UA118829C2 - METHOD FOR DETERMINING CARDIOVASCULAR RISK IN PATIENTS WITH SUBCLINICAL HYPOTHYREOSIS - Google Patents

Abstract

The invention relates to a method for the determination of cardiovascular risk (CVR) in patients with subclinical hypothyroidism (SG), which is based on the regression equationB, based on cardiometabolic features, such as lipoprotein cholesterol and thyrotropic hormone. , where patients with non-alcoholic fatty liver disease (NAFLD) are further examined, for which low-density lipoprotein cholesterol is taken into account, and additional blood telomere length and vasculoend levels are determined telialnoho growth factor and regression equation is: EMBED Equation.3, where EMBED Equation.3 - KBP degree ratio in patients with NAZHHP in conjunction with SG; EMBED Equation.3 - telomere length in blood; EMBED Equation.3 - low density lipoprotein cholesterol, mmol / l; EMBED Equation.3 - vasculoendothelial growth factor (WEFR) level, pg / ml; EMBED Equation.3 is a thyroid-stimulating hormone, mUd / l, EMBED Equation.3 ranges from 0 to 1 and reflects the probability of high CVD risk, the closer the predicted probability to unity, the higher the CVR in patients with NAFLD in combination with SG, if the value of EMBED Equation.3 is in the range from 0 to 0.5, it is concluded that the patient has low CVD in comorbid pathology, if EMBED Equation.3 exceeds 0.5 - KBV high in patients with NAFLD in combination with SG .

Description

(54) METHOD OF DETERMINING CARDIOVASCULAR RISK IN PATIENTS WITH SUBCLINICAL

HYPOTHYROISIS

(57) Abstract:

The invention relates to a method of determining cardiovascular risk (CVR) in patients with subclinical hypothyroidism (SH), which consists in the fact that on the basis of cardiometabolic features, such as cholesterol, lipoproteins and thyrotrol hormone, a regression equation is used to determine the coefficient of cardiovascular risk (risk) where additional examination patients with non-alcoholic fatty liver disease (NAFLD), for which low-density lipoprotein cholesterol is taken into account and telomere length in the blood and the level of vasculo-endothelial growth factor are additionally determined, and the regression equation looks like this:

The crisis is still going on (4366 "Hi 0860. Ho 000 Ya K 0871-kh; -1 ZVO

K. Mr. where the risk is the coefficient of the degree of CVR in patients with NAFLD in combination with SG; hee telomere length in blood;

X2. low-density lipoprotein cholesterol, mmol/l;

Khz. level of vasculoendothelial growth factor (VEGF), pg/ml;

Ha. thyroid-stimulating hormone, mU/l,

K. . - o. the value /RiskU is in the range from 0 to 1 and reflects the probability of a high risk

CVR, the closer the value of the predicted probability is to one, the higher the degree of CVR in patients with NAFLD in combination with SG, if the risk value is in the range from 0 to 0.5. . niya Kryzyk, it is concluded that the patient has a low CVR with comorbid pathology, if it exceeds 0.5 - the CVR is high in a patient with NAFLD in combination with SG.

The invention belongs to medicine, in particular to internal medicine, and can be used to determine the degree of cardiovascular risk in patients with non-alcoholic fatty liver disease (NAFLD) in combination with subclinical hypothyroidism (SH).

Today, NAFLD is one of the most widespread diseases in gastroenterology, which leads to a deterioration in the quality of life of the working population, its disability and even death. First of all, it is associated with an increased risk of NAFLD progression with the development of liver cirrhosis and hepatocellular carcinoma. NAFLD ranks second (1,295) among common liver lesions and is inferior to hepatitis C (32,95). In the economically developed countries of the world, the prevalence of non-alcoholic steatosis of the liver is on average 20-35 95, non-alcoholic steatohepatitis - C 95, including Korea and many other Asian countries. IN

In the USA, steatosis of the liver has 34 95 of the adult population, in Japan - 29 95.

