LOW SERUM THYROTROPIN CONCENTRATIONS AS A RISK FACTOR FOR ATRIAL-FIBRILLATION IN OLDER PERSONS
LOW SERUM THYROTROPIN CONCENTRATIONS AS A RISK FACTOR FOR ATRIAL-FIBRILLATION IN OLDER PERSONS
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DOI：
10.1056/nejm199411103311901
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发表时间：
1994-11-10
影响因子：
158.5
通讯作者：
DAGOSTINO, RB
中科院分区：
文献类型：
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作者：
SAWIN, CT;GELLER, A;DAGOSTINO, RB
背景：血清促甲状腺激素浓度低是甲亢的敏感指标，但也可发生在没有甲状腺功能亢进症临床表现的人群中。我们研究了临床甲状腺功能正常的老年人的低促甲状腺激素浓度是否为随后房颤的危险因素。我们研究了2007名(814名男性和1193名女性)60岁或60岁以上没有房颤的人，以确定在10年的随访期内这种心律失常的频率。根据血清促甲状腺激素水平分为：低值(<0.1亩/升，61例)；轻度低值(<0.1~0.4亩/升，187例)；正常者(0.4~5.0亩/升，1576例)；高值(<5.0亩/升，183例)。10年随访期间，血清促甲状腺激素初值偏低者13例，稍低者23例，正常者133例，高值者23例。低促甲状腺素值(<0.1mU/L)患者10年内房颤累积发生率为28%，正常者为11%；年龄调整后房颤发生率分别为28/1000人年和10/1000人年(P=0.005)。调整其他已知危险因素后，血清促甲状腺激素浓度偏低的老年患者发生房颤的相对危险度为3.1(95%可信区间为1.7~5.5；P<；0.001)，血清促甲状腺激素轻度偏低和偏高组的10年房颤发生率与正常值组比较差异无统计学意义。在60岁或60岁以上的人中，血清促甲状腺激素浓度低与在接下来的十年中发生房颤的风险增加三倍相关。
Background, Low serum thyrotropin concentrations are a sensitive indicator of hyperthyroidism but can also occur in persons who have no clinical manifestations of the disorder. We studied whether low serum thyrotropin concentrations in clinically euthyroid older persons are a risk factor for Subsequent atrial fibrillation.Methods. We studied 2007 persons (814 men and 1193 women) 60 years of age or older who did not have atrial fibrillation in order to determine the frequency of this arrhythmia during a 10-year follow-up period. The subjects were classified according to their serum thyrotropin concentrations: those with low values (less than or equal to 0.1 mU per liter; 61 subjects); those with slightly low values (> 0.1 to 0.4 mU per liter; 187 subjects); those with normal values (> 0.4 to 5.0 mU per liter; 1576 subjects); and those with high values (> 5.0 mU per liter; 183 subjects).Results. During the 10-year follow-up period, atrial fibrillation occurred in 13 persons with low initial values for serum thyrotropin, 23 with slightly low values, 133 with normal values, and 23 with high values. The cumulative incidence of atrial fibrillation at 10 years was 28 percent among the subjects with low serum thyrotropin values (less than or equal to 0.1 mU per liter), as compared with 11 percent among those with normal values; the age-adjusted incidence of atrial fibrillation was 28 per 1000 person-years among those with low values and 10 per 1000 person-years among those with normal values (P = 0.005). After adjustment for other known risk factors, the relative risk of atrial fibrillation in elderly subjects with low serum thyrotropin concentrations, as compared with those with normal concentrations, was 3.1 (95 percent confidence interval, 1.7 to 5.5; P < 0.001), The 10-year incidence of atrial fibrillation in the groups with slightly low and high serum thyrotropin values was not significantly different from that in the group with normal values.Conclusions. Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.