Kevin Ro1,2, Alexander D Yuen3, Lin Du4, Clarissa C Ro3, Christian Seger3, Michael W Yeh3, Angela M Leung1,2, Connie M Rhee5. 1. 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine , Los Angeles, California. 2. 2 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System , Los Angeles, California. 3. 3 Section of Endocrine Surgery, Department of Surgery, University of California Los Angeles David Geffen School of Medicine , Los Angeles, California. 4. 4 Department of Biostatistics, University of California Los Angeles , Los Angeles, California. 5. 5 Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine School of Medicine , Orange, California.
Abstract
BACKGROUND: Prior studies suggest that the relationship between hypothyroidism and mortality is dependent on underlying cardiovascular risk. Little is known about the association of hypothyroidism with hospitalization risk, and how these associations are modified by cardiovascular status. METHODS: This study examined the association of thyroid status, defined by serum thyrotropin (TSH), with hospitalization risk among patients who received care at a large university-based tertiary care center between 1990 and 2015. Thyroid status was categorized as hypothyroidism versus euthyroidism (TSH >4.7 vs. 0.3-4.7 mIU/L, respectively). The relationship between thyroid status and hospitalization risk stratified by cardiovascular status was examined using multivariable Cox models. RESULTS: Among 52,856 patients who met eligibility criteria, 49,791 (94.2%) had euthyroidism and 3065 (5.8%) had hypothyroidism. In analyses stratified by congestive heart failure (CHF) status, compared to euthyroidism, hypothyroidism was associated with higher risk of hospitalization in those with CHF but slightly lower risk in those without CHF (adjusted hazard ratio [aHRs] = 1.86 [confidence interval (CI) 1.17-2.94] and HR = 0.95 [CI 0.92-0.99], respectively; p = 0.006). In sensitivity analyses accounting for death as a competing event, underlying coronary artery disease modified the hypothyroidism-hospitalization relationship, such that stronger associations were observed among those with versus without coronary artery disease. In competing risk analyses, hypothyroidism was associated with higher versus lower risk of hospitalization among those with versus without cerebrovascular disease, respectively. CONCLUSIONS: Hypothyroidism is associated with higher hospitalization risk among patients with underlying cardiovascular disease. Future studies are needed to determine whether correction of thyroid status with replacement therapy ameliorates hospitalization risk in this population.
BACKGROUND: Prior studies suggest that the relationship between hypothyroidism and mortality is dependent on underlying cardiovascular risk. Little is known about the association of hypothyroidism with hospitalization risk, and how these associations are modified by cardiovascular status. METHODS: This study examined the association of thyroid status, defined by serum thyrotropin (TSH), with hospitalization risk among patients who received care at a large university-based tertiary care center between 1990 and 2015. Thyroid status was categorized as hypothyroidism versus euthyroidism (TSH >4.7 vs. 0.3-4.7 mIU/L, respectively). The relationship between thyroid status and hospitalization risk stratified by cardiovascular status was examined using multivariable Cox models. RESULTS: Among 52,856 patients who met eligibility criteria, 49,791 (94.2%) had euthyroidism and 3065 (5.8%) had hypothyroidism. In analyses stratified by congestive heart failure (CHF) status, compared to euthyroidism, hypothyroidism was associated with higher risk of hospitalization in those with CHF but slightly lower risk in those without CHF (adjusted hazard ratio [aHRs] = 1.86 [confidence interval (CI) 1.17-2.94] and HR = 0.95 [CI 0.92-0.99], respectively; p = 0.006). In sensitivity analyses accounting for death as a competing event, underlying coronary artery disease modified the hypothyroidism-hospitalization relationship, such that stronger associations were observed among those with versus without coronary artery disease. In competing risk analyses, hypothyroidism was associated with higher versus lower risk of hospitalization among those with versus without cerebrovascular disease, respectively. CONCLUSIONS:Hypothyroidism is associated with higher hospitalization risk among patients with underlying cardiovascular disease. Future studies are needed to determine whether correction of thyroid status with replacement therapy ameliorates hospitalization risk in this population.
Authors: Connie M Rhee; Steven Kim; Daniel L Gillen; Tolga Oztan; Jiaxi Wang; Rajnish Mehrotra; Sooraj Kuttykrishnan; Danh V Nguyen; Steven M Brunelli; Csaba P Kovesdy; Gregory A Brent; Kamyar Kalantar-Zadeh Journal: J Clin Endocrinol Metab Date: 2015-01-29 Impact factor: 5.958
Authors: Elizabeth H Bradley; Leslie Curry; Leora I Horwitz; Heather Sipsma; Jennifer W Thompson; MaryAnne Elma; Mary Norine Walsh; Harlan M Krumholz Journal: J Am Coll Cardiol Date: 2012-07-18 Impact factor: 24.094
Authors: Renate T de Jongh; Paul Lips; Natasja M van Schoor; Kelly J Rijs; Dorly J H Deeg; Hannie C Comijs; Mark H H Kramer; Jan P Vandenbroucke; Olaf M Dekkers Journal: Eur J Endocrinol Date: 2011-07-18 Impact factor: 6.664
Authors: Elizabeth H Bradley; Leslie Curry; Leora I Horwitz; Heather Sipsma; Yongfei Wang; Mary Norine Walsh; Don Goldmann; Neal White; Ileana L Piña; Harlan M Krumholz Journal: Circ Cardiovasc Qual Outcomes Date: 2013-07
Authors: Ana Cristina Perez; Pardeep S Jhund; David J Stott; Lars Gullestad; John G F Cleland; Dirk J van Veldhuisen; John Wikstrand; John Kjekshus; John J V McMurray Journal: JACC Heart Fail Date: 2014-01-25 Impact factor: 12.035