The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Introduction: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval ‒ 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. Results: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). Discussion: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected

Diabetes, subclinical thyroid disfunction and subclinical atherosclerosis measured by coronary artery calcium and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Br)

A associação entre o diabetes e as doenças tireoidianas subclínicas pode aumentar o risco das doenças cardiovasculares. Nosso objetivo foi avaliar a associação do diabetes e do hipotireoidismo subclínico com a aterosclerose subclínica medida pelo escore de cálcio coronário (CAC) e pela espessura da íntima-média de carótidas (EIMC) a partir dos dados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foram realizadas duas avaliações transversais, uma com os dados da linha de base (2008-2010) para a avaliação do CAC e outra com as informações obtidas durante a terceira visita (2017-2019) para a avaliação da EIMC. Em ambas as análises foram aplicados modelos logísticos para EIMC>percentil 75 e CAC>0 e modelos lineares para EIMC como variável contínua e Log de CAC+1. Os resultados foram apresentados sem ajuste, com ajustes para variáveis sociodemográficas (idade, sexo, raça e nível educacional) e o ajuste multivariável para fatores sociodemográficos mais fatores de risco cardiovascular (IMC, hipertensão, dislipidemia, tabagismo, atividade física) foram incluídos. Para a avaliação da EIMC, após exclusões de participantes com história de doença cardiovascular prévia, foram incluídos 5.077 indivíduos sem doença, 1.578 com apenas diabetes, 662 com apenas hipotireoidismo subclínico e 234 com ambas as doenças. O modelo de regressão linear apresentou uma associação do EIMC com diabetes (: 0,019; 95% IC, 0,012-0,027; Ppercentil 75 com o diabetes (RC: 1,49, 95% IC, 1,30-1,71). Nenhuma interação entre o diabetes e o hipotireoidismo subclínico foi encontrada usando-se a EIMC como variável contínua (P=0,29) ou como variável categórica (P=0,92). Para avaliação do CAC, após exclusões, foram incluídos 3.809 participantes distribuídos nos subgrupos: sem doença (2.885), com apenas hipotireoidismo subclínico (297), com apenas diabetes (572) e ambas as doenças (55). Após os ajustes houve associação de CAC>0 apenas com o subgrupo diabetes (RC: 1,31; 95% IC, 1,05-1,63), mas não com o subgrupo que apresentava hipotireoidismo subclínico e diabetes. O modelo de regressão linear apresentou associação do Log de CAC +1 com diabetes (Beta 0,236; 0,163-0,403, P percentil 75 and CAC>0 and linear models cIMT as a continuous variable and Log CAC+1. Results were presented without adjustment, adjusted for sociodemographic variables (age, sex, self-reported race and educational level) and multivariable including sociodemographic and cardiovascular risk factors (BMI, hypertension, dyslipidemia, smoking and physical activity). For cIMT, after exclusions of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes ( 0.019; 95%CI, 0.012 to 0.027; P0 with diabetes (OR, 1.31; 95%CI, 1.05-1.63) but not with subclinical hypothyroidism or the association of diabetes with subclinical hypothyroidism. Linear regression models showed an association of log (CAC+1) with diabetes (Beta 0.236; 0.163 to 0.403, P <0.0001), but not with only subclinical hypothyroidism or both diseases. No interaction between diabetes and subclinical hypothyroidism for CAC as a categorical variable (P=0.29) or as a continuous variable was found (P=0.11). Our results showed an association of diabetes with subclinical atherosclerosis measured by CAC and cIMT, however, it was not found any additive effect of diabetes and subclinical hypothyroidism with an increased burden of subclinical atherosclerosi