Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation

被引：197

作者：

Baumgartner, Christine ^{[1
]}

da Costa, Bruno R. ^{[2
,3
]}

Collet, Tinh-Hai ^{[4
]}

Feller, Martin ^{[1
,2
]}

Floriani, Carmen ^{[1
]}

Bauer, Douglas C. ^{[5
,6
]}

Cappola, Anne R. ^{[7
]}

Heckbert, Susan R. ^{[8
]}

Ceresini, Graziano ^{[9
]}

Gussekloo, Jacobijn ^{[10
]}

den Elzen, Wendy P. J. ^{[11
,12
]}

Peeters, Robin P. ^{[13
,14
]}

Luben, Robert ^{[16
]}

Voelzke, Henry ^{[17
]}

Doerr, Marcus ^{[18
,19
]}

Walsh, John P. ^{[20
,21
]}

Bremner, Alexandra ^{[22
]}

Iacoviello, Massimo ^{[23
]}

Macfarlane, Peter ^{[24
]}

Heeringa, Jan ^{[15
]}

Stott, David J. ^{[25
]}

Westendorp, Rudi G. J. ^{[26
,27
]}

Khaw, Kay-Tee ^{[16
]}

Magnani, Jared W. ^{[28
]}

Aujesky, Drahomir ^{[1
]}

Rodondi, Nicolas ^{[1
,2
]}

机构：

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

[2] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland

[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, St Michaels Hosp, Li Ka Shing Knowledge Inst,AHRC, Toronto, ON, Canada

[4] Univ Lausanne Hosp, Serv Endocrinol Diabet & Metab, Lausanne, Switzerland

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

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

[7] Univ Penn, Sch Med, Philadelphia, PA 19104 USA

[8] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA

[9] Univ Hosp Parma, Geriatr Endocrine Unit, Dept Clin & Expt Med, Parma, Italy

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

[11] Leiden Univ, Med Ctr, Dept Clin Chem, Leiden, Netherlands

[12] Leiden Univ, Med Ctr, Lab Med, Leiden, Netherlands

[13] Erasmus MC, Dept Internal Med, Rotterdam, Netherlands

[14] Erasmus MC, Dept Epidemiol, Rotterdam, Netherlands

[15] Erasmus MC, Dept Epidemiol & Biostat, Rotterdam, Netherlands

[16] Univ Cambridge, Dept Publ Hlth & Primary Care, Addenbrookes Hosp, Cambridge, England

[17] Univ Med Greifswald, Inst Community Med Clin Epidemiol Res, Greifswald, Germany

[18] Univ Med Greifswald, Dept Internal Med, Greifswald, Germany

[19] Univ Med Greifswald, German Ctr Cardiovasc Res DZHK, Greifswald, Germany

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

[21] Charles Gairdner Hosp, Dept Endocrinol & Diabet, Nedlands, WA, Australia

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

[23] Univ Bari, Cardiol Unit, Dept Emergency & Organ Transplantat, Bari, Italy

[24] Univ Glasgow, Inst Hlth & Wellbeing, Glasgow, Lanark, Scotland

[25] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[26] Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark

[27] Univ Copenhagen, Ctr Healthy Aging, Copenhagen, Denmark

[28] Univ Pittsburgh, Dept Med, Inst Heart & Vasc, 930 Scaife Hall, Pittsburgh, PA USA

来源：

CIRCULATION | 2017年 / 136卷 / 22期

基金：

瑞士国家科学基金会; 英国医学研究理事会;

关键词：

atrial fibrillation; hypothyroidism; thyrotropin; thyroxine; INDIVIDUAL PARTICIPANT DATA; CORONARY-HEART-DISEASE; THYROTROPIN LEVELS; LARGE POPULATION; SERUM TSH; DYSFUNCTION; FAILURE; ASSOCIATION; MORTALITY; HYPERTHYROIDISM;

D O I：

10.1161/CIRCULATIONAHA.117.028753

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. Methods: We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Results: Of 30085 participants from 11 cohorts (278955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend <= 0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. Conclusions: In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF.

引用

页码：2100 / 2116

页数：17

共 48 条

[1] Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation [J].

Acharya, Tushar ;

Tringali, Steven ;

Bhullar, Manminder ;

Nalbandyan, Marta ;

Ilineni, Vishnu Karthik ;

Carbajal, Enrique ;

Deedwania, Prakash .

AMERICAN JOURNAL OF CARDIOLOGY, 2015, 116 (12) :1852-1857

[2] Systematic reviews in health care - Systematic reviews of evaluations of prognostic variables [J].

Altman, DG .

BMJ-BRITISH MEDICAL JOURNAL, 2001, 323 (7306) :224-228

[3] The Association Between Blood Pressure and Normal Range Thyroid Function Tests in a Population Based Tehran Thyroid Study [J].

Amouzegar, A. ;

Heidari, M. ;

Gharibzadeh, S. ;

Mehran, L. ;

Tohidi, M. ;

Azizi, F. .

HORMONE AND METABOLIC RESEARCH, 2016, 48 (03) :151-156

[4]

[Anonymous], J AM COLL CARDIOL, DOI DOI 10.1016/j.jacc.2014.03.022

[5] Thyrotropin levels and risk of fatal coronary heart disease [J].

Asvold, Bjorn O. ;

Bjoro, Trine ;

Nilsen, Tom Ivar L. ;

Gunnell, David ;

Vatten, Lars J. .

ARCHIVES OF INTERNAL MEDICINE, 2008, 168 (08) :855-860

[6] Impact of atrial fibrillation on the risk of death [J].

Benjamin, EJ ;

Wolf, PA ;

D'Agostino, RB ;

Silbershatz, H ;

Kannel, WB ;

Levy, D .

CIRCULATION, 1998, 98 (10) :946-952

[7] Effects of subclinical thyroid dysfunction on the heart [J].

Biondi, B ;

Palmieri, EA ;

Lombardi, G ;

Fazio, S .

ANNALS OF INTERNAL MEDICINE, 2002, 137 (11) :904-914

[8] Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients [J].

Biondi, B ;

Palmieri, EA ;

Fazio, S ;

Cosco, C ;

Nocera, M ;

Saccà, L ;

Filetti, S ;

Lombardi, G ;

Perticone, F .

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2000, 85 (12) :4701-4705

[9] The Colorado thyroid disease prevalence study [J].

Canaris, GJ ;

Manowitz, NR ;

Mayor, G ;

Ridgway, EC .

ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (04) :526-534

[10]

Cappola AR, 2015, J CLIN ENDOCR METAB, V100, P1088, DOI 10.1210/jc.2014-3586

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