Abstract
Vasospastic angina (VA) is a functional disease caused by the alteration of vasomotor tone. We investigated the association of hyperthyroidism with the development and prognosis of VA. Study data were obtained from a prospective multicenter registry that included patients who had symptoms suggestive of VA. Coronary angiography and an ergonovine provocation test were performed, and patients were classified into a VA and a non-VA group. Among 1239 patients with suspected VA, 831 patients were classified in the VA group. Hyperthyroidism was more common in the VA group than in the non-VA group (10.0% vs. 3.7%, p < 0.001). After adjusting for confounding factors, hyperthyroidism was independently associated with a 3.27-fold increased risk of VA. Especially in women, hyperthyroidism was associated with a 4.38-fold higher risk of VA. All-cause death rates did not differ according to the presence or absence of hyperthyroidism. Hyperthyroidism is independently associated with the occurrence of VA especially in women but did not affect the total death in VA patients. Clinicians need to be aware of the role of thyroid function in patients with suspected VA.
Highlights
Vasospastic angina (VA) is a functional disease caused by the focal or diffuse spasm of the smooth muscle layer of the coronary arterial wall, causing a high grade of obstruction
When we consider that the VA is a disease caused by the alteration and imbalance of vasomotor tone [10], we can assume that the thyroid hormone, which influences the sympathetic tone and vascular constriction/relaxation, is more likely to be related to the development and the prognosis of VA than to atherosclerotic ischemic heart disease
We investigated for the first time, as far as we know, the association between hyperthyroidism and VA development and its impact on the prognosis of VA using a prospective, multi-center, large scale cohort from Korea
Summary
Vasospastic angina (VA) is a functional disease caused by the focal or diffuse spasm of the smooth muscle layer of the coronary arterial wall, causing a high grade of obstruction. Several studies of patients with VA have shown that high blood pressure and dyslipidemia, which are the traditional risk factors of atherosclerotic cardiovascular disease, are not significantly associated with vasospasm, but smoking is the only proven risk of vasospasm [5,6]. A recent study demonstrated that hyperthyroidism is associated with increased risk of developing myocardial infarction and stroke independent of atherosclerotic risk factors, but is not associated with mortality in a large scale cohort [7] Hyperthyroidism has been known to increase vasomotor activity and up-regulate numbers of adrenergic receptors, resulting in enhanced sympathoadrenal activity [8,9]. We investigated for the first time, as far as we know, the association between hyperthyroidism and VA development and its impact on the prognosis of VA using a prospective, multi-center, large scale cohort from Korea
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