The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M68-M69 (2003)
© 2003 The Gerontological Society of America
Increased Prevalence of Peripheral Arterial Disease in Older Men and Women With Subclinical Hypothyroidism
Min Min Mya1 and
Wilbert S. Aronow1,2
Department of Medicine, Divisions of 1 Geriatrics and
2 Cardiology, Westchester Medical Center/New York Medical College, Valhalla.
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Abstract
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Background. We report the prevalence of symptomatic peripheral arterial disease (PAD) associated with subclinical hypothyroidism in older persons.
Methods. We investigated the association of subclinical hypothyroidism with symptomatic PAD in 18 persons (16 women and 2 men) with subclinical hypothyroidism and in 231 euthyroid persons (151 women and 96 men), mean age 79 ± 9 years, in an academic nursing home.
Results. Symptomatic PAD was present in 14 of 18 persons (78%) with subclinical hypothyroidism and in 40 of 231 euthyroid persons (17%; p <.0001, comparing subclinical hypothyroidism with euthyroidism). Symptomatic PAD was present in 13 of 16 women (81%) and in 1 of 2 men (50%) with subclinical hypothyroidism (p was not significant).
Conclusions. Subclinical hypothyroidism was associated with a high prevalence of symptomatic PAD in elderly men and women.
HAK and associates, in the Rotterdam Study (1), reported that subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women. We reported that older men and women with subclinical hypothyroidism had a higher prevalence of dyslipidemia and of coronary artery disease than older men and women with euthyroidism (2). A case-control study in older women found an association between subclinical hypothyroidism and peripheral arterial disease (PAD) (3). Here we report data showing an increased prevalence of symptomatic PAD in older men and women with subclinical hypothyroidism.
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Methods
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In men and women, mean age 79 ± 9 years, in a university-affiliated nursing home, 18 persons (16 women and 2 men) had subclinical hypothyroidism, and 231 persons (135 women and 96 men) were euthyroid. Euthyroidism was diagnosed if the thyroid-stimulating hormone level was between 0.4 and 4.7 µU/ml, and the thyroxine level was between 4.5 and 12.0 µg/dl. Subclinical hypothyroidism was diagnosed if the serum thyroid-stimulating hormone level was elevated, and the serum thyroxine level was in the normal range.
Symptomatic PAD was diagnosed if the person had a documented history of surgery for PAD or if the person had ischemic pain at rest, ulceration, or gangrene in an extremity; intermittent claudication, numbnesss, coldness, cyanosis, or pallor in an extremity; or trophic changes with dry, scaly, and shiny atrophic skin, diminished hair growth, thickened, brittle toenails, or subcutaneous atrophy in an extremity associated with absent or weak arterial pulses (4). Symptomatic PAD was also diagnosed if the person had symptomatic extracranial carotid arterial disease diagnosed by carotid duplex ultrasonography (5). Chi-square tests were used to analyze dichotomous variables.
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Results
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Table 1 shows the prevalence of symptomatic PAD in older persons with subclinical hypothyroidism and with euthyroidism and lists the level of statistical significance. Symptomatic PAD was present in 13 of 16 women (81%) and in 1 of 2 men (50%) with subclinical hypothyroidism (p not significant). Symptomatic PAD was present in the lower extremities in the 40 euthyroid patients with PAD. Of the 14 patients with subclinical hypothyroidism and symptomatic PAD, 3 patients had both symptomatic PAD of the lower extremities and symptomatic extracranial carotid arterial disease, and 11 patients had symptomatic PAD of the lower extremities.
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Discussion
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In the Rotterdam Study, Hak and associates reported that subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women (1). We previously reported (2) that an increased serum low-density lipoprotein cholesterol or decreased serum high-density lipoprotein cholesterol was present in 15 of 18 older persons (83%) with subclinical hypothyroidism and in 128 of 231 older persons (55%) with euthyroidism (p <.025). We also reported that coronary artery disease was present in 10 of the 18 older persons (56%) with subclinical hypothyroidism and in 38 of the 231 older persons (16%) with euthyroidism (p <.001) (2).
A case-control study in 80 women, mean age 71 years, with PAD and an age-matched control group of 30 women found an association between subclinical hypothyroidism and PAD (3). In the present study, older men and women with subclinical hypothyroidism had a higher prevalence of symptomatic PAD (78%) than older men and women with euthyroidism (17%; p <.0001).
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Acknowledgments
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Address correspondence to Wilbert S. Aronow, MD, FGSA, Cardiology Division, New York Medical College, 23 Pebble Way, New Rochelle, NY 10804. E-mail: wsaronow{at}aol.com
Received August 2, 2002
Accepted August 15, 2002
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References
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- Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000;132:270-278.[Abstract/Free Full Text]
- Mya MM, Aronow WS. Subclinical hypothyroidism is associated with coronary artery disease in older persons. J Gerontol Med Sci. 2002; 57A:M658–M659.
- Powell J, Zadeh JA, Carter G, Greenhalgh RM, Fowler PBS. Raised serum thyrotrophin in women with peripheral arterial disease. Br J Surg. 1987;74:1139-1141.[Medline]
- Aronow WS, Sales FF, Etienne F, Lee NH. Prevalence of peripheral arterial disease and its correlation with risk factors for peripheral arterial disease in elderly patients in a long-term health care facility. Am J Cardiol. 1988;62:644-646.[Medline]
- Aronow WS, Schoenfeld MR. Prevalence of atherothrombotic brain infarction and extracranial carotid arterial disease and their association in elderly blacks, Hispanics, and whites. Am J Cardiol. 1993;71:999-1000.[Medline]
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Abstract
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