Noninvasive diagnosis of preclinical stages of coronary and precerebral atherosclerosis in patients with newly diagnosed hypo- and hyperthyroidism

According to WHO data, cardiovascular diseases account for 63% of total mortality from non-communicable diseases worldwide, with the largest share of deaths attributed to ischemic heart disease (IHD) and stroke. Untimely detection of preclinical stages of atherosclerosis in comorbid patients leads to delayed initiation of preventive pharmacological and non-pharmacological therapy.
The need to develop and implement a diagnostic algorithm for atherosclerosis of coronary and precerebral arteries in patients with hypo- and hyperthyroidism in clinical practice is driven by the widespread prevalence of thyroid pathology in the Republic of Belarus and globally. This is due to the development of severe cardiovascular complications in the absence of adequate preventive measures, early disability of patients, high financial costs of interventional and cardiac surgical diagnostic and treatment procedures, and the necessity to ensure more rational use of budget funds for outpatient and inpatient treatment, as well as reducing expenses related to loss of working capacity due to cardiovascular diseases in individuals with thyroid dysfunction.
Objective of the study: to evaluate the potential of a diagnostic algorithm for atherosclerosis of coronary and precerebral arteries at the preclinical stage in patients with hypo- and hyperthyroidism for inclusion in a set of medical services aimed at providing care to comorbid patients with thyroid pathology and atherosclerosis-associated circulatory system diseases.
Materials and Methods. The study included 118 working-age patients with thyroid diseases newly diagnosed with hypo- or hyperthyroidism without clinical signs and history of IHD and chronic cerebral circulation insufficiency. Examination of asymptomatic patients with hypo- or hyperthyroidism included analysis of clinical and anamnesis data (complaints, anamnesis, objective examination with blood pressure measurement and making an anthropometric passport of the patient), biochemical blood test with lipid spectrum interpretation and determination of the type of hyperlipidemia according to the WHO classification, and instrumental data (transthoracic echocardiography, volumetric sphygmography with determination of CAVI and ABI indices, ultrasound of brachiocephalic arteries (BCA), cardiac computed tomography with coronary calcium screening programs and CT coronary angiography (CT-CAG)).
Results. Atherosclerotic lesions of BCA were detected in 58.5% of individuals with hypothyroidism and 28.8% with thyroid hyperfunction with a multi-vessel lesion rate of 34.0% and 12.5%, and one or a combination of several signs of atherosclerotic plaque (ASP) instability in 41.5% and 4.2% of patients with hypo- and hyperthyroidism respectively. Atherosclerosis of coronary arteries was verified in 44.6% of examined patients with hypothyroidism and 20.0% with hyperthyroidism, with multi-vessel (2 or more) coronary artery lesions in 36.1% and 3.1% of individuals with hypo- and hyperthyroidism respectively. All patients included in the study with instrumentally confirmed atherosclerosis were prescribed lipid-lowering therapy with statins. Hemodynamically significant stenosing lesion (ASP > 50%) according to CT-CAG was detected in 4.8% of asymptomatic patients with hypothyroidism and in 1 patient with hyperthyroidism. Selective percutaneous coronary artery angiography was performed on 5 asymptomatic patients with different thyroid hormone statuses resulting in percutaneous coronary intervention with the implantation of 2 or more coronary stents in three patients with hypothyroidism and coronary artery bypass grafting in a patient with hypothyroidism and a patient with hyperthyroidism due to multi-vessel atherosclerotic lesions with ASP over 85–90%.
Conclusion. The diagnostic algorithm for atherosclerosis of coronary and precerebral arteries in patients with hypo- and hyperthyroidism can be recommended for quickly determining the optimal diagnostic approach for detecting asymptomatic stages of atherosclerosis in various locations. It is particularly useful for diagnosing atherosclerosis in the coronary and precerebral arteries in patients with either hypo- or hyperthyroidism. The algorithm is designed to be safe for both doctors and patients, cost-effective, and easy to implement in different regions of the Republic of Belarus and internationally. Implementing this algorithm will enhance the quality of medical care for patients with comorbid conditions and help decrease the incidence of atherothrombosis in the coronary and precerebral arteries among the Belarusian population. It will also aid in defining both pharmacological and non-pharmacological strategies for preventing cardiovascular events in individuals with varying thyroid hormone statuses.

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