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Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.
Monday,2013-01-14 16:54 America/Los_Angeles — poolea2
| Title | Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | Collet, T-H, Gussekloo, J, Bauer, DC, Elzen, WPJ den, Cappola, AR, Balmer, P, Iervasi, G, Asvold, BO, Sgarbi, JA, Völzke, H, Gencer, B, Maciel, RMB, Molinaro, S, Bremner, A, Luben, RN, Maisonneuve, P, Cornuz, J, Newman, AB, Khaw, K-T, Westendorp, RGJ, Franklyn, JA, Vittinghoff, E, Walsh, JP, Rodondi, N |
| Corporate/Institutional Authors | Thyroid Studies Collaboration, |
| Journal | Arch Intern Med |
| Volume | 172 |
| Issue | 10 |
| Pagination | 799-809 |
| Date Published | 2012 May 28 |
| ISSN | 1538-3679 |
| Keywords | Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Atrial Fibrillation, Cause of Death, Cohort Studies, Coronary Artery Disease, Female, Humans, Hyperthyroidism, Male, Middle Aged, Prognosis, Prospective Studies, Risk Assessment, Severity of Illness Index, Sex Distribution, Survival Analysis, Switzerland, Thyroid Function Tests, Thyrotropin, Young Adult |
| Abstract | <p><b>BACKGROUND: </b>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.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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% forAF 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).</p><p><b>CONCLUSION: </b>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.</p> |
| DOI | 10.1001/archinternmed.2012.402 |
| Alternate Journal | Arch. Intern. Med. |
| PubMed ID | 22529182 |
| PubMed Central ID | PMC3872478 |
| Grant List | P30 AG024827 / AG / NIA NIH HHS / United States R01 AG-15928 / AG / NIA NIH HHS / United States R01 HL075366 / HL / NHLBI NIH HHS / United States N01-HC-80007 / HC / NHLBI NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States K24 AR051895 / AR / NIAMS NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-AG-62101 / AG / NIA NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States R01-NR012459 / NR / NINR NIH HHS / United States / / Medical Research Council / United Kingdom P30-AG-024827 / AG / NIA NIH HHS / United States AG-032317 / AG / NIA NIH HHS / United States G1000143 / / Medical Research Council / United Kingdom N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States R01 NR012459 / NR / NINR NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States AG-027058 / AG / NIA NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States / / Cancer Research UK / United Kingdom N01-AG-62106 / AG / NIA NIH HHS / United States G0401527 / / Medical Research Council / United Kingdom N01-HC-85083 / HC / NHLBI NIH HHS / United States N01 HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States R01 AG-20098 / AG / NIA NIH HHS / United States R01 AG028050 / AG / NIA NIH HHS / United States R01 AG020098 / AG / NIA NIH HHS / United States R01 AG032317 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-AG-62103 / AG / NIA NIH HHS / United States AG-023629 / AG / NIA NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 AG027058 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States R56 AG023629 / AG / NIA NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |