CONTEXT: Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain. OBJECTIVE: Our objective was to determine the extent to which subclinical hyperthyroidism and hypothyroidism influence the risk of heart failure and cardiovascular diseases in older people. SETTING AND DESIGN: The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study. PATIENTS: Patients included men and women aged 70-82 yr (n=5316) with known cardiovascular risk factors or previous cardiovascular disease. MAIN OUTCOME MEASURES: Incidence rate of heart failure hospitalization, atrial fibrillation, and cardiovascular events and mortality according to baseline thyroid status were evaluated. Euthyroid participants (TSH=0.45-4.5 mIU/liter) were compared with those with subclinical hyperthyroidism (TSH<0.45 mIU/liter) and those with subclinical hypothyroidism (TSH≥4.5 mIU/liter, both with normal free T4). RESULTS: Subclinical hyperthyroidism was present in 71 participants and subclinical hypothyroidism in 199 participants. Over 3.2 yr follow-up, the rate of heart failure was higher for subclinical hyperthyroidism compared with euthyroidism [age- and sex-adjusted hazard ratio (HR)=2.93, 95% confidence interval (CI)=1.37-6.24, P=0.005; multivariate-adjusted HR=3.27, 95% CI=1.52-7.02, P=0.002). Subclinical hypothyroidism (only at threshold>10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR=3.01, 95% CI=1.12-8.11, P=0.029; multivariate HR=2.28, 95% CI=0.84-6.23). There were no strong evidence of an association between subclinical thyroid dysfunction and cardiovascular events or mortality, except in those with TSH below 0.1 or over 10 mIU/liter and not taking pravastatin. CONCLUSION: Older people at high cardiovascular risk with low or very high TSH along with normal free T4 appear at increased risk of incident heart failure.
CONTEXT: Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain. OBJECTIVE: Our objective was to determine the extent to which subclinical hyperthyroidism and hypothyroidism influence the risk of heart failure and cardiovascular diseases in older people. SETTING AND DESIGN: The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study. PATIENTS: Patients included men and women aged 70-82 yr (n=5316) with known cardiovascular risk factors or previous cardiovascular disease. MAIN OUTCOME MEASURES: Incidence rate of heart failure hospitalization, atrial fibrillation, and cardiovascular events and mortality according to baseline thyroid status were evaluated. Euthyroid participants (TSH=0.45-4.5 mIU/liter) were compared with those with subclinical hyperthyroidism (TSH<0.45 mIU/liter) and those with subclinical hypothyroidism (TSH≥4.5 mIU/liter, both with normal free T4). RESULTS: Subclinical hyperthyroidism was present in 71 participants and subclinical hypothyroidism in 199 participants. Over 3.2 yr follow-up, the rate of heart failure was higher for subclinical hyperthyroidism compared with euthyroidism [age- and sex-adjusted hazard ratio (HR)=2.93, 95% confidence interval (CI)=1.37-6.24, P=0.005; multivariate-adjusted HR=3.27, 95% CI=1.52-7.02, P=0.002). Subclinical hypothyroidism (only at threshold>10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR=3.01, 95% CI=1.12-8.11, P=0.029; multivariate HR=2.28, 95% CI=0.84-6.23). There were no strong evidence of an association between subclinical thyroid dysfunction and cardiovascular events or mortality, except in those with TSH below 0.1 or over 10 mIU/liter and not taking pravastatin. CONCLUSION: Older people at high cardiovascular risk with low or very high TSH along with normal free T4 appear at increased risk of incident heart failure.
Authors: Jennifer S Mammen; John McGready; Rachael Oxman; Chee W Chia; Paul W Ladenson; Eleanor M Simonsick Journal: Thyroid Date: 2015-08-13 Impact factor: 6.568
Authors: Eun-Jeong Kim; Asya Lyass; Na Wang; Joseph M Massaro; Caroline S Fox; Emelia J Benjamin; Jared W Magnani Journal: Am Heart J Date: 2013-10-19 Impact factor: 4.749
Authors: Carole E Aubert; Carmen Floriani; Douglas C Bauer; Bruno R da Costa; Daniel Segna; Manuel R Blum; Tinh-Hai Collet; Howard A Fink; Anne R Cappola; Lamprini Syrogiannouli; Robin P Peeters; Bjørn O Åsvold; Wendy P J den Elzen; Robert N Luben; Alexandra P Bremner; Apostolos Gogakos; Richard Eastell; Patricia M Kearney; Mari Hoff; Erin Le Blanc; Graziano Ceresini; Fernando Rivadeneira; André G Uitterlinden; Kay-Tee Khaw; Arnulf Langhammer; David J Stott; Rudi G J Westendorp; Luigi Ferrucci; Graham R Williams; Jacobijn Gussekloo; John P Walsh; Drahomir Aujesky; Nicolas Rodondi Journal: J Clin Endocrinol Metab Date: 2017-08-01 Impact factor: 5.958
Authors: Bjørn O Åsvold; Lars J Vatten; Trine Bjøro; Douglas C Bauer; Alexandra Bremner; Anne R Cappola; Graziano Ceresini; Wendy P J den Elzen; Luigi Ferrucci; Oscar H Franco; Jayne A Franklyn; Jacobijn Gussekloo; Giorgio Iervasi; Misa Imaizumi; Patricia M Kearney; Kay-Tee Khaw; Rui M B Maciel; Anne B Newman; Robin P Peeters; Bruce M Psaty; Salman Razvi; José A Sgarbi; David J Stott; Stella Trompet; Mark P J Vanderpump; Henry Völzke; John P Walsh; Rudi G J Westendorp; Nicolas Rodondi Journal: JAMA Intern Med Date: 2015-06 Impact factor: 21.873
Authors: Vicky A LeGrys; Michele Jonsson Funk; Carol E Lorenz; Ayush Giri; Rebecca D Jackson; JoAnn E Manson; Robin Schectman; Todd L Edwards; Gerardo Heiss; Katherine E Hartmann Journal: J Clin Endocrinol Metab Date: 2013-03-28 Impact factor: 5.958
Authors: Layal Chaker; Christine Baumgartner; Wendy P J den Elzen; Tinh-Hai Collet; M Arfan Ikram; Manuel R Blum; Abbas Dehghan; Christiane Drechsler; Robert N Luben; Marileen L P Portegies; Giorgio Iervasi; Marco Medici; David J Stott; Robin P Dullaart; Ian Ford; Alexandra Bremner; Anne B Newman; Christoph Wanner; José A Sgarbi; Marcus Dörr; W T Longstreth; Bruce M Psaty; Luigi Ferrucci; Rui M B Maciel; Rudi G Westendorp; J Wouter Jukema; Graziano Ceresini; Misa Imaizumi; Albert Hofman; Stephan J L Bakker; Jayne A Franklyn; Kay-Tee Khaw; Douglas C Bauer; John P Walsh; Salman Razvi; Jacobijn Gussekloo; Henry Völzke; Oscar H Franco; Anne R Cappola; Nicolas Rodondi; Robin P Peeters Journal: J Clin Endocrinol Metab Date: 2016-09-07 Impact factor: 5.958