The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.
Subclinical Thyroid Dysfunction and the Risk of Heart Failure in Older Persons at High Cardiovascular Risk
Open accessAbstract
CONTEXT: Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain. 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. SETTING AND DESIGN: The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study. PATIENTS: Patients included men and women aged 70-82 yr (n=5316) with known cardiovascular risk factors or previous cardiovascular disease. 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). 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. 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.
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“Cardiovascular morbidity and mortality are particularly increased in men, in elderly patients with high-normal FT 4 levels and in patients with underlying heart disease [71-73, 76, 77, 87, 91, 92, 94] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [76]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The risk of HF was increased in the Prospective Study of Pravastatin (PROSPER Study) in elderly patients with a history of cardiovascular disease [76] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [76]
Experimental — accuracy not yet measuredIn the citing paper
“Some of these studies, including the meta-analyses, have also examined nonfatal cardiovascular events in SH, with similar increased risks (383,388,390,391).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [383]
In the citing paper
“Some other, smaller studies have reached similar conclusions (374,383), although other smaller studies have failed to find a correlation (380,381,384,386).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [383]
In the citing paper
“Some studies report increased overall mortality rates in SH subjects (374,379-383), especially older subjects, while others indicate no relation (384)(385)(386)(387).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [383]
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Citations
Cites
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Self-citationSubclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management
Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., et al. (2004) · JAMA · doi:10.1001/jama.291.2.228 · Cited by 1,800
Klein, I., & Danzi, S. (2007) · Circulation · doi:10.1161/circulationaha.106.678326 · Cited by 1,324
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259
Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality
Rodondi, N., den Elzen, W. P. J., Bauer, D. C., Cappola, A. R., Razvi, S., Walsh, J. P., Åsvold, B. O., Iervasi, G., Imaizumi, M., Collet, T.-H., et al. (2010) · JAMA · doi:10.1001/jama.2010.1361 · Cited by 1,216
Self-citationThyroid Status, Disability and Cognitive Function, and Survival in Old Age
Gussekloo, J. (2004) · JAMA · doi:10.1001/jama.292.21.2591 · Cited by 899
Self-citationThyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Cappola, A. R., Fried, L. P., Arnold, A. M., Danese, M. D., Kuller, L. H., Burke, G. L., Tracy, R. P., & Ladenson, P. W. (2006) · JAMA · doi:10.1001/jama.295.9.1033 · Cited by 862
Parle, J. V., Maisonneuve, P., Sheppard, M. C., Boyle, P., & Franklyn, J. A. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06067-6 · Cited by 669
Subclinical thyroid dysfunction as a risk factor for cardiovascular disease
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2467 · Cited by 536
Cited by
Sorted by citations
Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938
2013 ETA Guideline: Management of Subclinical Hypothyroidism
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013) · European Thyroid Journal · doi:10.1159/000356507 · Cited by 877
Gencer, B., Collet, T.-H., Virgini, V., Bauer, D. C., Gussekloo, J., Cappola, A. R., Nanchen, D., den Elzen, W. P. J., Balmer, P., Luben, R. N., et al. (2012) · Circulation · doi:10.1161/circulationaha.112.096024 · Cited by 517
Self-citationSubclinical Thyroid Dysfunction and Fracture Risk: A Meta-analysis
Blum, M. R., Bauer, D. C., Collet, T.-H., Fink, H. A., Cappola, A. R., da Costa, B. R., Wirth, C. D., Peeters, R. P., Åsvold, B. O., den Elzen, W. P. J., et al. (2015) · JAMA · doi:10.1001/jama.2015.5161 · Cited by 343
Self-citationBiondi, B., Bartalena, L., Cooper, D. S., Hegedüs, L., Laurberg, P., & Kahaly, G. J. (2015) · European Thyroid Journal · doi:10.1159/000438750 · Cited by 323
Metadata
- 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., de Craen, A. J. M., & on behalf of the PROSPER Group
- Affiliations
- Leiden University Medical Center (NL)
- Department of Public Health and Primary Care (J.G.), 2333 ZA Leiden, The Netherlands
- University of Glasgow (GB)
- Department of Cardiology (J.W.J.), 2333 ZA Leiden, The Netherlands
- Robertson Centre for Biostatistics (I.F.), Glasgow G12 8QQ, United Kingdom
- University of Bern (CH)
- Leiden University Medical Center, Department of Gerontology and Geriatrics (D.N., R.G.J.W., S.T., S.P.M., A.J.M.d.C.), 2333 ZA Leiden, The Netherlands
- Corresponding author
- Nanchen, David
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-03-01
- Volume
- 97
- Issue
- 3
- Pages
- 852-861
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2110776403
- Cited by
- 211
- References
- 34
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 11 · 2023: 13 · 2022: 15 · 2021: 14 · 2020: 9 · 2019: 15 · 2018: 12 · 2017: 22 · 2016: 11 · 2015: 25 · 2014: 13 · 2013: 25 · 2012: 14
- FWCI
- 19.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Science Foundation
- Bristol-Myers Squibb
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (132943, 138267, 320030)
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (050.060.810, 05040202)
- Université de Lausanne
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hyperthyroidism, subclinical hypothyroidism, subclinical thyroid dysfunction, heart failure, heart failure hospitalization, older adults, cardiovascular risk, thyroid-stimulating hormone, atrial fibrillation, cardiovascular events, mortality, pravastatin, free thyroxine, TSH suppression therapy, statin therapy
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Cardiovascular Diseases, Female, Follow-Up Studies, Heart Failure, Humans, Male, Prospective Studies, Risk, Risk Factors, Thyroid Diseases, Survival Rate
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