In foreign literature, the problem of subclinical disorders of thyroid gland function (Х3) in patients with NAFLD has been actively considered recently. This is due to the significant prevalence of thyroid dysfunction in the population, as well as a deviation in the metabolism of thyroid hormones in this pathology. It was found that an increase in the level of thyroid-stimulating hormone (TSH), even at the level of highly normal indicators, which is not manifested clinically at this stage, is a statistically significant predictor of liver steatosis and disorders of lipid and carbohydrate metabolism. But these studies are few. They are population-based with the participation of a large population cohort, in which clinical examination of patients is not carried out and insufficient attention is paid to the study of the impact of dysfunction

Shield for the course of the main disease. Therefore, to date, the problem of the combined course of NAFLD and thyroid dysfunction remains unsolved and requires further study.

There is a known method of determining atherosclerotic lesions of the vascular wall in patients with abdominal obesity and non-alcoholic fatty liver disease (invention of the Russian Federation Mo 2637412, МПК СО1М 33/48, publ. 04.12.2017), which includes ip miigo diagnosis of pathological changes in the liver Steatoscreen and determination of the Steatoscreen value . At the same time, the average thickness of the intima-media of the carotid artery in the patient is determined by the formula U-0.64-0.347 Steatoscreen, and if

At 20.86 mm, early signs of atherosclerosis are determined in the patient. A diagnostic method using peak systolic blood flow velocity in the internal carotid artery is also proposed

From the patient. This group of methods prospectively determines the value of pathological changes in the liver, diagnosed using the non-invasive Steatoscreen method for determining probable atherosclerotic lesions of the vascular wall.

The lack of accuracy in determining the risk of progression can be attributed to the disadvantages of the method

NAFLD and the imperfection of the mathematical apparatus, since linear regression can be applied only if there is no multicollinearity between the factors.

The closest in terms of its functional purpose and technical essence to the proposed invention is the method of determining the prognostic value of subclinical atherosclerosis of arteries for the detection of cardiovascular risk in patients with autoimmune thyroiditis |L.V. Kazakova, T.A. Nekrasova, A.Yu. Lukushkina, L.G. Strongin, E.I. Karpovych, S.A.

Semashko, Yu.A. Orlova, 20121), which consists in the fact that the authors examined 3 groups of patients (1st - control, 2nd - with autoimmune thyroiditis and euthyroidism, 3rd - with autoimmune thyroiditis and SG) using general clinical, laboratory and ultrasonic methods. General clinical examination includes examination, determination of anthropometric data (weight, height), calculation of body mass index, measurement of blood pressure (BP), calculation of heart rate (HR); laboratory studies related to hormonal status (TSH, T4v, TZv), lipid profile, including total cholesterol (HO) and high-density lipoprotein cholesterol (HDL), other biochemical parameters.

Instrumental examination included ultrasound examination (USD) of the SCT, electrocardiography, echocardiography, assessment of endothelial function and stiffness of arteries using the ultrasound method. For multiple quantitative comparisons of groups, the authors use Student's test with Bonferroni correction, Spearman's coefficient to characterize correlation relationships. As a result of the analysis, it was found that in the presence of subclinical hypothyroidism, there is a significant decrease in the endothelial function of the brachial artery with normal parameters of the endothelium independent vasodilation, the stiffness of the walls of the arteries with endothelial dysfunction increases, which is determined by a number of factors, including the levels of free TK, free TA, TSH, lipid profile and blood pressure.

The shortcomings of the method include insufficient accuracy in assessing the degree of cardiovascular risk, which is important for determining treatment tactics for this category of patients. In addition, since hypothyroidism belongs to diseases that contribute to the development of dyslipidemia, because of atherosclerosis, arterial hypertension, abdominal obesity, endothelial dysfunction and cardiovascular complications, it is important to consider the issue of the effect of hypothyroidism on the level of vasculoendothelial growth factor (VEGFR) in the blood of patients .

