Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.
Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.
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DOI：
10.1001/archinternmed.2012.402
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发表时间：
2012-05-28
影响因子：
--
通讯作者：
Rodondi, Nicolas
中科院分区：
文献类型：
--
作者：
Collet, Tinh-Hai;Gussekloo, Jacobijn;Bauer, Douglas C.;den Elzen, Wendy P. J.;Cappola, Anne R.;Balmer, Philippe;Iervasi, Giorgio;Asvold, Bjorn O.;Sgarbi, Jose A.;Voelzke, Henry;Gencer, Baris;Maciel, Rui M. B.;Molinaro, Sabrina;Bremner, Alexandra;Luben, Robert N.;Maisonneuve, Patrick;Cornuz, Jacques;Newman, Anne B.;Khaw, Kay-Tee;Westendorp, Rudi G. J.;Franklyn, Jayne A.;Vittinghoff, Eric;Walsh, John P.;Rodondi, Nicolas
来自前瞻性队列研究的数据关于亚临床甲状腺功能亢进和心血管结局之间的关系是相互矛盾的。我们的目的是在所有可用的大型前瞻性队列中评估与内源性亚临床甲状腺功能亢进相关的冠心病（CHD）死亡率、冠心病事件和房颤（AF）的风险。从10个队列中汇总了52674名参与者的个人数据。研究人员分析了来自6个队列的22437名参与者的冠心病事件，并分析了来自5个队列的8711名参与者的AF事件。甲状腺功能亢进定义为促甲状腺素水平在0.45 - 4.49 mIU/L之间，内源性亚临床甲状腺功能亢进定义为促甲状腺素水平低于0.45 mIU/L，游离甲状腺素水平正常，排除接受甲状腺改变药物的患者。在52674名参与者中，2188名（4.2%）患有亚临床甲状腺功能亢进。在随访期间，8527名参与者死亡（包括1896名冠心病患者），22437名参与者中有3653名发生冠心病事件，8711名参与者中有785名发生房颤。在年龄和性别调整分析中，亚临床甲亢与总死亡率（风险比[HR]， 1.24, 95% CI, 1.06-1.46）、冠心病死亡率（风险比，1.29,95% CI, 1.02-1.62）、冠心病事件（风险比，1.21,95% CI, 0.99-1.46）和房颤（风险比，1.68,95% CI, 1.16-2.43）增加相关。年龄、性别或既往存在的心血管疾病的风险没有显著差异，在进一步调整心血管危险因素后，风险相似，亚临床甲状腺功能亢进患者AF的总死亡率归因风险为14.5%，而41.5%。与促甲状腺素水平在0.10 ~ 0.44 mIU/L之间的患者相比，促甲状腺素水平低于0.10 mIU/L的患者发生冠心病死亡和AF的风险（但不包括其他结局）更高（两者趋势P值≤0.03）。内源性亚临床甲状腺功能亢进与总死亡率、冠心病死亡率和AF发生率增加相关，当促甲状腺素水平低于0.10 mIU/L时，冠心病死亡率和AF发生率最高。
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. 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. 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). 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.
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