What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants
Open accessAbstract
BACKGROUND: Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality. METHODS: We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality. RESULTS: Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01-1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05-1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38-2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13-1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28-3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26-1.81). CONCLUSIONS: Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.
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Overt hypothyroidism is associated with increased risk of overall mortality (25%) compared to euthyroidism.
“a recent meta-analysis, including 55 studies and a total of 1,898,314 subjects, concluded that the presence of overt hypothyroidism is associated with an increased risk of myocardial ischemia (13%), myocardial infarction (15%), arrhythmias (96%) and overall mortality (25%) when compared to euthyroidism [11].”
From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [11]
Overt hypothyroidism is associated with increased risk of myocardial ischemia (13%) compared to euthyroidism.
“a recent meta-analysis, including 55 studies and a total of 1,898,314 subjects, concluded that the presence of overt hypothyroidism is associated with an increased risk of myocardial ischemia (13%), myocardial infarction (15%), arrhythmias (96%) and overall mortality (25%) when compared to euthyroidism [11].”
From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [11]
Overt hypothyroidism is associated with increased risk of myocardial infarction (15%) compared to euthyroidism.
“a recent meta-analysis, including 55 studies and a total of 1,898,314 subjects, concluded that the presence of overt hypothyroidism is associated with an increased risk of myocardial ischemia (13%), myocardial infarction (15%), arrhythmias (96%) and overall mortality (25%) when compared to euthyroidism [11].”
From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [11]
The relationship between subclinical hypothyroidism and overall mortality is conflicting, although the two meta-analyses with larger number of studies suggest increased risk in younger subjects.
“The relationship between SC-HT and overall mortality is more conflicting although the two meta-analyses [11, 25] which considered a larger number of studies suggest an increased risk in younger subjects (Fig. 1, Panels A and C).”
From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [11]
Overt hypothyroidism is associated with increased risk of arrhythmias (96%) compared to euthyroidism.
“a recent meta-analysis, including 55 studies and a total of 1,898,314 subjects, concluded that the presence of overt hypothyroidism is associated with an increased risk of myocardial ischemia (13%), myocardial infarction (15%), arrhythmias (96%) and overall mortality (25%) when compared to euthyroidism [11].”
From Thyroid and heart, a clinically relevant relationship (2021) · cites this paper as [11]
Hypothyroid subjects on long-term LT4 alone have a 5% increase in BMI and increased cholesterol.
“a 5% increase in BMI, increased cholesterol”
Hypothyroid subjects on long-term LT4 alone have a 25%-30% increase in cardiovascular and all-cause mortality.
“a 25%–30% increase in cardiovascular and all-cause mortality (10–13)”
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References 46 · Cited by 148
- Authors
- Ning, Y., Cheng, Y. J., Liu, L. J., Sara, J. D. S., Cao, Z. Y., Zheng, W. P., Zhang, T. S., Han, H. J., Yang, Z. Y., Zhang, Y., Wang, F. L., Pan, R. Y., Huang, J. L., Wu, L. L., Zhang, M., & Wei, Y. X.
- Affiliations
- Capital Medical University (CN)
- Sun Yat-sen University (CN)
- Mayo Clinic (US)
- Second Military Medical University (CN)
- Fujian Medical University (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Chinese Center For Disease Control and Prevention (CN)
- Guangdong General Hospital (CN)
- Zhujiang Hospital (CN)
- Corresponding author
- Zhang, Ming
- Wei, Yong X.
- ORCID
- Venue
- BMC Medicine
- Published
- 2017-02-02
- Volume
- 15
- Issue
- 1
- Pages
- 21-21
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC5289009
- OpenAlex
- W2581794827
- Cited by
- 148
- References
- 46
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 19 · 2023: 37 · 2022: 19 · 2021: 12 · 2020: 15 · 2019: 9 · 2018: 12 · 2017: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Beijing Municipal Training Foundation for Highly qualified and Technological Talents of Health System (2014-3-038)
- Beijing Nova Program (No. 2009B38)
- 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
- hypothyroidism, cardiovascular events, ischemic heart disease, myocardial infarction, cardiac mortality, all-cause mortality, subclinical hypothyroidism, thyroid-stimulating hormone, euthyroidism, cardiovascular risk factors
- MeSH terms
- Cardiovascular Diseases, Humans, Hypothyroidism, Male, Risk Factors, Cohort Studies, Survival Analysis
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