Thyroid status, cardiovascular risk, and mortality in older adults
Thyroid status, cardiovascular risk, and mortality in older adults
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DOI：
10.1001/jama.295.9.1033
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发表时间：
2006-03-01
影响因子：
120.7
通讯作者：
Ladenson, PW
中科院分区：
文献类型：
--
作者：
Cappola, AR;Fried, LP;Ladenson, PW
先前的研究表明，促甲状腺激素水平的亚临床异常与心血管系统的有害影响有关。目的探讨未服用甲状腺药物的老年男性和女性基线甲状腺状态与房颤、心血管疾病和死亡率的关系。设计、环境和参与者：1989-1990年，一项大型前瞻性队列研究——心血管健康研究纳入了3233名年龄在65岁或以上、血清促甲状腺激素基线水平的美国社区居民。主要结局指标：截至2002年6月，评估了房颤、冠心病、脑血管疾病、心血管死亡和全因死亡的发生率。根据甲状腺功能检查结果对亚临床甲状腺功能亢进、甲状腺功能亢进、亚临床甲状腺功能减退和明显甲状腺功能减退四组进行分析。结果有明显甲状腺毒症者（n = 4）因人数少而被排除。82%的参与者（n = 2639）甲状腺功能正常，15% （n = 496）有亚临床甲状腺功能减退，1.6% （n = 51）有明显的甲状腺功能减退，1.5% （n = 47）有亚临床甲状腺功能亢进。排除房颤患者后，亚临床甲状腺功能亢进患者的房颤发生率高于甲状腺功能正常者（67 vs 31 / 1000人年；调整后的风险比为1.98；95%可信区间为1.29-3.03）。亚临床甲状腺功能亢进组和甲状腺功能亢进组在冠心病、脑血管疾病、心血管死亡或全因死亡发生率上没有差异。同样，亚临床甲状腺功能减退或明显甲状腺功能减退组与甲状腺功能减退组在心血管结局或死亡率方面也没有差异。具体来说，亚临床甲状腺功能减退症患者发生冠心病的校正风险比为1.07（95%可信区间为0.90-1.28）。结论：我们的数据显示亚临床甲状腺功能亢进与房颤的发生之间存在关联，但不支持未被认识到的亚临床甲状腺功能亢进或亚临床甲状腺功能减退与其他心血管疾病或死亡率相关的假设。
Context Previous studies have suggested that subclinical abnormalities in thyroid-stimulating hormone levels are associated with detrimental effects on the cardiovascular system.Objective To determine the relationship between baseline thyroid status and incident atrial fibrillation, incident cardiovascular disease, and mortality in older men and women not taking thyroid medication.Design, Setting, and Participants A total of 3233 US community-dwelling individuals aged 65 years or older with baseline serum thyroid-stimulating hormone levels were enrolled in 1989-1990 in the Cardiovascular Health Study, a large, prospective cohort study.Main Outcome Measures Incident atrial fibrillation, coronary heart disease, cerebrovascular disease, cardiovascular death, and all-cause death assessed through June 2002. Analyses are reported for 4 groups defined according to thyroid function test results: subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism.Results Individuals with overt thyrotoxicosis ( n = 4) were excluded because of small numbers. Eighty-two percent of participants ( n = 2639) had normal thyroid function, 15% ( n = 496) had subclinical hypothyroidism, 1.6% ( n = 51) had overt hypothyroidism, and 1.5% ( n = 47) had subclinical hyperthyroidism. After exclusion of those with prevalent atrial fibrillation, individuals with subclinical hyperthyroidism had a greater incidence of atrial fibrillation compared with those with normal thyroid function ( 67 events vs 31 events per 1000 person-years; adjusted hazard ratio, 1.98; 95% confidence interval, 1.29-3.03). No differences were seen between the subclinical hyperthyroidism group and euthyroidism group for incident coronary heart disease, cerebrovascular disease, cardiovascular death, or all-cause death. Likewise, there were no differences between the subclinical hypothyroidism or overt hypothyroidism groups and the euthyroidism group for cardiovascular outcomes or mortality. Specifically, individuals with subclinical hypothyroidism had an adjusted hazard ratio of 1.07 ( 95% confidence interval, 0.90-1.28) for incident coronary heart disease.Conclusion Our data show an association between subclinical hyperthyroidism and development of atrial fibrillation but do not support the hypothesis that unrecognized subclinical hyperthyroidism or subclinical hypothyroidism is associated with other cardiovascular disorders or mortality.