The kidney, subclinical thyroid disease and cardiovascular outcomes in older patients

Zijlstra, L.E., van Velzen, D.M., Simsek, S., Mooijaart, S.P., van Buren, M., Stott J, D.J. , Ford, I. , Jukema, J. and Trompet, S. (2020) The kidney, subclinical thyroid disease and cardiovascular outcomes in older patients. Endocrine Connections, 9(1), pp. 55-62. (doi: 10.1530/EC-19-0502) (PMID:31846431) (PMCID:PMC6993270)

[img]
Preview
Text
214108.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

571kB

Abstract

Objective: Thyroid hormones have been implicated to play a role in cardiovascular disease, along with studies linking thyroid hormone to kidney function. The aim of this study is to investigate whether kidney function modifies the association of subclinical thyroid dysfunction and the risk of cardiovascular outcomes. Methods: In total, 5804 patients were included in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). For the current analysis, 426 were excluded because of overt thyroid disease at baseline or 6 months, 266 because of inconsistent thyroid function at baseline and 6 months, 294 because of medication use that could influence thyroid function, and 16 because of missing kidney or thyroid values. Participants with normal fT4 were classified, based on TSH both at inclusion and 6 months, into three groups: subclinical hypothyroidism (TSH >4.5 mIU/L); euthyroidism (TSH = 0.45–4.5 mIU/L); and subclinical hyperthyroidism (TSH <0.45 mIU/L). Strata of kidney function were made based on estimated glomerular filtration rate into three clinically relevant groups: <45, 45–60, and >60 mL/min/1.73 m2. The primary endpoint consists of death from coronary heart disease, non-fatal myocardial infarction and (non)fatal stroke. Results: Mean age was 75.3 years, and 49.0% patients were male. Mean follow-up was 3.2 years. Of all participants, 109 subjects (2.2%) had subclinical hypothyroidism, 4573 (94.0%) had euthyroidism, and 182 (3.7%) subclinical hyperthyroidism. For patients with subclinical hypothyroidism, euthyroidism, and subclinical hyperthyroidism, primary outcome occurred in 9 (8.3%), 712 (15.6%), and 23 (12.6%) patients, respectively. No statistically significant relationship was found between subclinical thyroid dysfunction and primary endpoint with adjusted hazard ratios of 0.51 (0.24–1.07) comparing subclinical hyperthyroidism and 0.90 (0.58–1.39) comparing subclinical hypothyroidism with euthyroidism. Neither was this relationship present in any of the strata of kidney function, nor did kidney function interact with subclinical thyroid dysfunction in the association with primary endpoint (P interaction = 0.602 for subclinical hyperthyroidism and 0.388 for subclinical hypothyroidism). Conclusions: In this secondary analysis from PROSPER, we found no evidence that the potential association between thyroid hormones and cardiovascular disease is modified by kidney function in older patients with subclinical thyroid dysfunction.

Item Type:Articles
Additional Information:The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial was supported by an unrestricted investigator-initiated grant from Bristol-Myers Squibb, USA.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Stott J, Professor David and Ford, Professor Ian
Authors: Zijlstra, L.E., van Velzen, D.M., Simsek, S., Mooijaart, S.P., van Buren, M., Stott J, D.J., Ford, I., Jukema, J., and Trompet, S.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Endocrine Connections
Publisher:Bio Scientifica
ISSN:2049-3614
ISSN (Online):2049-3614
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Endocrine Connections 9(1):55-62
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record