The technical task of the invention is to increase the accuracy of the method of determining the cardiovascular risk in patients with NAFLD in combination with SG, taking into account cardiometabolic indicators that affect the degree of CVR in patients with NAFLD in combination with SG to prevent the development of cardiovascular (CV) complications in order to increase the effectiveness of preventive measures and treatment measures in this contingent of patients.

This problem is solved as follows. In the method of determining the cardiovascular risk in patients with SG, which consists in the fact that on the basis of cardiometabolic signs, such as cholesterol, lipoproteins and thyroid-stimulating hormone, using a regression equation, p. . The crisis. cardiovascular risk factor ( ), according to the invention, patients with non-alcoholic fatty liver disease NAFLD are additionally examined, for which low-density lipoprotein cholesterol is taken into account and telomeres in the blood and the level of vascular endothelial growth factor are additionally determined, and the regression equation looks like: and Crisis - And I exp(- (4366. X; 40860. X» 0.009. Xz 40871. Xu -19391))"

Kryzyku village, Fr. . , where is the coefficient of the degree of CVR in patients with NAFLD in combination with SG; h. telomeres in the blood;

X2. low-density lipoprotein cholesterol, mmol/l;

X3. the level of vasculoendothelial growth factor (VEGFR);

Ha. thyrotropin hormone.

The value K of the risk lies in the range from 0 to 1 and reflects the probability of a high CVR. The closer the value of the predicted probability is to one, the higher the degree of CVR in patients with

NAZHHLP in combination with SG. If the risk K value is in the range from 0 to 0.5, it is concluded that the patient has a low CVR with comorbid pathology, if the risk K exceeds 0.5 -

CVR is high in a patient on NAFLD in combination with SG.

In fig. 1 shows the classification diagram.

In fig. 2 shows the KOS curve.

Table 1 shows the coefficients of the binary logistic regression model created to determine the degree of cardiovascular risk in patients with NAFLD in combination with SG.

Table 2 shows the characteristics of the binary logistic regression model created to determine the degree of cardiovascular risk in patients with NAFLD in combination with SG.

Table C presents the classification results of the binary logistic regression model created to determine the degree of cardiovascular risk in patients with NAFLD in combination with SG.

Table 4 provides the Hosmer-Lemeshov criterion.

Table 5 shows the results of the KOSS analysis.

Let's consider the proposed method in more detail.

The implementation of the proposed method is carried out as follows. The results of a comprehensive study of 65 patients with NAFLD in combination with SG were analyzed, who were divided into two groups as follows: 1st group - patients with moderate cardiovascular risk (43 patients); The 2nd group - patients with high cardiovascular risk (22 patients).

The diagnosis of NAFLD in combination with SG was carried out according to the current unified clinical protocol "Non-alcoholic steatohepatitis" (Order of the Ministry of Health of Ukraine No. 826 dated 06.11.2014), according to the recommendations of the European Association for the Study of the Liver (EABI), the European Association for the Study of Diabetes (EAADSO), the European Association for the Study of Obesity (EABO). SG was diagnosed according to the recommendations of the European Thyroid Association (2013).

When determining cardiometabolic features that affect the formation of various degrees

CVR in NAFLD patients in combination with SG, the following signs were used as potential predictors: - passport data: P.I.B., year of birth; - anthropometric indicators: body weight, waist circumference, hip circumference, height; - indicators of endothelial dysfunction: C-reactive protein, circulating desquamated endothelial cells, thickness of the intima-media complex (IMC), level of vasculoendothelial growth factor;

- indicators of vascular aging: telomeres in the blood, telomeres in the buccal epithelium; - indicators of lipid metabolism: total cholesterol, triglycerides, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, atherogenicity coefficient; - indicators of the functional state of the liver: alanine aminotransferase (ALT) and aspartate aminotransferase (AST), gammaglutamyl transpeptidase; alkaline phosphatase; - indicators of carbohydrate metabolism: fasting blood glucose, insulin, glycosylated hemoglobin; - indicators of the functional state of the thyroid gland: thyroid-stimulating hormone; free T4,

TC is free, A/t to TPO (antibodies to thyroid peroxidase).

