Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study
Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study
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DOI：
10.7326/0003-4819-132-4-200002150-00004
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发表时间：
2000-02-15
影响因子：
39.2
通讯作者：
Witteman, JCM
中科院分区：
文献类型：
--
作者：
Hak, AE;Pols, HAP;Witteman, JCM
背景：已发现明显甲状腺功能减退与心血管疾病有关。亚临床甲状腺功能减退和甲状腺自身免疫是否也是心血管疾病的危险因素还存在争议。目的：探讨绝经后妇女亚临床甲状腺功能减退和甲状腺自身免疫是否与主动脉粥样硬化和心肌梗死相关。设计：基于人群的横断面研究。环境：荷兰鹿特丹的一个地区。参与者：随机抽取参加鹿特丹研究的1149名女性（平均年龄+/- SD， 69.0 +/- 7.5岁）。测量：基线时获得甲状腺状态、主动脉粥样硬化和心肌梗死史的数据。亚临床甲状腺功能减退定义为促甲状腺激素水平升高（>4.0 mU/L）和血清游离甲状腺素水平正常（11 ~ 25 pmol/L [0.9 ~ 1.9 ng/d L]）。在甲状腺过氧化物酶抗体试验中，血清水平大于10 IU/mL被认为是阳性结果。结果：10.8%的参与者存在亚临床甲状腺功能减退，并与主动脉粥样硬化（优势比为1.7 [95% CI， 1.1至2.6]）和心肌梗死（优势比为2.3 [CI， 1.3至4.0]）的较高年龄校正患病率相关。额外调整体重指数、总脂蛋白和高密度脂蛋白胆固醇水平、血压和吸烟状况，以及排除服用p受体阻滞剂的妇女，对这些估计没有影响。亚临床甲状腺功能减退和甲状腺过氧化物酶抗体患者的相关性略强（主动脉粥样硬化的优势比为1.9 [CI， 1.1至3.6]；心肌梗死的优势比为3.1 [CI， 1.5至6.3]）。甲状腺自身免疫本身与心血管疾病之间未发现关联。与心肌梗死相关的亚临床甲状腺功能减退的人群归因风险百分比在已知心血管疾病主要危险因素的范围内。结论：亚临床甲状腺功能减退是老年妇女发生动脉粥样硬化和心肌梗死风险的重要指标。
Background: Overt hypothyroidism has been found to be associated with cardiovascular disease. Whether subclinical hypothyroidism and thyroid autoimmunity are also risk factors for cardiovascular disease is controversial.Objective: To investigate whether subclinical hypothyroidism and thyroid autoimmunity are associated with aortic atherosclerosis and myocardial infarction in postmenopausal women.Design: Population-based cross-sectional study.Setting: A district of Rotterdam, the Netherlands.Participants: Random sample of 1149 women (mean age +/- SD, 69.0 +/- 7.5 years) participating in the Rotterdam Study.Measurements: Data on thyroid status, aortic atherosclerosis, and history of myocardial infarction were obtained at baseline. Subclinical hypothyroidism was defined as an elevated thyroid-stimulating hormone level (>4.0 mU/L) and a normal serum free thyroxine level (11 to 25 pmol/L [0.9 to 1.9 ng/d L]). In tests for antibodies to thyroid peroxidase, a serum level greater than 10 IU/mL was considered a positive result.Results: Subclinical hypothyroidism was present in 10.8% of participants and was associated with a greater age-adjusted prevalence of aortic atherosclerosis (odds ratio, 1.7 [95% CI, 1.1 to 2.6]) and myocardial infarction (odds ratio, 2.3 [CI, 1.3 to 4.0]). Additional adjustment for body mass index, total and high-density lipoprotein cholesterol level, blood pressure, and smoking status, as well as exclusion of women who took p-blockers, did not affect these estimates. Associations were slightly stronger in women who had subclinical hypothyroidism and antibodies to thyroid peroxidase (odds ratio for aortic atherosclerosis, 1.9 [CI, 1.1 to 3.6]; odds ratio for myocardial infarction, 3.1 [CI, 1.5 to 6.3]). No association was found between thyroid autoimmunity itself and cardiovascular disease. The population attributable risk percentage for subclinical hypothyroidism associated with myocardial infarction was within the range of that for known major risk factors for cardiovascular disease.Conclusion: Subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women.