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The relationship between hypothyroidism and atherosclerosis has been confirmed by case-control studies and autopsy; the relationship is much clearer in patients with overt hypothyroidism than in patients with subclinical disease. Overt hypothyroidism increases low-density lipoprotein (LDL) cholesterol levels, induces diastolic hypertension, alters coagulability, and negatively affects vascular smooth muscle function. Treatment of overt hypothyroidism can moderate these negative effects, but the effect of treatment is less clear in patients with subclinical hypothyroidism. Reductions in total cholesterol levels are highest in patients who had the highest pretreatment thyroid-stimulating hormone (TSH) and lipid levels. Hypothyroidism treatment also can reduce hypertension and improve vascular smooth muscle function. Treatment of subclinical hypothyroidism may lower cholesterol levels in patients with hypercholesterolemia. Cappola and Ladenson reviewed the most recent information about hypothyroidism and cardiovascular risk factors.