All signs were coded and placed according to a 27-dimensional vector, which takes into account the absence, presence, direction and magnitude of each sign.

Mathematical processing of the results was carried out using the package of application programs 5RBOB5 21.0 for UMipaom/5.

The binary logistic regression equation, which determines the probability of disease progression, has the following form:

Р- І нехрид where Р is the probability that the disease will progress; 4 - the value of the logistic function, which is determined according to the formula: 7-5 "Hi Bo Ho You Ha Bo de Ho. risk factor for the progression of the disease,

B. coefficients, the calculation of which is a task of binary logistic regression.

Value of coefficient p; indicates the change in the odds ratio with a change in X;, The odds ratio is the fraction of dividing the probability that the disease will progress by the probability that it will not progress, calculated as hl -B),

The method of stepwise inclusion of predictors, which ranks features according to their contribution to the model, is used in estimating regression equations. Taking into account the considered signs, the logistic regression equation was compiled, according to which the probability of the degree of cardiovascular risk in patients with NAFLD in combination with SG is determined:

Kryzyku - Y I ehr(- (4366. X; 40860. X" 0.009. Xz 40871. Xu -19391))"

Zo de - the coefficient of the degree of CVR in patients with NAFLD in combination with SG;

H. telomeres in the blood;

X2. low-density lipoprotein cholesterol, mmol/l;

X3. the level of vasculoendothelial growth factor (VEF);

Ha. thyrotropin hormone.

K. . . at.

The RISK value ranges from 0 to 1 and reflects the probability of a high CVR. The closer the value of the predicted probability is to one, the higher the degree of CVR in patients with . K. Mr.

NAZHHLP in combination with SG. If the RISK value is in the range from 0 to 0.5, it is concluded that the patient has a low CVR with comorbid pathology, if the RU is 0.5 -

CVR is high in a patient on NAFLD in combination with SG.

The calculated coefficients of the regression function and the results of checking their significance are shown in the table. 1. All variables, according to the Wald statistic (Table 1), are significant (ri>0.05) and correctly selected.

The quality of the approximation of the regression model is evaluated using the similarity function. In the study, 5-39,297 at p-0.001 (Table 2), which indicates that in general, independent variables have a significant contribution to predicting the dependent variable.

The Nigelkirk index, which ranges from 0 to 1, is a measure of certainty. According to the value of the calculated indicator K? Neijelkerka, part of the variance explained with the help of the obtained logistic function is 68 95 (Table 2).

In fig. 1 presents a diagram of the distribution of calculated coefficients of the degree of cardiovascular risk in NAFLD patients with SG. The values of m are plotted along the horizontal axis. . . The crisis. predicted probability of cardiovascular risk; calculated according to the developed binary logistic regression equation vertically - the number of patients with the corresponding value of Crisis. The closer the value of the predicted probability is to one, the higher the degree of cardiovascular risk in patients with NAFLD with SG.

The classification table (Table 3) allows you to judge the number of correct and incorrect forecasts. From the table, it can be concluded that of the total number of patients with moderate cardiovascular risk, which was equal to 43, 41 were recognized by the test and 2 were falsely assigned to the high cardiovascular risk group. Of a total of 22 patients at high cardiovascular risk, 18 were recognized by the test and 4 were falsely classified as moderate cardiovascular risk. In total, 59 cases out of 65 were correctly recognized, which is 90.8 95.

The overall assessment of the agreement between the influence of identified cardiovascular risk factors in patients with NAFLD in combination with SG and the actual occurrence of an adverse outcome was carried out using the Hosmer-Lemeshov agreement test (No) (Table 4). The obtained value - 10.905, with a significance level of p»0.05 (p-0.143), indicates the high quality of the selected model.

