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ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 15 - 2024 |
doi: 10.3389/fendo.2024.1451645
The Long-Term Prognostic Implications of Free Triiodothyronine to Free Thyroxine Ratio in Patients with Obstructive Sleep Apnea and Acute Coronary Syndrome
Provisionally accepted- 1 Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China
- 2 National Clinical Research Center for Cardiovascular Diseases, Beijing, China, Beijing, China
- 3 Laboratory of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NIH), Bethesda, Maryland, United States
- 4 Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- 5 Peking Union Medical College Hospital (CAMS), Beijing, China
Abstract Objective: Obstructive sleep apnea (OSA) and thyroid dysfunction frequently overlap clinically and are risk factors for cardiovascular disease. The free triiodothyronine to free thyroxine (FT3/FT4) ratio as a novel biomarker of cardiovascular disease prognosis, but the impact of the FT3/FT4 ratio on the prognosis of OSA in patients with acute coronary syndromes (ACS) remains uncertain. Methods: In this prospective cohort study, 2160 patients with ACS were recruited and underwent portable sleep monitoring at Beijing Anzhen Hospital from June 2015 to January 2020. OSA was diagnosed when apnea-hypopnea index of ≥15 events/h. Patients were further divided into tertiles according to FT3/FT4 ratio. All patients had scheduled follow-up visits at 1, 3, 6, 9 and 12 months after discharge, with subsequent outpatient visits or telephone follow-up visits every 6 months. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction (MI), stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. Results: Among 1,547 euthyroid patients enrolled (mean age, 56.0 ± 10.5 years), 812 patients (52.5%) had OSA. The FT3/FT4 ratio between OSA and non-OSA patients was not significantly different. During 2.8 (1.4, 3.5) years follow up, the risk of MACCE increased with the decreasing FT3/FT4 tertiles in patients with OSA (tertile3 as reference, tertile2: hazard ratio (HR) 1.26, 95% CI: 0.85-1.86, P = 0.255; tertile1: 1.60, 95% CI 1.11-2.32; P = 0.013). After adjustment for confounders, the lowest FT3/FT4 tertile was still independently associated with an increased risk of MACCE (adjusted HR 1.66, 95% CI 1.11-2.50, P = 0.015). Conclusion: Lower FT3/FT4 ratio associated with poor prognosis in patients with ACS and OSA.
Keywords: Acute Coronary Syndrome, obstructive sleep apnea, FT3/FT4 ratio, Thyroid Hormones, prognosis
Received: 19 Jun 2024; Accepted: 26 Aug 2024.
Copyright: © 2024 Zhou, Qian, Ai, Zhao, Chen, Li, Zhang, Fan, Gong and Nie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Gong, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, 100029, Beijing, China
Shaoping Nie, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, 100029, Beijing, China
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