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Editor-in-Chief: Dario Galante




Comparative Study of Hypothyroidism with Cardiometabolic Risk

1Lab incharge, Apollo Reach Hospital, Karimnagar, Telangana, India

2Department of Biochemistry, Chalmeda Ananda Rao Institutue of Medical sciences, Karimnagar, Telangana, India

3Department of Biochemistry, Prathima Institute of Medical sciences, Karimnagar, Telangana, India

4Department of Microbiology, Prathima Institute of Medical sciences, Karimnagar, Telangana, India

American Journal of Cardiovascular Disease Research. 2015, 3(1), 1-4
doi: 10.12691/ajcdr-3-1-1
Copyright © 2015 Science and Education Publishing

Cite this paper:
T Sudhakar, Sabitha Kandi, B Venugopal, K. Bhagwan Reddy, K V Ramana. Comparative Study of Hypothyroidism with Cardiometabolic Risk. American Journal of Cardiovascular Disease Research. 2015; 3(1):1-4. doi: 10.12691/ajcdr-3-1-1.

Correspondence to: K  V Ramana, Department of Microbiology, Prathima Institute of Medical sciences, Karimnagar, Telangana, India. Email:


Hypothyroidism is a thyroid deficient state which shows its influence on other metabolic pathways whereas sub-clinical hypothyroidism (SCH) is a condition where there is decreased secretion of Thyroid Stimulating Hormone (TSH) with no significant clinical symptoms. Thyroid hormones (T3, T4 and TSH) play an effective role in various aspects of metabolism, development and differentiation of cells. In the present study which included 558 male subjects who came for regular health checkup, 68 (12.18%) were newly diagnosed as suffering from hypothyroidism and among them, 27 (4.83%) had altered lipid parameters. The presenting symptoms included unknown cause of fatigue and weight gain. The atherogenic lipid abnormalities in subjects with hypothyroidism in Indians should be interpreted with paramount importance as there is unexpected improvement or worsening of their lipid profile which may be influenced by abnormal thyroid hormone secretion. The altered lipid profile is seen in conditions where TSH is more than 10 mIU/ml which can result in increased risk of cardiac diseases and altered hemodynamic states. Alcoholism, smoking, sedentary life style, genetic predisposition and stress are added factors to earlier onset of SCH. The important aspects in management of thyroid diseases include the public health awareness, regular screening for the presence of dyslipedemia and thyroid function tests.