To evaluate the effectiveness of the model, KOSC analysis (Fig. 2, Table 5) is also used, which revealed its characteristics, which are an indicator of excellent quality. The value of the area under the AOS curve (Agea Opaeg Sigma) was 0.919.

The usefulness of the mathematical model was verified in practice when determining the cardiovascular risk in patients with NAFLD in combination with SG who were under outpatient or inpatient observation at the National Institute of Therapy named after L.T.

Small NAMS of Ukraine".

68 patients with NAFLD combined with SG were examined. Each of the patients underwent a complex clinical and instrumental examination with additional determination of low-density lipoprotein cholesterol content, the level of vasculoendothelial growth factor and thyroid-stimulating hormone (TSH), and the level of telomeres in blood serum.

We give two clinical examples.

Example 1. Patient M., 43 years old, outpatient card No. 248, 2016, complained

For discomfort in the upper abdomen, an increase in body weight over the past year by 3 kg, periodic episodes of feeling short of breath.

Generally accepted methods of examination are carried out: medical history and life history, objective examination.

Anamnesis of the disease: considers himself sick since the age of 3 years, when weight gain was first recorded. During the routine examination, the value of TSH was found, which corresponded to the control value and was equal to 3.4 mU/l. With ultrasound of the thyroid gland - without pathological changes, organs of the abdominal cavity - signs of non-alcoholic steatosis of the liver. Recommended diet, dosed physical activity. In the family anamnesis, there are no features of diseases of the cardiovascular system.

Objective examination: the general condition is relatively satisfactory. Skin integuments of normal color, dry. Vesicular breathing above the lungs. Limits of relative cardiac dullness within the physiological norm. Cardiac activity is rhythmic, tones are muffled. Heart rate - 76 beats. per minute Blood pressure - 120/85 mm Hg. Art. There are no peripheral edemas. Defecation and diuresis without differences.

Anthropometric indicators are evaluated: body weight 78 kg, height 162 cm; they measure a body mass index (BMI) of 29.77 kg/m, which exceeds the norm (25 kg/m?) and indicates the presence of excess body weight. Determine the waist circumference (OT) 102 cm (more than 80 cm for women), hip circumference (OS) 88 cm, OT/OS - 1.2.

On palpation, the abdomen is enlarged due to excess adipose tissue, soft, painless. The liver is enlarged. Dimensions according to Kurlov 14x13x12 cm.

Along with the generally accepted set of tests, the patient is subjected to additional tests (research of telomere length, VEGFR in blood serum).

Research results:

In blood serum: total cholesterol (CO) - 6.87 mmol/l, triglycerides - 2.7 mmol/l, CHO lLYDNSH - 0.28 mmol/l; the calculated value of ХО ЛИІНЩ - 2.8 mmol/l. Glucose - 5.2 mmol/l.

The level of TSH was 4.0 mU/l, free T4 - 0.8 mmol/l, which indicates the presence of subclinical hypothyroidism.

The level of AST - 0.38 mmol/l, ALT - 0.48 mmol/l, GHTP - 28 mmol/l, which is evidence of adequate functional activity of the liver.

The patient is additionally subjected to a molecular genetic study to determine the length of the telomere, which is 0.9, which indicates a slight decrease compared to the control value and may act as a factor that prevents vascular aging.

Determine the level of VEGF, which in patient M. has a value of 278 pg/ml, which indicates a slight but reliable increase compared to the control value.

Thus, the following values of the prognostic criteria were determined for the patient: body length (measured be) - 0.9, HDL content (hg) - 2.8 mmol/l, GFR level (khz) - 278 pg/ml, TSH content (ha) - 4.0 mU/l.

Individual quantitative assessment of prognostic criteria is carried out for the patient and calculated automatically in Ehse! prognostic index according to the developed formula:

Kryzyku - P ehr(- (4366.09 0860. 28--0009.278--0871.4-19391))"

The probability of cardiovascular risk of Crisis 7 ooo

Conclusion: since the probability of the degree of CVR is in the range from O to 0.5, we conclude that the subject has a low cardiovascular risk in the presence of NAFLD in combination with SG, which was confirmed after 1 year of observation.

