Skip to main content
Top
Published in: Reviews in Endocrine and Metabolic Disorders 4/2015

01-12-2015

Toxic chemicals and thyroid function: hard facts and lateral thinking

Authors: Leonidas H. Duntas, Nikos Stathatos

Published in: Reviews in Endocrine and Metabolic Disorders | Issue 4/2015

Login to get access

Abstract

Increasing quantities of evidence-based data incriminate a large number of environmental pollutants for toxic effects on the thyroid. Among the many chemical contaminants, halogenated organochlorines and pesticides variably affect the hypothalamic-pituitary-thyroid axis and disrupt thyroid function. PCBs and their metabolites and PBDEs bind to thyroid transport proteins, such as transthyretin, displace thyroxine, and disrupt thyroid function. Meanwhile, at the molecular level, PCB congeners may activate phosphorylation of Akt, p-Akt, and forkhead box O3a (FoxO3a) protein resulting in inhibition of the natrium/iodide symporter. Given therefore the growing concern developing around these multiple toxic chemicals today invading numerous environments and their long-term deleterious effects not only on the thyroid but also on general health, we strongly advocate their strict regulation and, moreover, their gradual reduction. A good degree of “lateral thinking”, we feel, will lead to a use of chemicals that will enhance life while concurrently carefully protecting the environment.
Literature
2.
go back to reference Body Burden – The pollution in newborns, environmental working group, 2005. Body Burden – The pollution in newborns, environmental working group, 2005.
3.
go back to reference Skakkebaek NE, Toppari J, Söder O, Gordon CM, Divall S, Draznin M. The exposure of fetuses and children to endocrine disrupting chemicals: a european society for paediatric endocrinology (ESPE) and pediatric endocrine society (PES) call to action statement. J Clin Endocrinol Metab. 2011;96(10):3056–8. doi:10.1210/jc.2011-1269.CrossRefPubMed Skakkebaek NE, Toppari J, Söder O, Gordon CM, Divall S, Draznin M. The exposure of fetuses and children to endocrine disrupting chemicals: a european society for paediatric endocrinology (ESPE) and pediatric endocrine society (PES) call to action statement. J Clin Endocrinol Metab. 2011;96(10):3056–8. doi:10.​1210/​jc.​2011-1269.CrossRefPubMed
4.
go back to reference Fourth National Report on Human Exposure to Environmental Chemicals. U.S. CDC 2009. Fourth National Report on Human Exposure to Environmental Chemicals. U.S. CDC 2009.
5.
go back to reference Menke A, Muntner P, Batuman V, Silbergeld EK, Guallar E. Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among US adults. Circulation. 2006;114(13):1388–94.CrossRefPubMed Menke A, Muntner P, Batuman V, Silbergeld EK, Guallar E. Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among US adults. Circulation. 2006;114(13):1388–94.CrossRefPubMed
6.
go back to reference Gore AC, Chappell VA, Fenton SE, Flaws JA, Nadal A, Prins GS, et al. Executive summary to EDC-2: the endocrine Society’s second scientific statement on endocrine-disrupting chemicals. Endocr Rev. 2015;36:593–602. doi:10.1210/er.2015-1093.CrossRefPubMed Gore AC, Chappell VA, Fenton SE, Flaws JA, Nadal A, Prins GS, et al. Executive summary to EDC-2: the endocrine Society’s second scientific statement on endocrine-disrupting chemicals. Endocr Rev. 2015;36:593–602. doi:10.​1210/​er.​2015-1093.CrossRefPubMed
