The Relationship Between Hyroid Stimulating Hormone And Risk Factors Of Cardiovascular And Cerebrovascular Diseases In Middle-aged And Elderly Patients With T2DM

Objective To investigate the relationship between serum TSH levels and risk factors of cardiovascular and cerebrovascular diseases in middle-aged and elderly patients with type 2 diabetes mellitus with mild subclinical hypothyroidism.According to the degree of association,clinical data can be provided for the intervention treatment of early subclinical hypothyroidism.Methods A total of 300 patients with type 2 diabetes who were hospitalized in the Endocrinology Department in the Minda Hospital of Hubei Minzu University from January 1,2019to December 30,2021 were collected.According to the occurrence of subclinical hypothyroidism,they were divided into subclinical hypothyroidism group and normal thyroid function group,with 150 cases in each group.The subclinical hypothyroidism group included 84 males,aged 39~90（60.65±9.59）years;and 66 females,aged 31~84（61.06±10.57）years.In the normal thyroid function group,there were 103 males,aged 26~80（55.83±9.24）years;and 47 females,aged31~77（58.19±10.50）years.In addition,150 patients with mild subclinical hypothyroidism were divided into groups.Since the data in this group are skewed data,the median（M=6.2700）is used for grouping,that is,the SCH high group（T1group）: 4.78000.05）.（2）In the normal thyroid function group,non-middle-aged and elderly patients accounted for 78.7%,middle-aged and elderly patients accounted for 21.3%,and subclinical hypothyroidism group accounted for67.3% and 32.7%,respectively.The proportion of middle-aged and elderly patients in the subclinical hypothyroidism group was higher than Normal thyroid function group（P<0.05）;Hypertension patients accounted for 43.3% in the euthyroid group,55.3% in the subclinical hypothyroidism group,The ratio of hypertensive patients in subclinical hypothyroidism group was higher than that in normal thyroid function group（P < 0.05）;In terms of 10-year CVD risk,the subclinical hypothyroidism group had a significantly higher 10-year CVD risk rate than the normal thyroid function group（98.7% vs 84.7%,P < 0.001）;There was no significant difference between the two groups in the levels of obesity,smoking and hyperlipidemia（P>0.05）.（3）In the normal thyroid function group,the TSH level of middle-aged and elderly patients was significantly higher than that of non-middle-aged and elderly patients（P<0.001）.There was no statistical significance between the two groups in the levels of FT3 and FT4（P>0.05）.In the subclinical hypothyroidism group,the TSH and FT3 levels of middle-aged and elderly patients were higher than those of non-middle-aged and elderly patients（P<0.05）,but there was no significant difference in FT4 level between the two groups（P>0.05）.（4）In T2 DM with mild SCH T2 subgroup,women accounted for 36.0% and men accounted for 64.0%;T1subgroup accounted for 52.0% women and 48.0% men.There was a significant difference in the sex ratio between the two groups（P<0.05）.In terms of smoking,smoking patients in T1 subgroup accounted for 45.3%,and T2 subgroup smoking patients accounted for 58.7%.There was no significant difference in smoking rate between the two groups（P>0.05）.Compared with the T1 group,the LDL-C,Hb A1 c,HOMA-IR and Framingham risk scores of the T2 group were significantly increased,and the differences were statistically significant（P<0.05）.There was no statistical significance in the other indicators between the two groups（P>0.05）.（5）The correlation analysis showed that: TSH was positively correlated with age,systolic blood pressure,diastolic blood pressure,TC,Hb A1 c,FINS,HOMA-IR and Framingham risk score;Negatively correlated with FCP and PCP;There was no correlation with gender,BMI,TG,HDL-C and LDL-C.（6）Logistic regression analysis showed that with increasing age,the risk of SCH in T2 DM patients increased [OR（95%CI）=1.040（1.015~1.066）,P < 0.05];In terms of gender,women are more likely to have SCH than men [OR（95%CI）=1.665（1.022~2.714）,P <0.05];Systolic blood pressure was an independent risk factor for SCH in T2 DM patients [OR（95%CI）=1.018（1.002~1.035）,P<0.05];With the increase of HOMA-IR,the risk of SCH in T2 DM patients increased [OR（95%CI）=1.048（1.006~1.091）,P<0.05].Conclusion（1）The prevalence of type 2 diabetes mellitus with subclinical hypothyroidism is predominantly female and increases with age.（2）Subclinical hypothyroidism can aggravate insulin resistance in patients with type 2 diabetes,aggravate the disorder of glucose and lipid metabolism,and increase the risk of cardiovascular disease in the next 10 years.（3）Serum TSH was positively correlated with Framingham risk score,suggesting that T2 DM patients with higher levels of TSH have a higher risk of cardiovascular disease.