Kristen A Hyland1, Alice M Arnold, Jennifer S Lee, Anne R Cappola. 1. Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 12-136 Translational Research Center, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104-5160, USA.
Abstract
CONTEXT: Use of a single set of thyroid function tests to define subclinical hypothyroidism may lead to misclassification over time and could influence findings from longitudinal studies. OBJECTIVE: We assessed the risks of coronary heart disease (CHD), heart failure (HF), and cardiovascular (CV) death in older adults with persistent subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTS: The study included 679 subclinically hypothyroid and 4184 euthyroid U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study and not taking thyroid preparations. MAIN OUTCOME MEASURE: We measured the 10-yr risk of incident CHD, HF, and CV death from persistent subclinical hypothyroidism, overall and stratified by degree of TSH elevation (4.5-6.9, 7.0-9.9, and 10.0-19.9 mU/liter). RESULTS: There was no association between persistent subclinical hypothyroidism and incident CHD [hazard ratio (HR), 1.12; 95% confidence interval (CI), 0.93-1.36], HF (HR, 1.05; 95% CI, 0.97-1.27), or CV death (HR, 1.07; 95% CI, 0.87-1.31) in adjusted analyses in which subclinical hypothyroidism was modeled as a time-varying exposure using up to four serial thyroid function tests. When subclinical hypothyroidism was stratified by degree of TSH elevation, no significant associations were found in any stratum. Findings were similar in fixed exposure analyses in which only participants with testing 2 yr apart were considered, with no association between persistent or transient subclinical hypothyroidism and incident CHD, HF, or CV death. CONCLUSIONS: Our data do not support increased risk of CHD, HF, or CV death in older adults with persistent subclinical hypothyroidism.
CONTEXT: Use of a single set of thyroid function tests to define subclinical hypothyroidism may lead to misclassification over time and could influence findings from longitudinal studies. OBJECTIVE: We assessed the risks of coronary heart disease (CHD), heart failure (HF), and cardiovascular (CV) death in older adults with persistent subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTS: The study included 679 subclinically hypothyroid and 4184 euthyroid U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study and not taking thyroid preparations. MAIN OUTCOME MEASURE: We measured the 10-yr risk of incident CHD, HF, and CV death from persistent subclinical hypothyroidism, overall and stratified by degree of TSH elevation (4.5-6.9, 7.0-9.9, and 10.0-19.9 mU/liter). RESULTS: There was no association between persistent subclinical hypothyroidism and incident CHD [hazard ratio (HR), 1.12; 95% confidence interval (CI), 0.93-1.36], HF (HR, 1.05; 95% CI, 0.97-1.27), or CV death (HR, 1.07; 95% CI, 0.87-1.31) in adjusted analyses in which subclinical hypothyroidism was modeled as a time-varying exposure using up to four serial thyroid function tests. When subclinical hypothyroidism was stratified by degree of TSH elevation, no significant associations were found in any stratum. Findings were similar in fixed exposure analyses in which only participants with testing 2 yr apart were considered, with no association between persistent or transient subclinical hypothyroidism and incident CHD, HF, or CV death. CONCLUSIONS: Our data do not support increased risk of CHD, HF, or CV death in older adults with persistent subclinical hypothyroidism.
Authors: John P Walsh; Alexandra P Bremner; Max K Bulsara; Peter O'Leary; Peter J Leedman; Peter Feddema; Valdo Michelangeli Journal: Arch Intern Med Date: 2005-11-28
Authors: Anne R Cappola; Linda P Fried; Alice M Arnold; Mark D Danese; Lewis H Kuller; Gregory L Burke; Russell P Tracy; Paul W Ladenson Journal: JAMA Date: 2006-03-01 Impact factor: 56.272
Authors: D G Ives; A L Fitzpatrick; D E Bild; B M Psaty; L H Kuller; P M Crowley; R G Cruise; S Theroux Journal: Ann Epidemiol Date: 1995-07 Impact factor: 3.797
Authors: David Nanchen; Jacobijn Gussekloo; Rudi G J Westendorp; David J Stott; J Wouter Jukema; Stella Trompet; Ian Ford; Paul Welsh; Naveed Sattar; Peter W Macfarlane; Simon P Mooijaart; Nicolas Rodondi; Anton J M de Craen Journal: J Clin Endocrinol Metab Date: 2012-01-11 Impact factor: 5.958
Authors: Nicolas Rodondi; Wendy P J den Elzen; Douglas C Bauer; Anne R Cappola; Salman Razvi; John P Walsh; Bjørn O Asvold; Giorgio Iervasi; Misa Imaizumi; Tinh-Hai Collet; Alexandra Bremner; Patrick Maisonneuve; José A Sgarbi; Kay-Tee Khaw; Mark P J Vanderpump; Anne B Newman; Jacques Cornuz; Jayne A Franklyn; Rudi G J Westendorp; Eric Vittinghoff; Jacobijn Gussekloo Journal: JAMA Date: 2010-09-22 Impact factor: 56.272
Authors: Jacobijn Gussekloo; Eric van Exel; Anton J M de Craen; Arend E Meinders; Marijke Frölich; Rudi G J Westendorp Journal: JAMA Date: 2004-12-01 Impact factor: 56.272
Authors: M Cushman; B M Psaty; E Macy; E G Bovill; E S Cornell; L H Kuller; R P Tracy Journal: Arterioscler Thromb Vasc Biol Date: 1996-09 Impact factor: 8.311
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: Seth S Martin; Natalie Daya; Pamela L Lutsey; Kunihiro Matsushita; Anna Fretz; John W McEvoy; Roger S Blumenthal; Josef Coresh; Philip Greenland; Anna Kottgen; Elizabeth Selvin Journal: J Clin Endocrinol Metab Date: 2017-09-01 Impact factor: 5.958
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: Margaret C Garin; Alice M Arnold; Jennifer S Lee; John Robbins; Anne R Cappola Journal: J Clin Endocrinol Metab Date: 2014-05-30 Impact factor: 5.958
Authors: Tinh-Hai Collet; Douglas C Bauer; Anne R Cappola; Bjørn O Asvold; Stefan Weiler; Eric Vittinghoff; Jacobijn Gussekloo; Alexandra Bremner; Wendy P J den Elzen; Rui M B Maciel; Mark P J Vanderpump; Jacques Cornuz; Marcus Dörr; Henri Wallaschofski; Anne B Newman; José A Sgarbi; Salman Razvi; Henry Völzke; John P Walsh; Drahomir Aujesky; Nicolas Rodondi Journal: J Clin Endocrinol Metab Date: 2014-06-10 Impact factor: 5.958