SUN-347 - Measuring the Control of Cardiovascular Risk Factors in the Population with Treated Hypothyroidism: NHANES (2007 - 2020)

Introduction:

The suboptimal treatment of hypothyroidism has been associated with adverse cardiovascular disease (CVD) events. This association may be multifactorial, with contributions from direct effects of thyroid hormone action on cardiovascular tissues and concomitant poor control of common CVD risk factors, such as hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HL). We sought to determine the prevalence of uncontrolled HTN, DM, and HL in individuals with treated hypothyroidism relative to the population without thyroid disease. Then, we investigated the association between suboptimal levothyroxine treatment and control of HTN, DM and HL.

Materials and

Methods:

We utilized a pooled cross-sectional study design with NHANES data (2007–2020). Participants age  20 years with HTN, DM, or HL were stratified by treated hypothyroidism status. Uncontrolled disease was defined using established clinical thresholds. We utilized separate weighted multivariable regression models to estimate the association between treated hypothyroidism and uncontrolled HTN, DM and HL. Additional covariates included age, sex, race/ethnicity, education, health insurance, condition-specific medication use, and access to routine health care. A secondary analysis with thyroid function data (2007–2012) further stratified the status of hypothyroidism treatment by thyroid stimulating hormone (TSH) level to examine the impact overtreatment (TSH < 0.4 mIU/L) and undertreatment (TSH > 4.5 mIU/L).

Results:

The analytic cohort included 15031, 6879, and 26370 adult participants with HTN, DM and HL, respectively. Among participants with treated hypothyroidism, the prevalence of uncontrolled HTN, DM, and HLD was 41.2%, 35.3%, and 32.4%, respectively. Treated hypothyroidism was not significantly associated with uncontrolled HTN (OR, 1.03; 95% CI, 0.83-1.28) or uncontrolled DM (OR, 0.86; 95% CI, 0.68-1.07) in multivariate regression models. However, after adjustment for covariates (including statin use), treated hypothyroidism was significantly associated with uncontrolled HL (OR, 1.21; 95% CI, 1.02-1.44). In secondary analyses, neither undertreatment nor overtreatment was associated with uncontrolled HTN or HL. However, undertreated hypothyroidism was associated with a lower likelihood of uncontrolled DM (OR, 0.23; 95% CI, 0.05-0.95; p = 0.043).

Conclusion:

We found that treated hypothyroidism was significantly associated with worse control of HL, but not uncontrolled HTN or DM. These findings suggest that HL may be an important mediator of the relationship between treated hypothyroidism and CVD. However, we did not find evidence that participants with suboptimally treated hypothyroidism were more likely to have suboptimally controlled HTN, DM, or HL. Future directions examining other potential mediators of the association between suboptimal hypothyroidism treatment and CVD may be appropriate.

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