8.
go back to reference Brucker-Davis F. Effects of environmental synthetic chemicals on thyroid function. Thyroid. 1998;8:827–55.CrossRefPubMed Brucker-Davis F. Effects of environmental synthetic chemicals on thyroid function. Thyroid. 1998;8:827–55.CrossRefPubMed
9.
go back to reference Zoeller TR. Environmental chemicals targeting thyroid. Hormones (Athens). 2010;9:28–40.CrossRef Zoeller TR. Environmental chemicals targeting thyroid. Hormones (Athens). 2010;9:28–40.CrossRef
14.
go back to reference Montaño M, Cocco E, Guignard C, Marsh G, Hoffmann L, Bergman A, et al. New approaches to assess the transthyretin binding capacity of bioactivated thyroid hormone disruptors. Toxicol Sci. 2012;130:94–105. doi:10.1093/toxsci/kfs228.CrossRefPubMed Montaño M, Cocco E, Guignard C, Marsh G, Hoffmann L, Bergman A, et al. New approaches to assess the transthyretin binding capacity of bioactivated thyroid hormone disruptors. Toxicol Sci. 2012;130:94–105. doi:10.​1093/​toxsci/​kfs228.CrossRefPubMed
15.
17.
go back to reference Guo H, Yang H, Chen H, Li W, Tang J, Cheng P, et al. Molecular mechanisms of human thyrocyte dysfunction induced by low concentrations of polychlorinated biphenyl 118 through the Akt/FoxO3a/NIS pathway. J Appl Toxicol. 2015;35:992–8. doi:10.1002/jat.3032.CrossRefPubMed Guo H, Yang H, Chen H, Li W, Tang J, Cheng P, et al. Molecular mechanisms of human thyrocyte dysfunction induced by low concentrations of polychlorinated biphenyl 118 through the Akt/FoxO3a/NIS pathway. J Appl Toxicol. 2015;35:992–8. doi:10.​1002/​jat.​3032.CrossRefPubMed
18.
go back to reference Xu B, Yang H, Sun M, Chen H, Jiang L, Zheng X, et al. 2,3′,4,4′,5-Pentachlorobiphenyl induces inflammatory responses in the thyroid through JNK and Aryl hydrocarbon receptor-mediated pathway. Toxicol Sci. 2015. Xu B, Yang H, Sun M, Chen H, Jiang L, Zheng X, et al. 2,3′,4,4′,5-Pentachlorobiphenyl induces inflammatory responses in the thyroid through JNK and Aryl hydrocarbon receptor-mediated pathway. Toxicol Sci. 2015.
21.
go back to reference Rádiková Z, Tajtáková M, Kocan A, Trnovec T, Seböková E, Klimes I, et al. Possible effects of environmental nitrates and toxic organochlorines on human thyroid in highly polluted areas in Slovakia. Thyroid. 2008;18:353–62. doi:10.1089/thy.2007.0182.CrossRefPubMed Rádiková Z, Tajtáková M, Kocan A, Trnovec T, Seböková E, Klimes I, et al. Possible effects of environmental nitrates and toxic organochlorines on human thyroid in highly polluted areas in Slovakia. Thyroid. 2008;18:353–62. doi:10.​1089/​thy.​2007.​0182.CrossRefPubMed
23.
go back to reference Brucker-Davis F, Ganier-Chauliac F, Gal J, Panaïa-Ferrari P, Pacini P, Fénichel P, et al. Neurotoxicant exposure during pregnancy is a confounder for assessment of iodine supplementation on neurodevelopment outcome. Neurotoxicol Teratol. 2015;51:45–51. doi:10.1016/j.ntt.2015.07.009.CrossRefPubMed Brucker-Davis F, Ganier-Chauliac F, Gal J, Panaïa-Ferrari P, Pacini P, Fénichel P, et al. Neurotoxicant exposure during pregnancy is a confounder for assessment of iodine supplementation on neurodevelopment outcome. Neurotoxicol Teratol. 2015;51:45–51. doi:10.​1016/​j.​ntt.​2015.​07.​009.CrossRefPubMed
25.