[1]  B. Biondi and I. Klien. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine vol. 24, No: 1, 2004: 1-13.
[2]  X. Zhu and S Y Chang. New insight into regulation of lipid metabolism by thyroid hormone. Current opinion in endocrinology, diabetes & obesity. 2010; vol. 17: No. 5: 408-413.
[3]  B.Biondi and G J Kahaly. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nature reviews endocrinology. 2010: Vol. 6; No. 8: 431-433.
[4]  I. Klein and K Ojamaa. Thyroid hormone and the cardiovascular system. The New England Journal of medicine. 2001; Vol. 344: No. 7: 501-509.
[5]  S Fazio, E H Palmeiri, G Lambardi, B Biondi. Effects of thyroid hormone on the cardiovascular system. Recent Progress in Hormone, Research. 2004; Vol. 59, 31-50.
Show More References
[6]  Ambika Gopal Krishna & Usha Menon. Thyroid disorders in India: An epidiological prospective. Indian journal of endocrinology metabolism. 2011; 15 (suppl) S78-S81.
[7]  P M Yen. Physiological & Molecular basis of thyroid hormone action. Physiol Rev. 2001; 81: 1097-1142.
[8]  Braverman L E, Ingbar S H, Starling K. Conversion of thyroxine (T4) to T3 in athyreotic human subjects. J Clin Invest. 1970; 49: 855-864.
[9]  Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, et al,. Harrisons Principles of internal medicine. Chapter; Disorders of thyroid gland. 17th edition. Mc Graw Hill. 2008: 2224-2247.
[10]  Gray R S, Irvine W J and B F Clarke. Screening for thyroid dysfunction in diabetes. Br Med J. Dec 1; 1979: 2 (6202): 1439.
[11]  Ayala AR, Danese MD, Ladenson PW. When to treat mild hypothyroidism. Endocrinology Metab Clin Nano. 2009; 29; 399-415.
[12]  Tunbridge WM, Everes DC, Hall R, Appleton D, Brewis M et al.,. The spectrum of thyroid disease in a community; The Wickham survey. Clin Endocrinology (oxf). 1977:7; 481-93.
[13]  Sawin CT, C aslelli WP, Hashman JM, Mc Namara P. Bacharach P. The aging thyroid def in Farmingham study. Arch Inten Med. 1985; 145: 1396-88.
[14]  Geul WK, Van Sluisveld II, Grobbee DE, Docter R, deBruyun AM, Hooykoas et al.,. The importance of thyroid microsomal antibodies in development of elevated serum TSH in middle age women. Association with serum lipids. Clin Endocrinol (oxf). 1993; 39: 275-80.
[15]  Vanderpump MP, Tunbridge WM, Appleton D, French JM, Bates D, Clarke F et al.,. The incidence of thyroid disorders in community, a 20 year follow up of the Wickham survey. Clin Endocrinol. 1995; 43: 55-68.
[16]  Vashali Deshmukh, Anish behl, Vagesh Iyer, Harish Joshi, Jayasree P Dholye, Prema K Varthakavi. Prevalence, clinical and biochemical profile of subclinical hypothyroidism in normal population in Mumbai. Indian Journal of Endocrinology & Metabolism. 2013; vol. 17: 3: 454-459.
[17]  Shurty Mohanty, W AMruthlal, G C Reddy, G Kusumanjali, A S Kanaga Sabapathy & Pragna Rao. Diagnostic strategies for SCH; Indian Journal of Biochem. 2008/23 (3). 279-282.
[18]  Athans BU, Staub JJ, Ryff deleche A, Oberhansti A, Stahetin HB. LDL?HDL changes in subclinical hypothyroidism; possible risk factors for coronary heart disease. Clin Endocrinol (oxf). 1988; 28: 157-63.
[19]  Hooggendoorn EH, Hermus A R, De Vegt F, Ross H A, Verbek AL, Kiemency L A et al.,. Thyroid functions & prevelance of anti TPO antibodies in a population with borderline sufficient iodine intake; influence of age & sex. Clin Chem, 2006; 52: 104-11.
[20]  Hollowell J G, Staehling N W, Flanders WD, Hannon W H, Gunta E W, Spencer C A, et al.,. Serum TSh. T4 & Thyroid antibodies in the United States population (1988 to 1994); national Health & Nutrition Examinations survey (NHANES III). J Clin Endocrinol Metab. 2002; 87: 489-99.
[21]  Bemben D A, Hamm R M, Morgan L, Winn P Davis A, Barton E. Thyroid disease in the elderly part-2 predictability of SCH. J Fam Pract. 1994; 38: 583-8.
[22]  Ambika GopalKrishna Unni Krishnan, Sanjay Kaha, Rakesh kumar Sahay, Ganapqthi Bentwal, Mathew John, Neeraj Tewari; prevalence of hypothyroidism in adults; An epidemiological study in 8 cities of India. 2013; vol. 17: 4: 647-652.
[23]  Garduno Gariera J D E, Alvirde Gareera U, Lopez Carrasco G et al.,. TSH and free thyroxine concentration are association with differing metabolic markers in euthyroid subjects. Eur J Endolog. 2010; 163: 273-8.
[24]  Spencer CA. Clinical uses and limitations of rapid TSH assays. Medical Laboratoey Products. 1988; 17-9.
[25]  Mao YS, Liu ZM, Chen LX et al.,. Ningbo thyroid dysfunction prevalence study; cross sectional survey in an employees-cohort. Clin Med J (Eng) 2010; 123; 1673-8.
[26]  Sgarbi JA, Matsumma LK, Kasamatsu TS et al.,. Subclinical thyroid dysfunction are independent risk factor for mortality in a 7.5 year follow up; The Japanese-Brazilian thyroid study. Eur J endocrinology. 2010; 162; 569-77.
[27]  Kung A W, Janus ED. Thyroid dysfunction in ambulatory elderly Chinese subjects in an area of borderline iodine intake. Thyroid. 1996: 6: 111-.
[28]  Staub J, Athans BU, Eugler H nRy7ff AS, Trabucco P, Marquardt K et al.,. Spectrum of subclinical and overt hypothyroidism. Effect on thyrotropin Prolactin & thyroid reserve and metabolic impact on peripheral target tissue. Am J Med. 1992; 92; 631-42.
[29]  Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witterman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and MI in elderly women: The Rotterdam study. Ann Intern Med. 2000; 132: 270-8.
[30]  Canaris G J, Manowitz N R, Mayor G, Ridgway EC. The Colorado disease prevalence study. Arch Intern Med; 2000; 160; 526-34.
[31]  DR Pradeep Sharma, DR Dibyaratha Palgiri, DR Sapna Goyal, DR Geeta Sharma, DR M S Pathak. Hypothyroidism causing dyslipidemia in both subclinical & overt hypothyroidism: Indian Journal of Basic & applied medical research. 2013; 7; vol. 2, 779-88.
[32]  Kuldip Singh, Saranpal Singh. Alteration in lipid fraction in SCH in northern Indian population. Indian Journal of Fundamental & Applied Life Sciences. 2011; 1; 127-32.
Show Less References


