Subclinical Thyroid Dysfunction and the Risk of Heart Failure Events An Individual Participant Data Analysis From 6 Prospective Cohorts

被引:396
作者
Gencer, Baris [1 ]
Collet, Tinh-Hai [1 ]
Virgini, Vanessa [2 ]
Bauer, Douglas C. [3 ,4 ]
Gussekloo, Jacobijn [5 ]
Cappola, Anne R. [8 ]
Nanchen, David [1 ]
den Elzen, Wendy P. J. [5 ]
Balmer, Philippe [1 ]
Luben, Robert N. [9 ]
Iacoviello, Massimo [10 ]
Triggiani, Vincenzo
Cornuz, Jacques [1 ]
Newman, Anne B. [11 ]
Khaw, Kay-Tee [9 ]
Jukema, J. Wouter [6 ]
Westendorp, Rudi G. J. [7 ,12 ]
Vittinghoff, Eric [3 ,4 ]
Aujesky, Drahomir [2 ]
Rodondi, Nicolas [2 ]
机构
[1] Univ Lausanne, Dept Ambulatory Care & Community Med, Lausanne, Switzerland
[2] Univ Hosp Bern, Dept Gen Internal Med, CH-3010 Bern, Switzerland
[3] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[4] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[5] Leiden Univ, Med Ctr, Dept Publ Hlth & Primary Care, Leiden, Netherlands
[6] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands
[7] Leiden Univ, Med Ctr, Dept Gerontol & Geriatr, Leiden, Netherlands
[8] Univ Penn, Sch Med, Dept Med, Div Endocrinol Diabet & Metab, Philadelphia, PA 19104 USA
[9] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England
[10] Univ Bari, Cardiol Unit, Bari, Italy
[11] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA
[12] Netherlands Consortium Hlth Ageing, Leiden, Netherlands
基金
瑞士国家科学基金会; 美国国家卫生研究院; 英国医学研究理事会;
关键词
cohort studies; epidemiology; heart failure; meta-analysis; thyroid; CARDIOVASCULAR RISK; CARDIAC-FUNCTION; LIFETIME RISK; HYPOTHYROIDISM; DISEASE; HEALTH; METAANALYSIS; POPULATION; SURVIVAL; HOSPITALIZATION;
D O I
10.1161/CIRCULATIONAHA.112.096024
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-American College of Cardiology/American Heart Association guidelines for the diagnosis and management of heart failure recommend investigating exacerbating conditions such as thyroid dysfunction, but without specifying the impact of different thyroid-stimulation hormone (TSH) levels. Limited prospective data exist on the association between subclinical thyroid dysfunction and heart failure events. Methods and Results-We performed a pooled analysis of individual participant data using all available prospective cohorts with thyroid function tests and subsequent follow-up of heart failure events. Individual data on 25 390 participants with 216 248 person-years of follow-up were supplied from 6 prospective cohorts in the United States and Europe. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L, subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L, and subclinical hyperthyroidism as TSH <0.45 mIU/L, the last two with normal free thyroxine levels. Among 25 390 participants, 2068 (8.1%) had subclinical hypothyroidism and 648 (2.6%) had subclinical hyperthyroidism. In age-and sex-adjusted analyses, risks of heart failure events were increased with both higher and lower TSH levels (P for quadratic pattern <0.01); the hazard ratio was 1.01 (95% confidence interval, 0.81-1.26) for TSH of 4.5 to 6.9 mIU/L, 1.65 (95% confidence interval, 0.84-3.23) for TSH of 7.0 to 9.9 mIU/L, 1.86 (95% confidence interval, 1.27-2.72) for TSH of 10.0 to 19.9 mIU/L (P for trend <0.01) and 1.31 (95% confidence interval, 0.88-1.95) for TSH of 0.10 to 0.44 mIU/L and 1.94 (95% confidence interval, 1.01-3.72) for TSH <0.10 mIU/L (P for trend=0.047). Risks remained similar after adjustment for cardiovascular risk factors. Conclusion-Risks of heart failure events were increased with both higher and lower TSH levels, particularly for TSH >= 10 and <0.10 mIU/L. (Circulation. 2012;126:1040-1049.)
引用
收藏
页码:1040 / U100
页数:19
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