go back to reference Geens T, Dirtu AC, Dirinck E, Malarvannan G, Van Gaal L, Jorens PG, et al. Daily intake of bisphenol A and triclosan and their association with anthropometric data, thyroid hormones and weight loss in overweight and obese individuals. Environ Int. 2015;76:98–105. doi:10.1016/j.envint.2014.12.003.CrossRefPubMed Geens T, Dirtu AC, Dirinck E, Malarvannan G, Van Gaal L, Jorens PG, et al. Daily intake of bisphenol A and triclosan and their association with anthropometric data, thyroid hormones and weight loss in overweight and obese individuals. Environ Int. 2015;76:98–105. doi:10.​1016/​j.​envint.​2014.​12.​003.CrossRefPubMed
26.
go back to reference Zota AR, Park JS, Wang Y, Petreas M, Zoeller RT, Woodruff TJ. Polybrominated diphenyl ethers, hydroxylated polybrominated diphenyl ethers, and measures of thyroid function in second trimester pregnant women in California. Environ Sci Technol. 2011;45:7896–905. doi:10.1021/es200422b.CrossRefPubMedPubMedCentral Zota AR, Park JS, Wang Y, Petreas M, Zoeller RT, Woodruff TJ. Polybrominated diphenyl ethers, hydroxylated polybrominated diphenyl ethers, and measures of thyroid function in second trimester pregnant women in California. Environ Sci Technol. 2011;45:7896–905. doi:10.​1021/​es200422b.CrossRefPubMedPubMedCentral
28.
go back to reference Dong W, Macaulay LJ, Kwok KW, Hinton DE, Stapleton HM. Using whole mount in situ hybridization to examine thyroid hormone deiodinase expression in embryonic and larval zebrafish: a tool for examining OH-BDE toxicity to early life stages. Aquat Toxicol. 2013;132–133:190–9. doi:10.1016/j.aquatox.2013.02.008.CrossRefPubMed Dong W, Macaulay LJ, Kwok KW, Hinton DE, Stapleton HM. Using whole mount in situ hybridization to examine thyroid hormone deiodinase expression in embryonic and larval zebrafish: a tool for examining OH-BDE toxicity to early life stages. Aquat Toxicol. 2013;132–133:190–9. doi:10.​1016/​j.​aquatox.​2013.​02.​008.CrossRefPubMed
30.
go back to reference Webster GM, Rauch SA, Ste Marie N, Mattman A, Lanphear BP, Venners SA. Cross-sectional associations of serum perfluoroalkyl acids and thyroid hormones in U.S. adults: variation according to TPOAb and iodine status (NHANES 2007–2008). Environ Health Perspect. 2015. Webster GM, Rauch SA, Ste Marie N, Mattman A, Lanphear BP, Venners SA. Cross-sectional associations of serum perfluoroalkyl acids and thyroid hormones in U.S. adults: variation according to TPOAb and iodine status (NHANES 2007–2008). Environ Health Perspect. 2015.
31.
go back to reference Berg V, Nøst TH, Hansen S, Elverland A, Veyhe AS, Jorde R, et al. Assessing the relationship between perfluoroalkyl substances, thyroid hormones and binding proteins in pregnant women; a longitudinal mixed effects approach. Environ Int. 2015;77:63–9. doi:10.1016/j.envint.2015.01.007.CrossRefPubMed Berg V, Nøst TH, Hansen S, Elverland A, Veyhe AS, Jorde R, et al. Assessing the relationship between perfluoroalkyl substances, thyroid hormones and binding proteins in pregnant women; a longitudinal mixed effects approach. Environ Int. 2015;77:63–9. doi:10.​1016/​j.​envint.​2015.​01.​007.CrossRefPubMed
33.
go back to reference Goldner WS, Sandler DP, Yu F, Shostrom V, Hoppin JA, Kamel F, et al. Hypothyroidism and pesticide use among male private pesticide applicators in the agricultural health study. J Occup Environ Med. 2013;55(10):1171–8.CrossRefPubMedPubMedCentral Goldner WS, Sandler DP, Yu F, Shostrom V, Hoppin JA, Kamel F, et al. Hypothyroidism and pesticide use among male private pesticide applicators in the agricultural health study. J Occup Environ Med. 2013;55(10):1171–8.CrossRefPubMedPubMedCentral
