Correlation of sdLDL-C with cardiometabolic risk indices in women with subclinical hypothyroidism– A cross-sectional study

Samyuktha Rani V.; Rukmini M. S.; Nandini M.; Ashok Prabhu K.

doi:10.51248/.v43i4.3344

Authors

Samyuktha Rani V.
Rukmini M. S.
Nandini M.
Ashok Prabhu K.

DOI:

https://doi.org/10.51248/.v43i4.3344

Keywords:

Subclinical hypothyroidism, sdLDL-C, cardiometabolic risk indices, atherogenic index

Abstract

Introduction and Aim: Subclinical hypothyroidism (SCH) characterised by normal free thyroxine (FT4), “free triiodothyronine (FT3)”, and raised serum TSH, is an early stage of mild thyroid hormone deficiency. A change in the lipid profile most often observed in SCH is mainly caused by increased serum levels of Triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), whereas high-density lipoprotein cholesterol (HDL-C) levels can be normal or elevated. Studies on small dense Low Density Lipoprotein – Cholesterol (sdLDL-C), associated with CVD risk are few. The aim of this study was to estimate serum sdLDL-C and find its correlation with thyroid profile (FT4 and TSH) and cardiometabolic risk indicators in female subjects with subclinical hypothyroidism.

Materials and Methods: The study had 112 female participants in total. After screening, subjects were divided into two groups. Control group (euthyroid) and study group (SCH). Age, TSH, FT4, TC, TG, HDL-C, LDL-C, sdLDL-C & Lipid ratios “(TC/HDL-C, LDL-C/HDL-C”, “Log TG/ HDL-C)” were examined and compared between the two groups.

Results: The correlation of sdLDL-C with TSH, FT4, lipid parameters & lipid ratios were studied. TG, TC, HDL-C, and LDL-C were not clinically significant. While sdLDL-C and lipid ratios had a statistical decrease, it was not clinically significant. A highly significant negative association between sdLDL-C, other lipid parameters, except HDL-C, lipid ratios are observed in the study group.

Conclusion: As anticipated, the current investigation did not demonstrate any statistically significant improvement in the sdLDL-C as a better predictor of CVD risk. No apparent lipid abnormalities were also seen in women, in the age group of 20-40 years as observed in the correlation studies. However, measurement of AIP along with FT4 would make a better assessment of CVD risk.

Author Biographies

Samyuktha Rani V.

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal

Rukmini M. S.

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal

Nandini M.

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal

Ashok Prabhu K.

Clinical Biochemistry Laboratory, Kasturba Medical College Hospital, Mangalore

References

Al-Fatlawi, A. C. An evaluation of blood glucose and lipid profile in female hypothyroidism patients in Kerbala province, Iraq. Biomedicine. 2022 Jul 3;42(3):556-560.

Pearce, E. N. Hypothyroidism and dyslipidaemia: modern concepts and approaches. Current cardiology reports. 2004 Nov; 6(6):451-456.

Stael, B., Tol, A.V., Chan, L., Will, H., Verhoeven, G., Auwerx, J. Alterations in thyroid status modulate apolipoprotein, hepatic triglyceride lipase, and low-density lipoprotein receptor in rats. Endocrinology. 1990 Sep 1;127(3):1144-1152.

Liberopoulos, E. N., Elisaf, M.S. Dyslipidaemia in patients with thyroid disorders. HORMONES-ATHENS-. 2002 Oct 15;1:218-223.

Singh, S.K., Reddy, D.V. Indian consensus for management of hypothyroidism. Medicine update. JAPI. 2002;12:389-394.

Jayasingh, I.A., Puthuran, P. Subclinical hypothyroidism and the risk of hypercholesterolemia. Journal of family medicine and primary care. 2016 Oct; 5(4):809.

Saric, M.S., Jurasic, M.J., Sovic, S., Kranjcec, B., Glivetic, T., Demarin, V. Dyslipidemia in subclinical hypothyroidism requires assessment of small dense low density lipoprotein cholesterol (sdLDL-C). Rom J Intern Med. 2017 Sep 26;55(3):159-166.

Ranjan, A., Sudha, K., Nandini, M., Durgarao, Y. Novel evidence of relationship between serum vitamin B12 and folate with total vitamin D in subclinical hypothyroidism. Biomedicine. 2020 Nov 9;40(3):278-280.

