Thyrotropin levels and risk of fatal coronary heart disease
Thyrotropin levels and risk of fatal coronary heart disease
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DOI：
10.1001/archinte.168.8.855
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发表时间：
2008-04-28
影响因子：
--
通讯作者：
Vatten, Lars J.
中科院分区：
文献类型：
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作者：
Asvold, Bjorn O.;Bjoro, Trine;Vatten, Lars J.
背景：最近的研究表明，在临床参考范围内相对较低的甲状腺功能与冠心病的危险因素呈正相关，但与冠心病死亡率的关系尚未确定。方法：在挪威一项基于人群的队列研究中，我们前瞻性地研究了17311名女性和8002名男性在基线时没有已知的甲状腺或心血管疾病或糖尿病的促甲状腺激素水平与致死性冠心病之间的关系。结果：在8.3年的中位随访期间，228名女性和182名男性死于冠心病。其中，192名女性和164名男性的促甲状腺激素水平在临床参考范围0.50至3.5 mIU/L之间。总体而言，参考范围内的促甲状腺激素水平与冠心病死亡率呈正相关（趋势P = 0.01）；这一趋势在女性中有统计学意义(P表示趋势=。[05]男性则不然。与处于参考范围较低部分（促甲状腺素水平，0.50-1.4 mIU/ Q）的女性相比，处于中等（促甲状腺素水平，1.5-2.4 mIU/L）和较高（促甲状腺素水平，2.5-3.5 mIU/L）类别的女性冠状动脉死亡的危险比分别为1.41（95%可信区间[CI]， 1.02-1.96）和1.69（95%可信区间，1.14-2.52）。结论：参考范围内的促甲状腺素水平与女性冠心病死亡率呈线性正相关。结果提示，甲状腺功能相对较低但临床上正常可能会增加致死性冠心病的风险。
Background: Recent studies suggest that relatively low thyroid function within the clinical reference range is positively associated with risk factors for coronary heart disease (CHD), but the association with CHD mortality is not resolved.Methods: In a Norwegian population-based cohort study, we prospectively studied the association between thyrotropin levels and fatal CHD in 17 311 women and 8002 men without known thyroid or cardiovascular disease or diabetes mellitus at baseline.Results: During median follow-up of 8.3 years, 228 women and 182 men died of CHD. Of these, 192 women and 164 men had thyrotropin levels within the clinical reference range of 0.50 to 3.5 mIU/L. Overall, thyrotropin levels within the reference range were positively associated with CHD mortality (P for trend =.01); the trend was statistically significant in women (P for trend=. 005) but not in men. Compared with women in the lower part of the reference range (thyrotropin level, 0.50-1.4 mIU/ Q, the hazard ratios for coronary death were 1.41 (95% confidence interval [CI], 1.02-1.96) and 1.69 (95% Cl, 1.14-2.52) for women in the intermediate (thyrotropin level, 1.5-2.4 mIU/L) and higher (thyrotropin level, 2.5-3.5 mIU/L) categories, respectively.Conclusions: Thyrotropin levels within the reference range were positively and linearly associated with CHD mortality in women. The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal CHD.