Risk Factors of Peripartum Cardiomyopathy and the Important Role of Prenatal Care

1Department of Cardiology and Vascular Medicine, Padjadjaran University, Jalan Eijkman 38, Bandung 40161, Indonesia

American Journal of Cardiovascular Disease Research. 2015, 3(1), 5-8
doi: 10.12691/ajcdr-3-1-2
Copyright © 2015 Science and Education Publishing

Cite this paper:
Hawani Sasmaya Prameswari, Augustine Purnomowati, Toni Mustahsani Aprami. Risk Factors of Peripartum Cardiomyopathy and the Important Role of Prenatal Care. American Journal of Cardiovascular Disease Research. 2015; 3(1):5-8. doi: 10.12691/ajcdr-3-1-2.

Correspondence to: Hawani  Sasmaya Prameswari, Department of Cardiology and Vascular Medicine, Padjadjaran University, Jalan Eijkman 38, Bandung 40161, Indonesia. Email:


Peripartum cardiomyopathy (PPCM) is one of dilated cardiomyopathy of unknown cause. The aim of this study is to determine the risk factors and the importance of prenatal care (PNC). This is a descriptive and analytical study with Chi Square test of PPCM cases collected from medical records January 1, 2011 through December 31, 2013 in the Dr.Hasan Sadikin Central General Hospital as the top-referral hospital of West Java Province. We collected 57 PPCM cases (18.7%) of 305 pregnant women or 6 months postpartum with cardiovascular problems. Distribution of PPCM cases decreased significantly (p= 0.002) from 2011 (27 patients), 2012 (16 patients), and 2013 (14 patients), with average age 30.3 (±7.9) years, cesarean delivery (43.8%), pervaginal (37.5%), forceps (15%), and vacuum-extractor (3.8%). Regular prenatal care was 84.20%. Lower socioeconomic patients were 63.2%, therefore the issue of welfare can lead to vulnerability to PPCM. Confirmed diagnosis using echography made during postpartum was 52.63% and antepartum was 47.5%. Preeclampsia was 43.80% (p=0.007) mostly NYHA functional class IV (86.30%). Echocardiography was performed on 57 patients have average ejection fraction 34.8%, global hypokinetic in 98.27% patients, 39.6% with all cardiac chamber dilatation, left atrium and left ventricle dilation in 34.48%, and 25.86% with left ventricular dilatation. The hospital based prevalence was 18.68%, with the majority (84.20%) was NYHA functional class IV. The significant risk factors were age over 30 years, multiparous, low socioeconomic, and preeclampsia. This study is probably the first report mentioning a high prevalence of PPCM in Indonesia. This report provides an awareness of PPCM during PNC to prevent the morbidity and mortality. PPCM disorder requires regular and careful PNC by taking into account existing risk factors is the key that is required and must be held in every health centre.



