Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.
Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.
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DOI：
10.1161/circulationaha.117.028753
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发表时间：
2017-11-28
期刊：
影响因子：
37.8
通讯作者：
Thyroid Studies Collaboration
中科院分区：
文献类型：
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作者：
Baumgartner C;da Costa BR;Collet TH;Feller M;Floriani C;Bauer DC;Cappola AR;Heckbert SR;Ceresini G;Gussekloo J;den Elzen WPJ;Peeters RP;Luben R;Völzke H;Dörr M;Walsh JP;Bremner A;Iacoviello M;Macfarlane P;Heeringa J;Stott DJ;Westendorp RGJ;Khaw KT;Magnani JW;Aujesky D;Rodondi N;Thyroid Studies Collaboration
心房颤动（AF）是一种高度流行的疾病，可导致心力衰竭、中风和死亡。加强对可改变的风险因素的了解可能会带来预防的机会。亚临床甲状腺功能亢进症患者AF的风险增加，但尚不确定正常范围内的甲状腺功能变化或亚临床甲状腺功能减退症是否也与AF相关。我们进行了一项系统性综述，并从前瞻性队列研究中获得了个体参与者数据，这些研究测量了基线时的甲状腺功能并评估了AF事件。研究从MEDLINE和EMBASE数据库中识别，从开始到7月27日，2016.甲状腺功能正常状态定义为促甲状腺激素（TSH）0.45- 4.49 mIU/l，亚临床甲状腺功能减退定义为TSH 4.5- 19.9 mIU/l，游离甲状腺素（fT 4）水平在参考范围内。使用考克斯比例风险模型检查甲状腺功能正常和亚临床甲状腺功能减退范围内的TSH水平与AF事件的相关性。在甲状腺功能正常的受试者中，我们还检查了fT 4水平与AF事件之间的关系。在来自11个队列的30，085名受试者（278，955人-年随访）中，1，958名（6.5%）患有亚临床甲状腺功能减退症，2，574名（8.6%）在随访期间发生AF。在甲状腺功能正常或亚临床甲状腺功能减退的受试者中，基线TSH与AF事件无显著相关性。在年龄和性别校正分析中，甲状腺功能正常个体的基线fT 4水平较高与AF风险增加相关（风险比=1.45; fT 4最高四分位数与最低四分位数的95%置信区间为1.26-1.66，四分位数间趋势p ≤0.001）。在对既存心血管疾病进行进一步调整后，估计值没有实质性差异。在甲状腺功能正常的个体中，较高的循环fT 4水平，而不是TSH水平，与AF事件的风险增加相关。
Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid stimulating hormone (TSH) 0.45–4.49mIU/l, and subclinical hypothyroidism as TSH 4.5–19.9mIU/l with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Of 30,085 participants from 11 cohorts (278,955 person-years of follow-up), 1,958 (6.5%) had subclinical hypothyroidism, and 2,574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio=1.45; 95% confidence interval, 1.26–1.66, for the highest quartile vs the lowest quartile of fT4, p for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF.