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Long-Term Outcome in Patients With Heart Failure Treated With Levothyroxine: An Observational Nationwide Cohort Study
- Source :
- The Journal of Clinical Endocrinology & Metabolism. 104:1725-1734
- Publication Year :
- 2018
- Publisher :
- The Endocrine Society, 2018.
-
Abstract
- Context Hypothyroidism has detrimental effects on the cardiovascular system, but controversy remains concerning the benefits of levothyroxine (L-T4) substitution in patients with heart failure (HF). Objective Examining the effects of L-T4 in patients with HF. Design Retrospective cohort study. Setting and participants All Danish citizens aged ≥18 years diagnosed with HF between 1997 and 2012. L-T4 treatment was identified from nationwide registers. Incidence rate ratios (IRRs) were calculated with Poisson regression models. Main outcome measures All-cause mortality, myocardial infarction (MI), cardiovascular death, and major adverse cardiovascular events (MACEs). Results A total of 224,670 patients were diagnosed with HF [mean age 70.7 (SD ± 14.7) years, 53% male]. Of these, 6560 patients were treated with L-T4 at baseline, and 9007 patients initiated L-T4 during follow-up. A total of 209,103 patients did not receive L-T4. During a median follow-up of 4.8 years [interquartile range (IQR) 9.2] 147,253 patients died. Increased risk of all-cause mortality (IRR 1.25; 95% CI, 1.21 to 1.29; IRR 1.13; 95% CI, 1.10 to 1.16), cardiovascular death (IRR 1.23; 95% CI, 1.18 to 1.27; IRR 1.11; 95% CI, 1.08 to 1.15), and MACE (IRR 1.26; 95% CI, 1.22 to 1.31; IRR 1.05; 95% CI, 1.02 to 1.09) was observed for treatment ongoing at baseline and initiated during follow-up, respectively. Increased risk of MI (IRR 1.32; 95% CI, 1.23 to 1.41) was observed for ongoing treatment, and reduced risk (IRR 0.87; 95% CI, 0.81 to 0.93) was observed for incident treatment. Conclusion Ongoing and incident L-T4 treatment in patients with HF was associated with an increased risk of all-cause mortality, cardiovascular death, and MACE. Increased risk of MI was observed for ongoing treatment, and reduced risk was observed for incident treatment.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Myocardial Infarction
Levothyroxine
Context (language use)
030204 cardiovascular system & hematology
Biochemistry
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Interquartile range
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Survival rate
Aged
Retrospective Studies
Aged, 80 and over
Heart Failure
business.industry
Biochemistry (medical)
Retrospective cohort study
Middle Aged
Prognosis
medicine.disease
Survival Rate
Thyroxine
Cardiovascular Diseases
Female
business
Mace
Follow-Up Studies
Cohort study
medicine.drug
Subjects
Details
- ISSN :
- 19457197 and 0021972X
- Volume :
- 104
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Endocrinology & Metabolism
- Accession number :
- edsair.doi.dedup.....421e410acf5d236543bae675b1b2be22