[1]  Sliwa K,Hilfiker-Kleiner D,Petrie MC,Mebazaa A,Pieske B,Buchmann E, et al. Current State of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur Heart J. 2010; 12: 767-78.
[2]  Sarker HN, Dass BP. Peripartum cardiomyopathy. ORION. 2009; 32: 686-89.
[3]  Rmaraj K, Sorrel VL. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleve Clin J Med. 2009; 76 (5): 289-96.
[4]  MishraVN, MishraN, Devanshi. Peripartum cardiomyopathy. JAPI. 2013; 61: 268-73
[5]  Aursulesei V, Datcu MD. Peripartum cardiomyopathy: A Systemic Review. Int J Cardiol. 2009; 131 (2): 8-35.
Show More References
[6]  Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United State.J Am Coll Cardiol. 2011; 58 (7): 659-70.
[7]  Zagrosek VR,Lundqvist CB, Borghi C,Cifkova R,Ferreira R,Foidart JM, et al. Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J. 2011; 32: 3147-97.
[8]  Joint National Comitte. The seventh report of the Joint Nationl Committe on prevention, detection, evaluation, treatment of high blood pressure. NIH. 2004: 30-52.
[9]  Walenta K,Schwarz V,Schirmer SH,Kinderman I,Friedrich EB,Solomayer EF, et al. Circulating microparticles as indicators of peripartum cardiomyopathy. Eur Heart J. 2012; 33: 1469-79.
[10]  Elkayam U,Mohammed W,Akhter, Singh H, Khan S, Bitar F, et al. Pregnancy-Associated Cardiomyopathy: Clinical characteristics and a comparison between early dan late presentation. Circulation. 2005; 111: 2050-55.
[11]  Sliwa K,Fett J,Elkayam U.Peripartum cardiomyopathy. Lancet. 2006; 368: 687-93.
[12]  Lim CP,Sim DK.Peripartum cardiomyopathy: experience in an Asian tertiary centre. Singapore Med J. 2013; 54 (1): 24-27.
[13]  Shah I,Hafizullah M,Shah TS,Faheem M,Rafiullah. Peripartum cardiomyopathy: risk factors, hospital course and prognosis; experiences at Lady Reading Hospital Peshawar. GARJPP. 2012; 1 (1): 1-11.
[14]  Johnson-Coyle L,Jensen L,Sobey A. Peripartum cardiomyopathy: Review and practice guidelines. Am J Crit Care Med. 2012; 21 (2): 89-97.
[15]  Goland S,Modi K,Bitar F,Janmohamed M,Mirocha JM, Czer L.Clinical profile and predictors of complications in peripartum cardiomyopathy. J Card Fail. 2009; 28 (5): 1-6.
[16]  Sliwa K,Blauwet L,Tibazarwa K,Smedema JP,Becker A,Mc Muray J, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: A proof of concept Pilot Study. Circulation. 2010; 121: 1465-73.
[17]  Habedank D,Kuhnle Y,Elgeti T,Dudenhausen JW, Haverkamp W,Dietz R.Recovery from peripartum cardiomyopathy after treatment with bromocriptine. 2008; 10: 1149-51.
[18]  Anderson JL, Horne BD. Birthing the genetics of peripartum cardiomyopathy. Circulation. 2010; 121: 2157-59.
[19]  Shafiq M,Khan RA,Khan A,Shah A,Hussain S.Unrecognised peripartum cardiomyopathy will have dire consequences. Anest Pain Int Care. 2013; 17 (2): 195-7.
[20]  Hasan JA, Qureshi A,Ramejo BB,Kamran A.Peripartum cardiomyopathy characteristics and outcome in a tertiary care hospital. J Park Med Assoc. 2010; 60: 377-80.
[21]  Shaikh S, Shaikh SA. Peripartum cardiomyopathy: Its frequency and maternaloutcome. BJOG. 2010; 16 (4): 590-3.
[22]  Fett JD. Validation of a self-test for early diagnosis of heart failure in peripartum cardiomyopathy. Critical Pathways in Cardiology. 2011; 10 (Mar): 44-5.
Show Less References


“Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina

1Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037

2Division of Cardiology, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037

American Journal of Cardiovascular Disease Research. 2015, 3(1), 9-12
doi: 10.12691/ajcdr-3-1-3
Copyright © 2015 Science and Education Publishing

Cite this paper:
Olusegun Sheyin, Melissa Fajardo, Oladapo Igandan, Bredy Pierre-Louis. “Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina. American Journal of Cardiovascular Disease Research. 2015; 3(1):9-12. doi: 10.12691/ajcdr-3-1-3.

