Response: Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults (Diabetes Metab J 2013;37:450-7)

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Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults

BACKGROUND: Recent evidence has suggested an association between subclinical hypothyroidism (SCH) and microalbuminuria in patients with type 2 diabetes. However, whether SCH is related to microalbuminuria among subjects with prediabetes has not been studied. Thus, we evaluated the association between SCH and microalbuminuria in a cohort of prediabetic Egyptian adults. METHODS: A total of 147 prediabetic subjects and 150 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR), thyroid stimulating hormone (TSH), free thyroxine, triiodothyronine levels, and urinary albumin-creatinine ratio (UACR) were assessed. RESULTS: The prevalence of SCH and microalbuminuria in the prediabetic subjects was higher than that in the healthy controls (16.3% vs. 4%, P<0.001; and 12.9% vs. 5.3%, P=0.02, respectively). Prediabetic subjects with SCH were characterized by significantly higher HOMA-IR, TSH levels, UACR, and prevalence of microalbuminuria than those with euthyroidism. TSH level was associated with total cholesterol (P=0.05), fasting insulin (P=0.01), HOMA-IR (P=0.01), and UACR (P=0.005). UACR was associated with waist circumference (P=0.01), fasting insulin (P=0.05), and HOMA-IR (P=0.02). With multiple logistic regression analysis, SCH was associated with microalbuminuria independent of confounding variables (beta=2.59; P=0.01). CONCLUSION: Our findings suggest that prediabetic subjects with SCH demonstrate higher prevalence of microalbuminuria than their non-SCH counterparts. SCH is also independently associated with microalbuminuria in prediabetic subjects. Screening and treatment for SCH may be warranted in those patients.

Sex hormones and oxidant- antioxidant status in post-menopausal women with coronary artery disease

The strikingly lower prevalence of acute coronary syndromes in pre-menopausal women than in men of similar age, then the progressive narrowing of that difference with age after menopause, suggests an important role for sex hormones and probably oxidative stress in the development of coronary artery disease. The aim of this study is to evaluate the sex hormones and oxidant stress [malondialdehyde, which is a metabolite of lipid peroxidation] and anti-oxidants [vitamin C and E] status in postmenopausal women with stable coronary artery disease and in those with acute coronary syndromes. This study was conducted on 40 non-hormone user postmenopausal women with coronary artery disease. They were divided into 3 groups: the 1[st] group [17 patients] who had an acute myocardial infarction, the 2[nd] group [10 patients] had unstable angina and the 3[rd] one [13 patients] had stable angina. This is an addition to 20 apparently healthy postmenopausal women of similar age. All cases and control subjects were subjected to thorough history taking, full clinical examination, routine laboratory investigations, resting echocardiography and special laboratory investigations including detection of serum level of; total and free testosterone, total estradiol, morning and nocturnal serum cortisol, malondialdehyde and plasma levels of alpha-tocopherol and vitamin-C. We found a higher serum level of total and free testosterone in cases than control subjects [P-value 0.016 and 0.031 respectively] and the serum free testosterone was significantly higher in the group of acute myocardial infarction than the group of stable angina [P-value 0.008]. The serum level of total estradiol was significantly lower in cases than in control group [P value 0.0001]. Serum malondialdehyde was significantly higher in cases than control subjects [P<0.0001], and it was significantly higher in cases of acute myocardial infarction in comparison to stable angina cases [P-value 0.005]. Vitamin E [[alpha]-tocopherol] and vitamin C were significantly lower in cases than control group [P 0.0001 and 0.048 respectively]. The serum levels of free testosterone as well as malondi-aldehyde were higher in postmenopausal women with coronary artery disease. However, serum level of estradiol, vitamin E and C were lower in them in comparison to control subjects