Recommended: timely prevention and medication correction (if necessary) with constant observation and monitoring of additional clinical and instrumental research methods, because patient M. has a low risk of developing cardiovascular events with a probable risk of its progression to moderate. This is necessary to reduce the rate of occurrence of more pronounced cardiometabolic changes, which contribute to the formation of a general cardiovascular risk in a patient with NAFLD in combination with SG, which has not only a medical, but also a socio-economic effect.

Example 2. Patient E., 42 years old, medical history No. 935, 2016, went to the polyclinic

Institute of therapy to the endocrinologist for a complaint of discomfort when swallowing, which recurs up to 3-4 times a week lasting up to 15-20 minutes, stopped independently.

Generally accepted methods of examination are carried out: medical history and life history, objective examination.

Medical history: considers himself sick for 5 years, when signs of hypothyroidism were first detected during routine examination, TSH level was 4.2 m Units/l, free TA - 15 pmol/l.

Zo Dali was not examined, no treatment was carried out, he followed dietary recommendations.

He does not use alcohol or hepatotoxic drugs. In the family history - the mother has hypothyroidism, coronary heart disease.

Objective examination: the general condition is relatively satisfactory. Skin integuments of normal color, dry. Xanthelasma of the eyelids are noted. Vesicular breathing above the lungs. The limits of relative heart dullness are extended to the left by 0.5 cm. Heart activity is rhythmic, tones are muffled. Heart rate 68 beats. per minute Blood pressure 125/85 mm Hg. Art. There are no peripheral edemas. Defecation and diuresis without differences.

Anthropometric indicators are evaluated: body weight 72 kg, height 167 cm; measure a BMI of 25.8 kg/m, which indicates a slight percentage of excess weight. Determine OT 93 cm (more than 94 cm for men), OS 94 cm, OT/OS 0.99. On palpation, the abdomen is not enlarged, soft, painless. The liver is enlarged. Dimensions according to Kurlov 14x13x12 cm.

Along with the generally accepted set of tests, the patient is subjected to a study of metabolic indicators and a vascular marker (GFR and TSH levels, telomere length in blood serum and low-density lipoprotein cholesterol content).

Results of instrumental studies:

According to the ultrasound of the carotid arteries - an increase in TKIM to 1. mm, without the presence of atherosclerotic plaques.

According to the ultrasound of the abdominal organs, there are signs of non-alcoholic steatosis of the liver.

Ultrasound of the thyroid gland - signs of autoimmune thyroiditis without nodule formation.

Results of laboratory studies:

In blood serum: total cholesterol (C) - 7.0 mmol/l, triglycerides - 2.1 mmol/l, CHO

LYDNSH - 0.31 mmol/l; CS LIINSH - 3.2 μmol/l. The TSH level was 5.4 mU/l. The level of insulin is 22.8 μU/ml, which indicates hyperinsulinemia.

The patient is additionally subjected to molecular genetic testing of deoxyribonucleic acid (DNA) with measurement of body length.

Results: the patient has a shortened telomere length - 0.65.

Determine the content of vascular endothelial growth factor. The result: the patient's VEGF level is 658 pg/ml, which is three times higher than the control value.

Thus, the following prognostic criteria values for the degree of cardiovascular risk were determined for the patient: telomere length (x) - 0.65, triglyceride content (x") - 3.2 mmol/l, level

VEGFR (khz) - 658, TSH content (ha) - 5.4 mmol/l.

Individual quantitative assessment of prognostic criteria is carried out for the patient and calculated automatically in Ehse! prognostic index according to the developed formula:

Kryzyku - And I ehr(- (4366.0,65--0860.32 --0009.658--0871-54-19391))" . p. . Kryzyku - 0960

The probability of cardiovascular risk; therefore, the examined patient has

NAFLD in combination with SG indicates a high cardiovascular risk, which indicates the likely development of cardiovascular events in the near future (1 year).