Correspondence to: Olusegun  Sheyin, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037. Email:


Introduction: Early risk stratification of patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) is crucial to identify those at high risk for further cardiac events as they may benefit from an early invasive strategy of coronary angiography and revascularization. The TIMI score, a widely used predictive model to guide management strategy in UA and NSTEMI may not accurately stratify risk. Case description: A 63-year-old man, who is an active smoker with past medical history of hypertension and dyslipidemia, presented with severe sub-sternal, crushing chest pain, which began four hours prior to presentation. His EKG revealed sinus tachycardia, without ST segment deviations or Q waves. He received aspirin, three doses of sublingual nitroglycerin and metoprolol, but continued to have chest pain, thus he was commenced on intravenous nitroglycerin infusion. His chest pain went away after two hours on nitroglycerin infusion. His initial serum troponin I was 0.31 ng/mL and 3.60 ng/mL four hours after presentation. He was admitted for NSTEMI and started on clopidogrel, atorvastatin and intravenous heparin. Echocardiogram revealed inferio-septal wall a kinesis and severely reduced left ventricular systolic function. His troponin I continued to rise, peaking at 37.4 ng/mL. He was started on eptifibatide and was referred for coronary angiography and percutaneous coronary intervention, with finding of fifty percent proximal and distal left anterior descending artery (LAD) lesions. Discussion: With a TIMI score of 2, our patient was classified as low risk at presentation. The need for intravenous nitroglycerin infusion for continuing chest pain in the management of UA or NSTEMI may suggest a greater degree of myocardial ischemia and a higher risk for adverse cardiovascular outcomes. This case demonstrates that UA and NSTEMI patients requiring intravenous nitroglycerin initially planned for conservative therapeutic approach need continuous risk stratification which may dictate a change to the invasive management strategy.



[1]  Rojer V, Go A, Lloyd-Jones D, et al. Heart Disease and Stroke Statistics--2012 Update: A Report From the American Heart Association. Circulation. 2012; 125: e2-e220.
[2]  Amsterdam EA, Wenger NK, Brindis RG, Casey Jr DE, Ganiats TG, Holmes Jr DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, Journal of the American College of Cardiology (2014).
[3]  Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 2000; 21:1406.
[4]  Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA 2005; 293: 2908.
[5]  Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000; 284: 835.
Show More References
[6]  Aragam K, Tamhane U, Kline-Rogers E, Li J, Fox K, Goodman S,Eagle K, Gurm H. Does Simplicity Compromise Accuracy in ACS Risk Prediction? A Retrospective Analysis of the TIMI and GRACE Risk Scores. PLoS One. 2009 Nov 23; 4 (11): e7947.
[7]  Borzak S, Cannon CP, Kraft PL, et al. Effects of prior aspirin and anti-ischemic therapy on outcome of patients with unstable angina. TIMI 7 Investigators. Thrombin Inhibition in Myocardial Ischemia. Am J Cardiol 1998; 81:678
[8]  Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, Van de Werf F, Avezum A, Goodman SG, Flather MD, Fox KAA, for the Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Arch Intern Med 2003; 163: 2345-53.
[9]  Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation. 2000; 101: 2557-2567.
[10]  Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, Neumann FJ, Robertson DH, DeLucca PT, Di Battiste PM, Gibson CM, Braunwald E; TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy)-Thrombolysis in Myocardial Infarction 18 Investigators. Comparison of early invasive and conservative strategies inpatients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001 Jun 21; 344 (25): 1879-87.
Show Less References