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. This evidence concerns the gene LPL and endothelial dysfunction.