Nanchen, D. et al. (2012) Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. Journal of Clinical Endocrinology and Metabolism, 97(3), pp. 852-861. (doi: 10.1210/jc.2011-1978)
Full text not currently available from Enlighten.
Abstract
<p>Context: Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain.</p> <p>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.</p> <p>Setting and Design: The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study.</p> <p>Patients: Patients included men and women aged 70–82 yr (n = 5316) with known cardiovascular risk factors or previous cardiovascular disease.</p> <p>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).</p> <p>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.</p> <p>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.</p>
Item Type: | Articles |
---|---|
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Macfarlane, Professor Peter and Welsh, Professor Paul and Stott J, Professor David and Ford, Professor Ian and Sattar, Professor Naveed |
Authors: | Nanchen, D., Gussekloo, J., Westendorp, R.G.J., Stott, D.J., Jukema, J.W., Trompet, S., Ford, I., Welsh, P., Sattar, N., Macfarlane, P.W., Mooijaart, S.P., Rodondi, N., and de Craen, A.J.M. |
College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Infection & Immunity |
Journal Name: | Journal of Clinical Endocrinology and Metabolism |
ISSN: | 0021-972X |
ISSN (Online): | 1945-7197 |
Published Online: | 11 January 2012 |
University Staff: Request a correction | Enlighten Editors: Update this record