{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T07:55:56Z","timestamp":1792742156975,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary heart disease (CHD) remains a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Whether thyroid hormone sensitivity indices add value for CHD risk stratification among euthyroid T2DM patients is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we included 412 euthyroid adults with T2DM hospitalized at a tertiary hospital (112 with CHD and 300 without). We assessed thyroid hormone sensitivity indices (TT4RI, TFQI, TSHI and FT3\/FT4 ratio), insulin resistance measures (HOMA-IR and METS-IR) and visceral fat area (VFA). Candidate predictors were screened by univariable logistic regression and collinearity diagnostics. A multivariable logistic regression model for prevalent CHD was developed using a stratified 70\/30 train\u2013validation split and evaluated with class-weighted stratified 5-fold cross-validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In univariable analyses, higher HOMA-IR, VFA, TT4RI, TSH, older age and hypertension were associated with CHD. Because TSH and TT4RI were highly collinear, TSH was excluded and TT4RI retained. In the final model, TT4RI, HOMA-IR, VFA and age remained independent predictors after accounting for hypertension. Discrimination was good (AUC 0.768 in the training set and 0.766 in the validation set; mean cross-validated AUROC 0.750 \u00b1 0.035), with acceptable precision\u2013recall performance (mean AUPRC 0.523 \u00b1 0.074) and reasonable calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Impaired thyroid hormone sensitivity, increased insulin resistance and greater visceral fat accumulation are independently associated with prevalent CHD in euthyroid patients with T2DM. A simple model incorporating TT4RI, HOMA-IR and VFA may help refine CHD risk stratification in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1757587","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:24:34Z","timestamp":1785471874000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Thyroid hormone sensitivity, insulin resistance and visceral fat area as determinants of prevalent coronary heart disease in euthyroid patients with type 2 diabetes"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoxue","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeju","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Hanzhong Central Hospital","place":["Hanzhong, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2012.0065","article-title":"Emerging economies and diabetes and cardiovascular disease","author":"Pradeepa","year":"2012","journal-title":"Diabetes Technol Ther"},{"key":"B2","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12933-021-01344-0","article-title":"CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries","volume":"20","author":"Mosenzon","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1177\/2047487319878371","article-title":"Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications","volume":"26","author":"Dal Canto","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S254883","article-title":"Magnitude of, and factors associated with cardiovascular disease among type two diabetes mellitus patients","volume":"13","author":"Tesfaye","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1172\/JCI10762","article-title":"Insulin resistance and cardiovascular disease","volume":"106","author":"Ginsberg","year":"2000","journal-title":"J Clin Invest"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1172\/JCI29024","article-title":"Insulin resistance and atherosclerosis","volume":"116","author":"Semenkovich","year":"2006","journal-title":"J Clin Invest"},{"key":"B7","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1186\/s12933-024-02334-8","article-title":"Metabolic score for insulin resistance (METS-IR) predicts all-cause and cardiovascular mortality in the general population: evidence from NHANES 2001-2018","volume":"23","author":"Duan","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.7.1177","article-title":"Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio Heart Study","volume":"25","author":"Hanley","year":"2002","journal-title":"Diabetes Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12933-023-01876-7","article-title":"Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China","volume":"22","author":"Zheng","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"R76","DOI":"10.1530\/EC-19-0096","article-title":"The impact of thyroid hormone dysfunction on ischemic heart disease","volume":"8","author":"von Hafe","year":"2019","journal-title":"Endocr Connect"},{"key":"B11","doi-asserted-by":"publisher","first-page":"5397686","DOI":"10.1155\/ije\/5397686","article-title":"Thyroid hormone resistance indices and their correlations with insulin resistance in Chinese euthyroid subjects","volume":"2025","author":"Cui","year":"2025","journal-title":"Int J Endocrinol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e3849","DOI":"10.1002\/dmrr.3849","article-title":"Central and peripheral sensitivity to thyroid hormones correlate to metabolically obesity phenotypes in Chinese euthyroid adults: A cross-sectional study","volume":"40","author":"Lu","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab646","article-title":"Reduced sensitivity to thyroid hormone is associated with diabetes and hypertension","volume":"107","author":"Mehran","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/oby.24084","article-title":"Association between thyroid hormone resistance and obesity: a cross-sectional study and mouse stimulation test","volume":"32","author":"Wang","year":"2024","journal-title":"Obes (Silver Spring)"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1410","article-title":"Impaired sensitivity to thyroid hormones is associated with diabetes and metabolic syndrome","volume":"42","author":"Laclaustra","year":"2019","journal-title":"Diabetes Care"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.657114","article-title":"Sensitivity to thyroid hormones and risk of prediabetes: A cross-sectional study","volume":"12","author":"Liu","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0883","article-title":"METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes","volume":"178","author":"Bello-Chavolla","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.2174\/1381612825666181204120506","article-title":"Treatment of early vascular ageing","volume":"24","author":"Antza","year":"2018","journal-title":"Curr Pharm Des"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24086910","article-title":"Aging of the arterial system","volume":"24","author":"Castelli","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12933-021-01331-5","article-title":"Role of obesity and hypertension in the incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes","volume":"20","author":"Sala","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpz193","article-title":"Arterial stiffness in hypertension and function of large arteries","volume":"33","author":"Zhang","year":"2020","journal-title":"Am J Hypertens"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12946","article-title":"Association of low baseline free thyroxin levels with progression of coronary artery calcification over 4 years in euthyroid subjects: the Kangbuk Samsung Health Study","volume":"84","author":"Park","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20181473","article-title":"Thyrotropin aggravates atherosclerosis by promoting macrophage inflammation in plaques","volume":"216","author":"Yang","year":"2019","journal-title":"J Exp Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ejim.2016.12.015","article-title":"Subclinical hypothyroidism, lipid metabolism and cardiovascular disease","volume":"38","author":"Delitala","year":"2017","journal-title":"Eur J Intern Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3892\/etm.2014.2037","article-title":"Mechanism of subclinical hypothyroidism accelerating endothelial dysfunction (Review)","volume":"9","author":"Lu","year":"2015","journal-title":"Exp Ther Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2021.0500","article-title":"Impaired sensitivity to thyroid hormones is associated with hyperuricemia, obesity, and cardiovascular disease risk in subjects with subclinical hypothyroidism","volume":"32","author":"Sun","year":"2022","journal-title":"Thyroid"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1067801","article-title":"Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study","volume":"13","author":"Neves","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/1476-511X-11-44","article-title":"A high normal TSH level is associated with an atherogenic lipid profile in euthyroid non-smokers with newly diagnosed asymptomatic coronary heart disease","volume":"11","author":"Wanjia","year":"2012","journal-title":"Lipids Health Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s12933-022-01698-z","article-title":"TSH levels within the normal range and risk of cardiovascular and all-cause mortality among individuals with diabetes","volume":"21","author":"Zhu","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-022-03223-4","article-title":"Association between sensitivity to thyroid hormones and risk of arrhythmia in patients with coronary heart disease: a RCSCD-TCM study in China","volume":"79","author":"Liu","year":"2023","journal-title":"Endocrine"},{"key":"B32","doi-asserted-by":"publisher","first-page":"942971","DOI":"10.3389\/fcvm.2022.942971","article-title":"Minor perturbations of thyroid homeostasis and major cardiovascular endpoints-Physiological mechanisms and clinical evidence","volume":"9","author":"M\u00fcller","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13823","article-title":"Association between thyroid hormone levels, body composition and insulin resistance in euthyroid subjects with normal thyroid ultrasound: The Kangbuk Samsung Health Study","volume":"89","author":"Kwon","year":"2018","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1366830","article-title":"Associations between sensitivity to thyroid hormones and insulin resistance in euthyroid adults with obesity","volume":"15","author":"Wei","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13162656","article-title":"Elevated free thyroxine levels might alter the effect of the lipid profile on insulin resistance in type 2 diabetes mellitus","volume":"13","author":"Lee","year":"2023","journal-title":"Diagnost (Basel)"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e22929","DOI":"10.1002\/jcla.22929","article-title":"Changes in glucose-lipid metabolism, insulin resistance, and inflammatory factors in patients with autoimmune thyroid disease","volume":"33","author":"Lei","year":"2019","journal-title":"J Clin Lab Anal"},{"key":"B37","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s12933-018-0762-4","article-title":"Association between insulin resistance and the development of cardiovascular disease","volume":"17","author":"Ormazabal","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1186\/s12933-023-02073-2","article-title":"Magnitude and time course of insulin resistance accumulation with the risk of cardiovascular disease: an 11-years cohort study","volume":"22","author":"Tian","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"63","DOI":"10.4239\/wjd.v10.i2.63","article-title":"Insulin resistance is associated with subclinical vascular disease in humans","volume":"10","author":"Adeva-Andany","year":"2019","journal-title":"World J Diabetes"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.repc.2021.06.004","article-title":"Insulin resistance as a predictor of cardiovascular diseases","volume":"40","author":"Domingues","year":"2021","journal-title":"Rev Port Cardiol (Engl Ed)"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e0252855","DOI":"10.1371\/journal.pone.0252855","article-title":"Insulin resistance genetic risk score and burden of coronary artery disease in patients referred for coronary angiography","volume":"16","author":"Skals","year":"2021","journal-title":"PloS One"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2007.07.003","article-title":"Diabetes mellitus and macrovascular disease: mechanisms and mediators","volume":"120","author":"Boyle","year":"2007","journal-title":"Am J Med"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3390\/cells10082035","article-title":"Severe hepatic insulin resistance induces vascular dysfunction: improvement by liver-specific insulin receptor isoform A gene therapy in a murine diabetic model","volume":"10","author":"G\u00f3mez-Hern\u00e1ndez","year":"2021","journal-title":"Cells"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2005.00521.x","article-title":"Insulin resistance\u2013a common link between type 2 diabetes and cardiovascular disease","volume":"8","author":"Lebovitz","year":"2006","journal-title":"Diabetes Obes Metab"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.03.005","article-title":"Endothelial dysfunction of coronary arteries in subjects without diabetes: An association with both insulin resistance and impaired insulin secretion response","volume":"139","author":"Lali\u0107","year":"2018","journal-title":"Diabetes Res Clin Pract"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1757587\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:24:36Z","timestamp":1785471876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1757587\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":45,"alternative-id":["10.3389\/fendo.2026.1757587"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1757587","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"1757587"}}