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Cited by 536Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryHormonal and reproductive studies

Subclinical thyroid dysfunction as a risk factor for cardiovascular disease

Walsh, John P., Bremner, Alexandra P., Bulsara, Max K., O’Leary, Peter, Leedman, Peter J., Feddema, Peter, Michelangeli, Valdo·2005·Archives of Internal Medicine
DOI 10.1001/archinte.165.21.2467
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Abstract

BACKGROUND: There have been few large epidemiological studies examining the association between thyroid dysfunction and cardiovascular disease. In particular, it is uncertain if subclinical hypothyroidism is a risk factor for cardiovascular disease. METHODS: Serum thyrotropin and free thyroxine concentrations were measured in 2108 archived serum samples from a 1981 community health survey in Busselton, Western Australia (Busselton Health Study). In a cross-sectional study, we examined the prevalence of coronary heart disease in subjects with and without subclinical thyroid dysfunction. In a longitudinal study, we examined the risk of cardiovascular mortality and coronary heart disease events (fatal and nonfatal combined) to the end of 2001 (excluding subjects who had coronary heart disease at baseline). RESULTS: In the cross-sectional analysis, subjects with subclinical hypothyroidism (n = 119) had a significantly higher prevalence of coronary heart disease than euthyroid subjects (n = 1906) (age- and sex-adjusted prevalence odds ratio, 1.8; 95% confidence interval, 1.0-3.1; P = .04). In the longitudinal analysis of subjects with subclinical hypothyroidism (n = 101), there were 21 cardiovascular deaths observed compared with 9.5 expected (age- and sex-adjusted hazard ratio, 1.5; 95% confidence interval, 1.0-2.4; P = .08) and 33 coronary heart disease events observed compared with 14.7 expected (age- and sex-adjusted hazard ratio, 1.7; 95% confidence interval, 1.2-2.4; P < .01). The increased risk of coronary heart disease events remained significant after further adjustment for standard cardiovascular risk factors. Subjects with subclinical hyperthyroidism (n = 39) had no adverse outcomes. CONCLUSION: Subclinical hypothyroidism may be an independent risk factor for coronary heart disease.

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  • Some large and well-conducted studies have failed to reproduce the associations between low serum TSH and adverse outcomes.

    “However, there is significant heterogeneity within the literature, with some large and well-conducted studies failing to reproduce these associations (13, 21), as well as unresolved questions about causality.”

    From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [21]

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Authors
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V.
Affiliations
  • Sir Charles Gairdner Hospital (AU)
  • The University of Western Australia (AU)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2005-11-28
Volume
165
Issue
21
Pages
2467
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.165.21.2467
OpenAlex
W2125387631
Cited by
536
References
31
Citations by year
2026: 4 · 2025: 8 · 2024: 16 · 2023: 11 · 2022: 20 · 2021: 18 · 2020: 71 · 2019: 17 · 2018: 17 · 2017: 27 · 2016: 23 · 2015: 26 · 2014: 33 · 2013: 38 · 2012: 32
FWCI
17.59
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
  • ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Keywords
subclinical hypothyroidism, subclinical hyperthyroidism, thyroid dysfunction, cardiovascular disease, coronary artery disease, cardiovascular mortality, thyroid-stimulating hormone, free thyroxine, cardiovascular risk factors
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Coronary Disease, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Risk Factors, Thyrotropin, Western Australia, Prevalence, Survival Rate, Confidence Intervals, Proportional Hazards Models, Age Distribution, Sex Distribution

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