34.
go back to reference Goldner WS, Sandler DP, Yu F, Hoppin JA, Kamel F, Levan TD. Pesticide use and thyroid disease among women in the agricultural health study. Am J Epidemiol. 2010;171(4):455–64.CrossRefPubMedPubMedCentral Goldner WS, Sandler DP, Yu F, Hoppin JA, Kamel F, Levan TD. Pesticide use and thyroid disease among women in the agricultural health study. Am J Epidemiol. 2010;171(4):455–64.CrossRefPubMedPubMedCentral
35.
go back to reference Wilson AG, Thake DC, Heydens WE, Brewster DW, Hotz KJ. Mode of action of thyroid tumor formation in the male long-Evans rat administered high doses of alachlor. Fundam Appl Toxicol. 1996;33(1):16–23.CrossRefPubMed Wilson AG, Thake DC, Heydens WE, Brewster DW, Hotz KJ. Mode of action of thyroid tumor formation in the male long-Evans rat administered high doses of alachlor. Fundam Appl Toxicol. 1996;33(1):16–23.CrossRefPubMed
36.
go back to reference Acquavella JF, Delzell E, Cheng H, Lynch CF, Johnson G. Mortality and cancer incidence among alachlor manufacturing workers 1968–99. Occup Environ Med. 2004;61(8):680–5.CrossRefPubMedPubMedCentral Acquavella JF, Delzell E, Cheng H, Lynch CF, Johnson G. Mortality and cancer incidence among alachlor manufacturing workers 1968–99. Occup Environ Med. 2004;61(8):680–5.CrossRefPubMedPubMedCentral
38.
go back to reference Li C, Cheng Y, Tang Q, Lin S, Li Y, Hu X, et al. The association between prenatal exposure to organochlorine pesticides and thyroid hormone levels in newborns in Yancheng, China. Environ Res. 2014;129:47–51.CrossRefPubMed Li C, Cheng Y, Tang Q, Lin S, Li Y, Hu X, et al. The association between prenatal exposure to organochlorine pesticides and thyroid hormone levels in newborns in Yancheng, China. Environ Res. 2014;129:47–51.CrossRefPubMed
39.
go back to reference Freire C, Koifman RJ, Sarcinelli PN, Simões Rosa AC, Clapauch R, Koifman S. Long-term exposure to organochlorine pesticides and thyroid status in adults in a heavily contaminated area in Brazil. Environ Res. 2013;127:7–15.CrossRefPubMed Freire C, Koifman RJ, Sarcinelli PN, Simões Rosa AC, Clapauch R, Koifman S. Long-term exposure to organochlorine pesticides and thyroid status in adults in a heavily contaminated area in Brazil. Environ Res. 2013;127:7–15.CrossRefPubMed
40.
go back to reference Bloom MS, Jansing RL, Kannan K, Rej R, Fitzgerald EF. Thyroid hormones are associated with exposure to persistent organic pollutants in aging residents of upper Hudson River communities. Int J Hyg Environ Health. 2014;217:473–82.CrossRefPubMedPubMedCentral Bloom MS, Jansing RL, Kannan K, Rej R, Fitzgerald EF. Thyroid hormones are associated with exposure to persistent organic pollutants in aging residents of upper Hudson River communities. Int J Hyg Environ Health. 2014;217:473–82.CrossRefPubMedPubMedCentral
41.
go back to reference Liu C, Shi Y, Li H, Wang Y, Yang K. p, p ′ -DDE disturbs the homeostasis of thyroid hormones via thyroid hormone receptors, transthyretin, and hepatic enzymes. Horm Metab Res. 2011;43(6):391–6.CrossRefPubMed Liu C, Shi Y, Li H, Wang Y, Yang K. p, p ′ -DDE disturbs the homeostasis of thyroid hormones via thyroid hormone receptors, transthyretin, and hepatic enzymes. Horm Metab Res. 2011;43(6):391–6.CrossRefPubMed
