Subclinical Hyperthyroidism and the Risk of Coronary Heart Disease and Mortality

被引：407

作者：

Collet, Tinh-Hai ^{[2
]}

Gussekloo, Jacobijn ^{[3
]}

Bauer, Douglas C. ^{[4
,5
]}

den Elzen, Wendy P. J. ^{[3
]}

Cappola, Anne R. ^{[6
]}

Balmer, Philippe ^{[2
]}

Iervasi, Giorgio ^{[7
]}

Asvold, Bjorn O. ^{[8
]}

Sgarbi, Jose A. ^{[9
,10
]}

Voelzke, Henry ^{[11
]}

Gencer, Baris ^{[2
]}

Maciel, Rui M. B. ^{[9
]}

Molinaro, Sabrina ^{[7
]}

Bremner, Alexandra ^{[12
]}

Luben, Robert N. ^{[14
]}

Maisonneuve, Patrick ^{[15
]}

Cornuz, Jacques ^{[2
]}

Newman, Anne B. ^{[16
]}

Khaw, Kay-Tee ^{[14
]}

Westendorp, Rudi G. J. ^{[17
,18
]}

Franklyn, Jayne A. ^{[19
]}

Vittinghoff, Eric ^{[5
]}

Walsh, John P. ^{[13
,20
]}

Rodondi, Nicolas ^{[1
]}

机构：

[1] Univ Bern, Dept Gen Internal Med, Inselspital, CH-3010 Bern, Switzerland

[2] Univ Lausanne, Dept Ambulatory Care & Community Med, Lausanne, Switzerland

[3] Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands

[4] Univ Calif San Francisco, Dept Med, San Francisco, CA USA

[5] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA

[6] Univ Penn, Sch Med, Dept Med, Div Endocrinol Diabet & Metab, Philadelphia, PA 19104 USA

[7] Tuscany Reg G Monasterio Fdn, Natl Council Res Inst Clin Physiol, Pisa, Italy

[8] Norwegian Univ Sci & Technol, Dept Publ Hlth, Trondheim, Norway

[9] Univ Fed Sao Paulo, Div Endocrinol, Dept Med, Sao Paulo, Brazil

[10] Fac Med Marilia, Div Endocrinol, Marilia, Brazil

[11] Univ Greifswald, Inst Community Med, Greifswald, Germany

[12] Univ Western Australia, Sch Populat Hlth, Crawley, Australia

[13] Univ Western Australia, Sch Med & Pharmacol, Crawley, Australia

[14] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England

[15] European Inst Oncol, Div Epidemiol & Biostat, Milan, Italy

[16] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA

[17] Leiden Univ, Dept Gerontol & Geriatr, Med Ctr, Leiden, Netherlands

[18] Netherlands Consortium Hlth Ageing, Leiden, Netherlands

[19] Univ Birmingham, Sch Clin & Expt Med, Coll Med & Dent Sci, Birmingham, W Midlands, England

[20] Sir Charles Gairdner Hosp, Dept Endocrinol & Diabet, Nedlands, WA 6009, Australia

来源：

ARCHIVES OF INTERNAL MEDICINE | 2012年 / 172卷 / 10期

基金：

英国医学研究理事会; 巴西圣保罗研究基金会; 瑞士国家科学基金会;

关键词：

AMERICAN THYROID ASSOCIATION; ALL-CAUSE MORTALITY; CARDIOVASCULAR RISK; FOLLOW-UP; DYSFUNCTION; METAANALYSIS; HYPOTHYROIDISM; GUIDELINES; MANAGEMENT; FAILURE;

D O I：

10.1001/archinternmed.2012.402

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Data from prospective cohort studies regarding the association between subclinical hyperthyroidism and cardiovascular outcomes are conflicting. We aimed to assess the risks of total and coronary heart disease (CHD) mortality, CHD events, and atrial fibrillation (AF) associated with endogenous subclinical hyperthyroidism among all available large prospective cohorts. Methods: Individual data on 52 674 participants were pooled from 10 cohorts. Coronary heart disease events were analyzed in 22 437 participants from 6 cohorts with available data, and incident AF was analyzed in 8711 participants from 5 cohorts. Euthyroidism was defined as thyrotropin level between 0.45 and 4.49 mIU/L and endogenous subclinical hyperthyroidism as thyrotropin level lower than 0.45 mIU/L with normal free thyroxine levels, after excluding those receiving thyroid-altering medications. Results: Of 52 674 participants, 2188 (4.2%) had subclinical hyperthyroidism. During follow-up, 8527 participants died (including 1896 from CHD), 3653 of 22 437 had CHD events, and 785 of 8711 developed AF. In age and sex-adjusted analyses, subclinical hyperthyroidism was associated with increased total mortality (hazard ratio [HR], 1.24, 95% CI, 1.06-1.46), CHD mortality (HR, 1.29; 95% CI, 1.02-1.62), CHD events (HR, 1.21; 95% CI, 0.99-1.46), and AF (HR, 1.68; 95% CI, 1.16-2.43). Risks did not differ significantly by age, sex, or preexisting cardiovascular disease and were similar after further adjustment for cardiovascular risk factors, with attributable risk of 14.5% for total mortality to 41.5% for AF in those with subclinical hyperthyroidism. Risks for CHD mortality and AF (but not other outcomes) were higher for thyrotropin level lower than 0.10 mIU/L compared with thyrotropin level between 0.10 and 0.44 mIU/L (for both, P value for trend, <=.03). Conclusion: Endogenous subclinical hyperthyroidism is associated with increased risks of total, CHD mortality, and incident AF, with highest risks of CHD mortality and AF when thyrotropin level is lower than 0.10 mIU/L.

引用

页码：799 / 809

页数：11

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