The impact of endothelial dysfunction on the course of metabolically associated liver disease in combination with subclinical hypothyroidism

Abstract

Background. Intrahepatic endothelial dysfunction is involved in many diseases, including fatty liver disease, and in combination with other numerous mechanisms may play a role in atherosclerosis in hypothyroidism. It is possible that endothelial dysfunction markers may be important in assessing the risk of cardiovascular events in patients with metabolic-associated fatty liver disease (MAFLD) in combination with subclinical hypothyroidism. Aims. The aim of this study was to evaluate changes in endothelial dysfunction markers in patients with MAFLD in combination with subclinical hypothyroidism. Methods. We studied 298 patients aged 40-69 years with a history of MAFLD. Of these, 128 patients had a verified diagnosis of both MAFLD and subclinical hypothyroidism. In such cases, the morphological state of the vascular endothelium was assessed by counting circulating desquamated epithelial cells (CDEC) and vascular endothelial growth factor (VEGF-A) in the blood using phase-contrast microscopy and the value of these parameters was in comparison todepending on the level of thyroid stimulating hormone, insulin, age, and cardiovascular risk. Results. It was found that the level of CDEC and VEGF-A was increased in patients with MAFLD and subclinical hypothyroidism. On the one hand, thyroid stimulating hormone levels were found to be associated with endothelial dysfunction and hyperinsulinemia. On the other hand, endothelial dysfunction indices also have links with the degree of cardiovascular risk. Patients with moderate and high cardiovascular risk have a relationship between CDEC and levels of triglycerides, C-reactive protein, and сardiovascular diseases. The levels of VEGF-A and CDEC were significantly higher in the adult age group. VEGF-A levels > 273 pg/mL were associated with abnormalities in the studied parameters, including those reflecting of the liver. Conclusion. Patients with MAFLD in combination with hypertension have elevated levels of CDEC and VEGF-A, which affects the involvement of these factors in the mechanisms of endothelial dysfunction in this category. Markers of endothelial dysfunction can be used to assess the prediction of possible cardiometabolic risk.