Lioudaki, E., Mavroeidi, N.G., Mikhailidis, D.P., Ganotakis, E.S. Subclinical hypothyroidism and vascular risk: an update. Hormones (Athens). 2013 Oct-Dec;12(4):495-506.

Biondi, B., Cappola, A.R., Cooper, D.S. Subclinical Hypothyroidism: A Review. JAMA. 2019 Jul 9;322(2):153-160.

Iqbal, A., Jorde, R., Figenschau, Y. Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromsø Study. J Intern Med. 2006 Jul; 260(1):53-61.

Kumar, A., Prabhu, M. M., Bhat, N., Stanley, W. A study of cardiovascular profile in patients with primary hypothyroidism. Biomedicine. 2022 Sep 12;42(4):766-770.

Lekakis, J., Papamichael, C., Alevizaki, M., Piperingos, G., Marafelia, P., Mantzos, J., Stamatelopoulos, S., & Koutras, D. A. (1997). Flow-mediated, endothelium-dependent vasodilation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and high-normal serum thyrotropin (TSH) values. Thyroid: official journal of the American Thyroid Association, 7(3), 411–414. https://doi.org/10.1089/thy.1997.7.411

Papaioannou, G.I., Lagasse, M., Mather, J. F., Thompson, P.D. Treating hypothyroidism improves endothelial function. Metabolism 2004; 53 (3): 278-279.

O’Brien, T., Dinneen, S.F., O’Brien, P.C., Palumbo, P.J. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993;68:860 866.

Sacks, F.M., Campos, H. Clinical review 163: Cardiovascular endocrinology 4: Low-density lipoprotein size and cardiovascular disease: a reappraisal. J Clin Endocrinol Metab 2003; 88:4525-4532.

Third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285:2486-2497.

Baliarsingh, S., Sharma, N., Mukherjee, R. Serum uric acid: Marker for atherosclerosis as it is positively associated with “atherogenic index of plasma”. Arch Physiol Biochem 2013;119:27 31.

Rizos, C.V., Elisaf, M.S., Liberopoulos, E.N. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J. 2011;5:76-84.

Liu, X.L., He, S., Zhang, S.F., Wang, J., Sun, X.F., Gong, C.M., et al., Alteration of lipid profile in subclinical hypothyroidism: A meta analysis. Med Sci Monit 2014;20:1432 1441.

James, S.R., Ray, L., Ravichandran, K., Nanda, S.K. High atherogenic index of plasma in subclinical hypothyroidism: Implications in assessment of cardiovascular disease risk. Indian J Endocrinol Metab. 2016 Sep-Oct;20(5):656-661.

Hueston, W. J., Pearson, W. S. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med. 2004; 2:351-355.

Luboshitzky, R., Aviv, A., Herer, P., Lavie, L. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid 2002;12:421 425.

Walsh, J.P., Bremner, A.P., Bulsara, M.K., et al. Thyroid dysfunction and serum lipids: a community-based study. Clin Endocrinol (Oxf) 2005; 63: 670-675.

Griffin BA. Lipoprotein atherogenicity: an overview of current mechanisms. P Nutr Soc 1999; 58: 163-169.

Campos, H., Blijlevens, E., McNamara, J.R., Ordovas, J.M., Wilson, P.W.F., Schaeferm, E.J. LDL particle size distribution: results from the Framingham Offspring Study. Arterioscler Thromb, 1992; 12: 1410-1419.

Hoogeveen, R.C., Gaubatz, J.W., Sun, W., Dodge, R.C., Crosby, J.R., Jiang, J., et al., Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol, 2014; 34: 1069-1077.

Gentile, M., Panico, S., Mattiello, A., Ubaldi, S., Iannuzzo, G., De Michele, M., et al., Association between small dense LDL and early atherosclerosis in a sample of menopausal women. Clin Chim Acta, 2013; 426: 1-5.

Kim, C.S., Kang, J.G., Lee, S.J. Relationship of low-density lipoprotein (LDL) particle size to thyroid function status in Koreans. Clin Endocrinol (Oxf) 2009; 71: 130-136.

Marwaha, R.K., Tandon, N., Garg, M.K., Kanwar, R., Sastry, A., Narang, A., et al., Dyslipidemia in subclinical hypothyroidism in an Indian population. Clin Biochem 2011; 44:1214 1217.