Recommended: taking into account the high cardiovascular risk in the BE patient, which is due to the progression of atherosclerotic changes in the carotid arteries and the progressive increase in the level of cardiometabolic indicators, the patient is shown the obligatory appointment of hypolipidemic therapy. In addition, additional clinical-instrumental and molecular-genetic testing is recommended for first-degree relatives in order to take timely preventive measures to prevent the formation of high-grade CVR.

Thus, the proposed method allows predicting the degree of cardiovascular risk in patients with NAFLD in combination with SG based on cardiometabolic indicators.

Application of the proposed method in clinical practice makes it possible to achieve an increase in the accuracy of determining the cardiovascular risk in patients with NAFLD combined with SG due to the determination of factors that affect the progression of cardiometabolic changes in NAFLD in patients with SG, which will help the doctor to prescribe adequate therapeutic and preventive measures and improve the quality of providing medical services to patients with NAFLD in combination with SG.

Table 1

Coefficients of the binary logistic regression model created to determine the degree of cardiovascular risk in patients with non-alcoholic fatty liver disease in combination with subclinical hypothyroidism

Signs, p. and Щ Significance in. Coefficients Standard errors Wald criteria p;

AND

4.366 1.738 6.311 0.012 0.860 0.437 3.872 0.049 0.009 0.004 6.661 0.010 0.871 0.361 5.820 0.016 -19.391 4.787 16.407 0.001

Table 2

Characteristics of a binary logistic regression model created to determine the degree of cardiovascular risk in patients with non-alcoholic fatty liver disease in combination with subclinical hypothyroidism

Results -2 Y 09 Probabilities in ? . of the final step of the Nigelkerk test Significance (p) of the analysis 39.297 0.680 43.905 0.001

Table C

Classification results of the binary logistic regression model created to determine the degree of cardiovascular risk in patients with non-alcoholic fatty liver disease in combination with subclinical hypothyroidism

Predicted groups

Valid groups Cardiovascular risk 95 correctly predicted

Cardiovascular Moderate | (4 2 | 2 1 ( 953 g risk

Table 4

Hosmer-Lemeshov criterion

Significance (p) 10.905 0.143

Table 5

Results of KOS analysis

Characteristics of KOS Kryva 95 95 Confidence interval

Standard and

Claims (1)

0.919 0.041 0.001 0.838 1.000 FORMULA OF THE INVENTION The method of determining the cardiovascular risk (CVR) in patients with subclinical hypothyroidism (SH), which consists in the fact that on the basis of cardiometabolic signs, such as lipoprotein cholesterol and thyroid-stimulating hormone, the coefficient of cardiovascular risk is determined using a regression equation risk (risk), which differs in that patients with non-alcoholic fatty liver disease (NAFLD) are additionally examined, for which low-density lipoprotein cholesterol is taken into account and the telomere length in the blood and the level of vasculo-endothelial growth factor are additionally determined, and the regression equation looks like: Kosyk, schi tekhr( 14366 X Noya 0009. 5 then HC ii Ks de Krizyku - the coefficient of the degree of CVR in patients with NAFLD in combination with SG; hee telomere length in blood; X2. low-density lipoprotein cholesterol, mmol/l; Khz. level of vasculoendothelial growth factor (VEGF), pg/ml; Ha. thyroid-stimulating hormone, mU/l, the K value of the risk is in the range from 0 to 1 and reflects the probability of the risk of high CVR, the closer the value of the predicted probability is to one, the higher the degree of CVR in patients with NAFLD in combination with SG, if the risk value is in in the range from 0 to 0.5, is done. . neck - Kryziku concludes that the patient has a low CVR with comorbid pathology, if it exceeds 0.5 - the CVR is high in a patient with NAFLD in combination with SG.