| BackgroundAlthough risk factors for cardiovascular disease are well documented and firmly established,the role of other mediators in initiating and exacerbating underlying cardiovascular disease is increasingly acknowledged.The traditional view that the common risk factors for coronary heart disease are age,sex,smoking,hypertension,diabetes,dyslipidemia,lack of physical activity,early cardiovascular family history.In recently,in the influence factors and progression of cardiovascular disease,thyroid dysfunction on cardiovascular disease is getting more and more attention.The role of thyroid hormones—particularly when abnormal—in aggravating cardiovascular disease is recognized,the influence factors and progression of cardiovascular disease,thyroid dysfunction of cardiovascular disease is getting more and more attention.Thyroid stimulating hormone(TSH)can sensitively reflect thyroid function and the level of thyroid hormones and also can predict the development of subclinical thyroid disease.Change of thyroid hormone is often followed by changes in TSH,even if thyroid hormone level is normal in the blood,abnormal TSH level may also contribute to lipid metabolism,bone,heart and even the nervous system.With the deepening understanding of thyroid function and cardiovascular disease,and the prevalence of thyroid function testing,it is found that excessive thyroid hormone can increase the incidence of coronary events.Several studies have found that the increase of free triiothyronine was an independent risk factor for acute myocardial ischemia.In 2014 Li Meng et al did some research in patients who have hyperthyroidism with acute coronary syndrome,found some clinical features and coronary angiographic characteristics.The possible mechanism of myocardial ischemia are the imbalance between myocardial oxygen supply and demand,transient thrombotic occlusion,coronary spasm and endothelial dysfunction.For patients with acute coronary syndrome(ACS)combined with thyrotoxicosis,namely hyperthyroidism,using of anti-thyroid drug(ATD)is crucial.For patients with ACS combined with hyperthyroidism and subclinical hyperthyroidism who have no thyrotoxicosis,i.e.,patients with ACS combined with low TSH,using of ATD is still in the blind.So far,although clinicians have noticed that thyroid hormone level have a significant impact on cardiovascular disease development and prognosis.The European Thyroid Association in 2015 made it clear that ATD was recommended for use in patients with heart disease,diabetes,renal failure,stroke,or transient ischemic attack,especially in the diagnosis and treatment guidelines for endogenous subclinical hyperthyroidism,Valvular heart disease,coronary or peripheral vascular disease and other patients,for the typical clinical manifestations of thyrotoxicosis should be actively treated;and for the age of 65 years of age,TSH significantly decreased and symptomatic subclinical hyperthyroidism patients,because of the risk of progression to clinical hyperthyroidism,especially in patients with symptomatic and or potential risk factors or concomitant disease,can also be treated.For patients of ACS associated with non-Graves disease induced hypothyroidism without thyrotoxicosis is not recommended ATD treatment.ATD application for such patients whether can improve the prognosis or not,still need further study.PurposeThis prospective study aims to evaluate the therapeutic effect and prognosis of ACS associated with non-Graves disease induced hypothyroidism without thyrotoxicosis.Materials and methodsSelecting from January 2012 to December 2015 in the Third Affiliated Hospital of Southern Medical University Department of Cardiology,all patients agreed to participate in this study and signed informed consent of patients with acute coronary syndrome.A total of 27 consecutive patients with ACS associated with non-Graves disease induced hypothyroidism without thyrotoxicosis.According to whether the treatment by ATD or not,there are divided into two groups,treatment group and control group.All patients were excluded from the following:1)patients with Graves disease;2)patients with thyrotoxicosis with low serum level of thyroid stimulating hormone;3)patients who have used drugs that affect thyroid function in the past six months:L-thyroxine sodium,methimazole,propylthio Pyrimidine,amiodarone,radioactive iodine 131.glucocorticoid,estrogen,lithium carbonate,immunomodulator.etc;4)patients with TSH due to pituitary disease;5)patients with pLulmonary embolism;6)patients with valvular heart disease;7)patients with autoirnmune diseases;8)patients with severe systemic disease(cirrhosis decompensation,renal replacement therapy,malignancy or life expectancy less than the year);9)patients with severe heart failure:NYHA cardiac function classification>Class ?.Killip grading>Class ?.The general clinical data:age,sex,smoking history and past medical history were collected for all patients.The average follow-up 6 months.Through the case review system,patients who were discharged from the hospital after 1 months,3 months and 6 months,found the detection of serum TSH concentration from the case review system,and by telephone or clinic follow-up,inquiring and recording the time,treatment and prognosis of the major adverse cardiovascular events(recurrent angina,recurrent myocardium infarction,emerging heart failure).To compare whether the application of ATD about the therapeutic effect and prognosis in this population or not.To compare whether the application of ATD about the therapeutic effect and prognosis in this population or not.All patients were enrolled in the treatment of coronary heart disease secondary to drug treatment,drug and behavioral intervention to follow the clinical practice guidelines treatment principles,determined by the clinician.All data were analyzed by SPSS22.0 statistical software,and the difference was statistically significant by P<0.05.Removal of ATD during follow-up treatment,secondary prevention of coronary heart disease treatment.There are 27 patients were included in the analysis.The subjects were divided into two groups:the treatment group,the control group.The multivariate logistic regression was used to analyze the effect of ATD on the prognosis.ResultsIn all 27 cases of ACS associated with non-Graves disease induced hypothyroidism without thyrotoxicosis,there is no patients died,13 cases of major adverse cardiac events(control group 12.5%vs treatment group 63.2%);recurrent nonfatal myocardial infarction occurred in 1 cases(0 in treatment group vs control group 5.3%),9 cases of recurrent angina(control group 0 vs treatment group 47.3%),7 cases of heart failure(control group 12.5%vs treatment group 10.5%),control group of major adverse cardiac events increased significantly.Through regression analysis,there was significant difference between the treatment group and the control group.Baseline variables and other previously reported to be of major adverse cardiac events Logistic multivariate potential variables were adjusted,the MACE cumulative risk was significantly increased in the control group.During the follow-up period,there was a significant difference between the two groups in the incidence of MACE in patients with reccurent angina.(OR=12.0,P=0.034).ConclusionATD for patients with ACS associated with non-Graves disease induced hypothyroidism without thyrotoxicosis can significantly reduce the incidence of MACE and reccurent angina pectoris,and also can evaluate short-term prognosis in this population. |
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