with severe hypercalcemia and high PTH-rP serum levels had shorter survival compared to their counterparts with mild hypercalcemia or moderately elevated PTH-rP serum levels, but the differences were not statistically significant

Association Between Obesity and Mortality After Acute First-Ever Stroke The Obesity-Stroke Paradox

Background and Purpose-Limited data exist concerning obesity and survival in patients after acute stroke. The objective of this study was to investigate the association between obesity and survival in patients with acute first-ever stroke. Methods-Patients were prospectively investigated based on a standard diagnostic protocol over a period of 16 years. Evaluation was performed on admission, at 7 days, at 1, 3, and 6 months after discharge, and yearly thereafter for up to 10 years after stroke. The study patients were divided into 3 groups according to body mass index (BMI): normal weight (&lt;25 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (&gt;= 30 kg/m(2)). Overall survival during follow-up was the primary end point. The secondary end point was the overall composite cardiovascular events over the study period. Results-Based on our inclusion criteria, 2785 patients were recruited. According to BMI, 1138 (40.9%) patients were of normal weight, 1113 (41.0%) were overweight, and 504 (18.1%) were obese. NIHSS score on admission (mean, 11.28 +/- 8.65) was not different among the study groups. Early (first week) survival in obese (96.4%; 95% CI, 94.8%-97.9%) and overweight patients (92.8%; 95% CI, 91.2%-94.4%) was significantly higher compared to that of normal-weight patients (90.2%; 95% CI, 88.4%-92.0%). Similarly, 10-year survival was 52.5% (95% CI, 46.4%-58.6%) in obese, 47.4% (95% CI, 43.5%-51.3%) in overweight, and 41.5% (95% CI, 39.7%-45.0%) in normal-weight patients (log-rank test = 17.7; P &lt; 0.0001). Overweight (HR, 0.82; 95% CI, 0.71-0.94) and obese patients (HR, 0.71; 95% CI, 0.59-0.86) had a significantly lower risk of 10-year mortality compared to normal-weight patients after adjusting for all confounding variables. Conclusions-Based on BMI estimation, obese and overweight stroke patients have significantly better early and long-term survival rates compared to those with normal BMI. (Stroke. 2011;42:30-36.

Association of the SHBG gene promoter polymorphism with early markers of atherosclerosis in apparently healthy women

Objective: Androgen may be detrimental in the development of cardiovascular disease in women. We investigated possible associations between the (TAAAA)n polymorphism of sex hormone binding globulin (SHBG) gene promoter, which influences transcriptional efficiency of the SHBG gene - and thus the tissue androgen availability - and early markers of atherosclerosis in apparently healthy women. Design and methods: In this prospective clinical study, 153 consecutive women (mean age 43.9 +/- 9 years, 66 of whom postmenopausal, without known diabetes, cardiovascular disease), visiting our internal medicine outpatients were examined for unrecognised features of the metabolic syndrome. Endothelium dependent vasodilatation (FMD) and intima media thickness of the common carotid artery (IMT) were recorded. According to the number of SHBG gene promoter repeats patients were classified as short (&lt;= 7), medium (=8) and long repeat (&gt;= 9) allele groups. Results: The (TAAAA) n repeat length was an independent predictor of FMD in multivariate analysis (p &lt; 0.03). FMD was positively correlated with SHBG levels (p = 0.004). Women carriers of two long alleles had increased IMT (p = 0.031) although this was not independent in the multivariate analysis. Conclusions: Longer (TAAAA)n repeats in the SHBG gene promoter are associated with impaired FMD, which is an early marker of atherosclerosis. As this polymorphism has been associated with a more androgenic phenotype in women, this association may reflect the life-long tissue exposure to higher free androgens and indirectly supports the view that androgenic exposure may have adverse cardiovascular effects in women. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Meal patterns in healthy adults: Inverse association of eating frequency with subclinical atherosclerosis indexes

Background &amp; aims: Meal patterns and their relationship with cardiovascular disease are insufficiently examined with important clinical implications. Our aim was to investigate associations between eating frequency (EF) and early markers of atherosclerosis. Methods: In this cross-sectional study, we consecutively recruited 164 healthy subjects (46.8 +/- 9.3years, 62 men). EF among other dietary parameters and markers of subclinical atherosclerosis, including flow mediated dilatation (FMD), pulse wave velocity (PWV), intima media thickness (IMT) and the presence of plaques in the carotid arteries were evaluated in all volunteers. Results: EF was positively associated with total energy intake (El) and a favorable profile in terms of adiposity, glucose tolerance and blood lipids. Subjects with an increased EF (&gt; median), had significantly lower IMT (p = 0.024) and prevalence of plaques (5.3% vs. 21.3%, p = 0.003), as compared to those below median. IMT and the prevalence of plaques were also significantly lower in those with increased EF compared with subjects with low EF belonging to the same group of energy intake (El) by El median. By multivariate regression analysis, carotid plaques remained significantly associated with EF (OR: 0.71, 95% Cl 0.56-0.89), while IMT also remained significantly associated with EF after adjustment for age and dietary factors (beta: -0.010, 95% Cl: -0.020 to -0.0002), but not after adding obesity-related risk factors. Conclusion: Increased EF is associated with lower prevalence of subclinical atherosclerosis in the carotid arteries in apparently healthy individuals. Whether consumption of the same amount of energy in more eating episodes favorably affects cardiovascular risk should be further investigated. (C) 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved