Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study
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Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events : A Large Population Study. / Selmer, Christian; Olesen, Jonas Bjerring; Hansen, Morten Lock; von Kappelgaard, Lene Mia; Madsen, Jesper Clausager; Hansen, Peter Riis; Pedersen, Ole Dyg; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar.
In: Journal of Clinical Endocrinology & Metabolism, Vol. 99, No. 7, 07.2014, p. 2372-2382.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events
T2 - A Large Population Study
AU - Selmer, Christian
AU - Olesen, Jonas Bjerring
AU - Hansen, Morten Lock
AU - von Kappelgaard, Lene Mia
AU - Madsen, Jesper Clausager
AU - Hansen, Peter Riis
AU - Pedersen, Ole Dyg
AU - Faber, Jens
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar Hilmar
PY - 2014/7
Y1 - 2014/7
N2 - CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.DESIGN: This was a retrospective cohort study.SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.
AB - CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.DESIGN: This was a retrospective cohort study.SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.
KW - Adult
KW - Asymptomatic Diseases
KW - Cardiovascular Diseases
KW - Cause of Death
KW - Denmark
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Registries
KW - Retrospective Studies
KW - Risk Factors
KW - Thyroid Diseases
U2 - 10.1210/jc.2013-4184
DO - 10.1210/jc.2013-4184
M3 - Journal article
C2 - 24654753
VL - 99
SP - 2372
EP - 2382
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 7
ER -
ID: 138772112