The effect of combined therapy with statins and levothyroxine on the lipid profile dynamics in patients with a comorbid course of arterial hypertension, type 2 diabetes mellitus and subclinical hypothyroidism

Abstract

To date, there are no sufficiently clear recommendations for the management of patients with the TSH level between the upper limit of the control range and 10.0 mIU/L, and with a high cardiovascular risk (CVR).Aim. to assess the effect of combined therapy with statins and levothyroxine on the state of lipid metabolism and total CVR in patients with comorbid course of arterial hypertension (AH), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SHT).Materials and methods. 67 patients aged 44 to 75 years with the stage II AH, T2DM and SHT were included. All patients used statins prior to inclusion in the study. At the TSH level of more than 6.0 μMU/ml levothyroxine was additionally prescribed in individually selected doses from 12.5 to 50 μg/day. Lipid and thyroid metabolism indexes, the concentration of C-reactive protein (CRP) and the tumor necrosis factor-α (TNF-α) were measured by standard methods. The period of observation was 12 months.Results. Patients with TSH levels of >6.0 μMU/ml, despite statin therapy, have more pronounced dyslipidemia, higher CRP values (p 0.05). The additional use of levothyroxine led to a significant decrease in total cholesterol (p=0.011), low-density lipoprotein cholesterol (p=0.025), and a highly significant decrease in CRP and TNF-α (p<0.001).Conclusions. Combined therapy, including statins and levothyroxine, leads to more significant improvement in the lipid profile than statins without the replacement therapy, a decrease in the signs of systemic inflammation, and, in the aggregate, has a positive effect on the total cardiovascular risk in this category of patients.