CETP and atherosclerosis: Hypothyroidism reduces clearance of chylomicron remnants, suppresses cholesteryl ester transfer protein activity, and decreases hepatic and lipoprotein lipase activity, elevating total cholesterol, low-density lipoprotein cholesterol, and homocysteine levels.[36,37] These lipid abnormalities accelerate atherosclerosis, inflammation, oxidative stress, and endothelial dysfunction, which are the key driver of CHD and MI, as reflected in the MR estimates.