Thyroid and Heart Failure PDF – From Pathophysiology to Clinics
3.30 MB PDF
In many fields of biomedicine there has been a virtual explosion of new knowledge over the past few years. Among these, a primary position is occupied by the physiological and pathophysiological neurohormonal control of the cardiovascular system, in which the state of the thyroid has assumed a prominent role. Extensive investigations that have made use of new technologies to study animal and human models of disease have focused on the modulation of cardiovascular function by the thyroid system. These results have supported and coincided with a growing understanding of the interacting biomolecular mechanisms that underlie the complex relationships between the thyroid system and cardiovascular function, although many aspects remain largely undefined.
The planning of this book was initiated at the end of 2007, as researchers and clinicians became aware of the pathophysiological and clinical significance of thyroid function with respect to cardiac failure. At the same time, the implications of this relationship for public health, including the socioeconomic aspects, became clear.
The driving considerations behind the book can be summarized as follows:
1) Cardiac failure worldwide represents a major public health problem.
2) Cardiac failure is the only common cardiovascular condition that is increasing in prevalence and incidence; it is responsible for about 1 million hospital admissions and 400,000 deaths annually in the United States and in Europe.
3) The critical role of the neuroendocrine system in the evolution of heart failure and in its prognosis is well defined; there is additional evidence that drugs able to modify the natural course of cardiovascular disease act on the neuroendocrine system, namely β-blockers and inhibitors of the renin-angiotensin-aldosterone system.
4) Thyroid hormones are essential for maintaining cardiovascular homeostasis. An altered thyroid hormone profile (including both the so-called low-T3 syndrome and mild primary thyroid dysfunction) is observed in more than 30% of the total heart failure population.
5) The relationship between an altered thyroid hormone profile and cardiac failure is nowadays widely accepted: nonetheless, it is controversially interpreted by research scientists and clinicians.
Considering the importance of cardiac failure and its relationship to thyroid function, a traditional monographic publication would have been unable to integrate and give sufficient relevance to all the component inter- and multi-disciplinary issues. Instead, the task of bringing together the many different but equally significant aspects was given to the Institute of Clinical Physiology of the National Research Council of Pisa. The integration and merging of information from different disciplines to form a unified whole has been a particular specialty of the Institute since its founding, in 1968, by Professor Luigi Donato.
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