42.
go back to reference Herin F, Boutet-Robinet E, Levant A, Dulaurent S, Manika M, Galatry-Bouju F, et al. Thyroid function tests in persons with occupational exposure to Fipronil. Thyroid. 2011;21(7):701–6.CrossRefPubMed Herin F, Boutet-Robinet E, Levant A, Dulaurent S, Manika M, Galatry-Bouju F, et al. Thyroid function tests in persons with occupational exposure to Fipronil. Thyroid. 2011;21(7):701–6.CrossRefPubMed
43.
go back to reference Hurley PM. Mode of carcinogenic action of pesticides inducing thyroid follicular cell tumors in rodents. Environ Health Perspect. 1998;106(8):437–45.CrossRefPubMedPubMedCentral Hurley PM. Mode of carcinogenic action of pesticides inducing thyroid follicular cell tumors in rodents. Environ Health Perspect. 1998;106(8):437–45.CrossRefPubMedPubMedCentral
44.
go back to reference Grimalt JO, Sunyer J, Moreno V, Amaral OC, Sala M, Rosell A, et al. Risk excess of soft-tissue sarcoma and thyroid cancer in a community exposed to airborne organochlorinated compound mixtures with a high hexachlorobenzene content. Int J Cancer. 1994;56(2):200–3.CrossRefPubMed Grimalt JO, Sunyer J, Moreno V, Amaral OC, Sala M, Rosell A, et al. Risk excess of soft-tissue sarcoma and thyroid cancer in a community exposed to airborne organochlorinated compound mixtures with a high hexachlorobenzene content. Int J Cancer. 1994;56(2):200–3.CrossRefPubMed
45.
go back to reference Lope V, Pérez-Gómez B, Aragonés N, López-Abente G, Gustavsson P, Plato N, et al. Occupational exposure to chemicals and risk of thyroid cancer in Sweden. Int Arch Occup Environ Health. 2009;82:267–74.CrossRefPubMed Lope V, Pérez-Gómez B, Aragonés N, López-Abente G, Gustavsson P, Plato N, et al. Occupational exposure to chemicals and risk of thyroid cancer in Sweden. Int Arch Occup Environ Health. 2009;82:267–74.CrossRefPubMed
46.
go back to reference Zaidi SS, Bhatnagar VK, Gandhi SJ, Shah MP, Kulkarni PK, Saiyed HN. Assessment of thyroid function in pesticide formulators. Hum Exp Toxicol. 2000;19(9):497–501.CrossRefPubMed Zaidi SS, Bhatnagar VK, Gandhi SJ, Shah MP, Kulkarni PK, Saiyed HN. Assessment of thyroid function in pesticide formulators. Hum Exp Toxicol. 2000;19(9):497–501.CrossRefPubMed
47.
go back to reference Roques BB, Leghait J, Lacroix MZ, Lasserre F, Pineau T, Viguié C, et al. The nuclear receptors pregnane X receptor and constitutive androstane receptor contribute to the impact of fipronil on hepatic gene expression linked to thyroid hormone metabolism. Biochem Pharmacol. 2013;86(7):997–1039. doi:10.1016/j.bcp.2013.08.012.CrossRefPubMed Roques BB, Leghait J, Lacroix MZ, Lasserre F, Pineau T, Viguié C, et al. The nuclear receptors pregnane X receptor and constitutive androstane receptor contribute to the impact of fipronil on hepatic gene expression linked to thyroid hormone metabolism. Biochem Pharmacol. 2013;86(7):997–1039. doi:10.​1016/​j.​bcp.​2013.​08.​012.CrossRefPubMed
50.
go back to reference Freire C, Koifman RJ, Sarcinelli P, Rosa AC, Clapauch R, Koifman S. Long term exposure to organochlorine pesticides and thyroid function in children from Cidade dos Meninos, Rio de Janeiro, Brazil. Environ Res. 2012;117:68–74.CrossRefPubMed Freire C, Koifman RJ, Sarcinelli P, Rosa AC, Clapauch R, Koifman S. Long term exposure to organochlorine pesticides and thyroid function in children from Cidade dos Meninos, Rio de Janeiro, Brazil. Environ Res. 2012;117:68–74.CrossRefPubMed
