ArticleAmerican heart journal plus : cardiology research and practice2026
Imaging-defined subclinical atherosclerosis in subclinical hypothyroidism: Prevalence, associated factors, and preventive implications.
Article in American heart journal plus : cardiology research and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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14 authors.
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Abstract
Background: Subclinical hypothyroidism (SCH) has been linked to adverse cardiovascular profiles; however, the burden of subclinical atherosclerosis detected by imaging and its associated drivers remain insufficiently characterized, particularly in real-world Middle Eastern populations. Objectives: To quantify the prevalence of imaging-defined subclinical atherosclerosis in adults with SCH and to identify clinical and biochemical factors independently associated with its presence. Methods: We conducted a cross-sectional study of 500 adults with SCH (TSH 4.5-10 mIU/L with normal free T4) evaluated at a tertiary cardiac center in Oman (December 2023-September 2025). Participants underwent fasting lipid assessment, high-sensitivity C-reactive protein (hs-CRP), carotid ultrasound (carotid plaque and intima-media thickness [CIMT]), and coronary artery calcium (CAC) scoring. The primary outcome was imaging-defined subclinical atherosclerosis, defined as the presence of at least one of the following: CIMT >1.0 mm, carotid plaque, or CAC >100. Multivariable logistic regression was performed using prespecified clinically relevant covariates, including age, sex, body mass index, metabolic syndrome, LDL-C, hs-CRP, and TSH category. Results: Overall, 46% of patients demonstrated imaging-defined subclinical atherosclerosis. The prevalence of CIMT >1.0 mm, carotid plaque, and CAC >100 was 26%, 29%, and 22%, respectively. Imaging-defined subclinical atherosclerosis was substantially more frequent among individuals with metabolic syndrome (72% vs. 33%, Conclusions: Nearly half of adults with SCH exhibit imaging evidence of subclinical atherosclerosis. Higher LDL-C, systemic inflammation, higher TSH, and metabolic syndrome identified a subgroup with a disproportionately greater burden of imaging-defined subclinical atherosclerosis. These findings support a more individualized cardiometabolic risk assessment strategy in SCH and justify prospective studies evaluating whether targeted preventive strategies improve long-term outcomes.
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