title: Thyroid hormones and coronary artery calcification in euthyroid men and women.
abstract: OBJECTIVE
  Overt and subclinical hypothyroidism are risk factors for atherosclerosis. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC).
  
  
  RESULTS
  We conducted a cross-sectional study of 41 403 apparently healthy young and middle-aged men and women with normal thyroid hormone levels. Free thyroxin, free triiodothyronine, and thyroid-stimulating hormone levels were measured by electrochemiluminescent immunoassay. CAC score was measured by multidetector computed tomography. The multivariable adjusted CAC ratios comparing the highest versus the lowest quartile of thyroid hormones were 0.74 (95% confidence interval, 0.60-0.91; P for trend <0.001) for free thyroxin, 0.81 (0.66-1.00; P for trend=0.05) for free triiodothyronine, and 0.78 (0.64-0.95; P for trend=0.01) for thyroid-stimulating hormone. Similarly, the odds ratios for detectable CAC (CAC >0) comparing the highest versus the lowest quartiles of thyroid hormones were 0.87 (0.79-0.96; P for linear trend <0.001) for free thyroxin, 0.90 (0.82-0.99; P for linear trend=0.02) for free triiodothyronine, and 0.91 (0.83-1.00; P for linear trend=0.03) for thyroid-stimulating hormone.
  
  
  CONCLUSIONS
  In a large cohort of apparently healthy young and middle-aged euthyroid men and women, low-normal free thyroxin and thyroid-stimulating hormone were associated with a higher prevalence of subclinical coronary artery disease and with a greater degree of coronary calcification.
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Yiyi
authors: Y
authors: Zhang
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Bo-Kyoung
authors: BK
authors: Kim
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Yoosoo
authors: Y
authors: Chang
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Seungho
authors: S
authors: Ryu
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Juhee
authors: J
authors: Cho
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Won-Young
authors: WY
authors: Lee
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Eun-Jung
authors: EJ
authors: Rhee
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Min-Jung
authors: MJ
authors: Kwon
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Sanjay
authors: S
authors: Rampal
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Di
authors: D
authors: Zhao
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Roberto
authors: R
authors: Pastor-Barriuso
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Joao A
authors: JA
authors: Lima
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.).
authors: Hocheol
authors: H
authors: Shin
authors: From the Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Y.Z., Y.C., S. Ryu, J.C., S. Rampal, D.Z., E.G.); Center for Cohort Studies, Total Healthcare Center (B.-K.K., Y.C., S. Ryu, J.C.), and Departments of Occupational and Environmental Medicine (Y.C., S. Ryu), Endocrinology and Metabolism (W.-Y.L., E.-J.R.), Laboratory Medicine (M.-J.K.), and Family Medicine (H.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.C.); Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (S. Rampal); National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.L.). eguallar@jhsph.edu hcfm.shin@samsung.com.
authors: Eliseo
authors: E
authors: Guallar
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015995:Prevalence; D012016:Reference Values; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood*; D014284:Triiodothyronine / Q000097:blood*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine
keywords: thyroid hormones; thyrotropin; thyroxine; triiodothyronine