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Subclinical Hyperthyroidism and the Risk of Coronary Heart Disease and Mortality
- Source :
- Archives of Internal Medicine-New Series-, 172(10), 799-809, Archives of Internal Medicine, vol. 172, no. 10, pp. 799-809, Archives of Internal Medicine
- Publication Year :
- 2012
-
Abstract
- 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.
- Subjects :
- Male
endocrine system diseases
Thyrotropin
Coronary Artery Disease
Thyroid Function Tests
030204 cardiovascular system & hematology
Severity of Illness Index
Hyperthyroidism
Cohort Studies
Coronary artery disease
0302 clinical medicine
Cause of Death
Atrial Fibrillation
Prospective Studies
Prospective cohort study
Subclinical infection
Aged, 80 and over
medicine.diagnostic_test
Hazard ratio
Atrial fibrillation
Middle Aged
Prognosis
3. Good health
Female
Switzerland
hormones, hormone substitutes, and hormone antagonists
Cohort study
Adult
endocrine system
medicine.medical_specialty
Adolescent
Age Distribution
Aged
Atrial Fibrillation/complications
Atrial Fibrillation/diagnosis
Coronary Artery Disease/complications
Coronary Artery Disease/diagnosis
Humans
Hyperthyroidism/complications
Hyperthyroidism/diagnosis
Risk Assessment
Sex Distribution
Survival Analysis
Thyrotropin/blood
Young Adult
030209 endocrinology & metabolism
Thyroid function tests
Article
03 medical and health sciences
Internal medicine
Internal Medicine
medicine
business.industry
medicine.disease
Endocrinology
Attributable risk
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Archives of Internal Medicine-New Series-, 172(10), 799-809, Archives of Internal Medicine, vol. 172, no. 10, pp. 799-809, Archives of Internal Medicine
- Accession number :
- edsair.doi.dedup.....a2429906fa6088006ef327c97161c736