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Review
. 2019 Jun 18;139(25):2892-2909.
doi: 10.1161/CIRCULATIONAHA.118.036859. Epub 2019 May 13.

Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment

Anne R Cappola  1 , Akshay S Desai  2 , Marco Medici  3 , Lawton S Cooper  4 , Debra Egan  5 , George Sopko  4 , Glenn I Fishman  6 , Steven Goldman  7 , David S Cooper  8 , Samia Mora  9 , Peter J Kudenchuk  10 , Anthony N Hollenberg  11 , Cheryl L McDonald  4 , Paul W Ladenson  8
Affiliations
Review

Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment

Anne R Cappola et al. Circulation. .

Abstract

Thyroid hormones have long been known to have a range of effects on the cardiovascular system. However, significant knowledge gaps exist concerning the precise molecular and biochemical mechanisms governing these effects and the optimal strategies for management of abnormalities in thyroid function in patients with and without preexisting cardiovascular disease. In September 2017, the National Heart, Lung, and Blood Institute convened a Working Group with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease. The Working Group reviewed and discussed the roles of normal thyroid physiology, the consequences of thyroid dysfunction, and the effects of therapy in 3 cardiovascular areas: cardiac electrophysiology and arrhythmias, the vasculature and atherosclerosis, and the myocardium and heart failure. This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field, including strategies for leveraging novel approaches using omics and big data. The Working Group recommended research in 3 broad areas: (1) investigation into the fundamental biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; (2) studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and (3) clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormone or thyromimetic drugs.

Keywords: arrhythmia, cardiac; atherosclerosis; heart failure; hyperthyroidism; hypothyroidism; lipids.

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Conflict of interest statement

Conflict of Interest Disclosures

Dr. Desai reports a research grant from Novartis and consulting fees from Novartis, Abbott, AstraZeneca, Boston Scientific, Bohringer-Ingelheim, Corvidia Therapeutics, Dalcor Pharma, Regeneron, Relypsa, and Signature Medical. Dr. Mora reports a research grant from Atherotech Diagnostics.

Figures

Figure 1:
Figure 1:
Commonly defined categories of thyroid status.
Figure 2.
Figure 2.
Role of big data in identifying novel genetic determinants of thyroid (dys)function. The identification of these markers is essential to perform reliable Mendelian randomization studies, which will clarify causality in the observed associations between thyroid (dys)function and cardiovascular complications. Furthermore, these genetic markers could play a role in Hypothalamus-Pituitary-Thyroid (HPT) axis setpoint prediction, which is essential to start personalizing the treatment of patients with thyroid diseases.
Figure 3.
Figure 3.
Effect of thyroid hormones on the cardiomyocyte via genomic and nongenomic actions, from Reference .
Figure 4.
Figure 4.
Cardiovascular effects of T3, from Reference .
See this image and copyright information in PMC

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