51.
go back to reference Reuber MD. Carcinogenicity of heptachlor and heptachlor epoxide. J Environ Pathol Toxicol Oncol. 1987;7(3):85–114.PubMed Reuber MD. Carcinogenicity of heptachlor and heptachlor epoxide. J Environ Pathol Toxicol Oncol. 1987;7(3):85–114.PubMed
52.
go back to reference Loomis D, Guyton K, Grosse Y, El Ghissasi F, Bouvard V, Benbrahim-Tallaa L, et al. Carcinogenicity of lindane, DDT, and 2,4-dichlorophenoxyacetic acid. Lancet Oncol. 2015;16(8):891–2.CrossRefPubMed Loomis D, Guyton K, Grosse Y, El Ghissasi F, Bouvard V, Benbrahim-Tallaa L, et al. Carcinogenicity of lindane, DDT, and 2,4-dichlorophenoxyacetic acid. Lancet Oncol. 2015;16(8):891–2.CrossRefPubMed
53.
go back to reference Song M, Kim YJ, Park YK, Ryu JC. Changes in thyroid peroxidase activity in response to various chemicals. J Environ Monit. 2012;14(8):2121–6.CrossRefPubMed Song M, Kim YJ, Park YK, Ryu JC. Changes in thyroid peroxidase activity in response to various chemicals. J Environ Monit. 2012;14(8):2121–6.CrossRefPubMed
54.
go back to reference Juberg DR, Gehen SC, Coady KK, LeBaron MJ, Kramer VJ, Lu H, et al. Chlorpyrifos: wieght of evidence evaluation of patential interaction with estrogen, androgen or thyroid pathways. Regul Toxicol Pharmacol. 2013;66(3):249–63.CrossRefPubMed Juberg DR, Gehen SC, Coady KK, LeBaron MJ, Kramer VJ, Lu H, et al. Chlorpyrifos: wieght of evidence evaluation of patential interaction with estrogen, androgen or thyroid pathways. Regul Toxicol Pharmacol. 2013;66(3):249–63.CrossRefPubMed
55.
go back to reference Slotkin TA, Cooper EM, Stapleton HM, Seidler FJ. Does thyroid disruption contribute to the developmental neurotoxicity of chlorpyrifos? Environ Toxicol Pharmacol. 2013;36(2):284–7.CrossRefPubMedPubMedCentral Slotkin TA, Cooper EM, Stapleton HM, Seidler FJ. Does thyroid disruption contribute to the developmental neurotoxicity of chlorpyrifos? Environ Toxicol Pharmacol. 2013;36(2):284–7.CrossRefPubMedPubMedCentral
56.
go back to reference De Cock M, Maas YG, van de Bor M. Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Rev Acta Paediatr. 2012;101(8):811–8.CrossRef De Cock M, Maas YG, van de Bor M. Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Rev Acta Paediatr. 2012;101(8):811–8.CrossRef
57.
go back to reference Crews D, Gore AC, Hsu TS, Dangleben NL, Spinetta M, Schallert T, et al. Transgenerational epigenetic imprints on mate preference. Proc Natl Acad Sci U S A. 2007;104:5942–6.CrossRefPubMedPubMedCentral Crews D, Gore AC, Hsu TS, Dangleben NL, Spinetta M, Schallert T, et al. Transgenerational epigenetic imprints on mate preference. Proc Natl Acad Sci U S A. 2007;104:5942–6.CrossRefPubMedPubMedCentral
Metadata
Title
Toxic chemicals and thyroid function: hard facts and lateral thinking
Authors
Leonidas H. Duntas
Nikos Stathatos
Publication date
01-12-2015
Publisher
Springer US
Published in
Reviews in Endocrine and Metabolic Disorders / Issue 4/2015
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI
https://doi.org/10.1007/s11154-016-9331-x

Other articles of this Issue 4/2015

Reviews in Endocrine and Metabolic Disorders 4/2015 Go to the issue

EditorialNotes

Preface

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.