Subclinical hyperthyroidism and the risk of cardiovascular events and all-cause mortality: an updated meta-analysis of cohort studies
Abstract
OBJECTIVES: Whether subclinical hyperthyroidism (SCH) results in poor prognosis remains controversial. Our aim was to evaluate the association between SCH and the risk of cardiovascular disease (CVD), cardiovascular mortality, and all-cause mortality by conducting a meta-analysis of cohort studies. METHODS: The PubMed and Embase databases were searched through November 2011 to identify studies that met pre-stated inclusion criteria. Relevant information for analysis was extracted. Either a fixed or a random effects model was used to calculate the overall combined risk estimates. RESULTS: Seventeen cohort studies were included in this meta-analysis. The overall combined relative risks for individuals with SCH compared with the reference group were 1.19 (95% confidence interval (CI): 1.10 to 1.28) for CVD, 1.52 (95% CI: 1.08 to 2.13) for cardiovascular mortality, and 1.25 (95% CI: 1.00 to 1.55) for all-cause mortality. Subgroup analysis by sample source (community or convenience sample) showed that the significant association for cardiovascular and all-cause mortality only existed when pooling studies from convenience samples. Heterogeneity was observed when pooling studies on the association between SCH and cardiovascular and all-cause mortality. Sensitivity analysis showed omission of each individual study did not significantly change the pooled effects. No evidence of publication bias was observed. CONCLUSIONS: Our findings demonstrated that SCH significantly increased the risk of CVD for the general population and the risk of cardiovascular and all-cause mortality for the individuals with other morbidities.
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Both analyses concluded that SH confers an increased risk of cardiovascular mortality, with hazard ratios of 1.52 and 1.29.
“Both analyses concluded that SH confers an increased risk of cardiovascular mortality, with hazard ratios of 1.52 (390) and 1.29 (388).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [390]
Some of these studies, including the meta-analyses, have also examined nonfatal cardiovascular events in SH, with similar increased risks.
“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 [390]
There have been two recent meta-analyses that examined this question, one of study-level data of 17 cohorts and the other of individual-level data in 52,674 participants.
“There have been two recent meta-analyses that examined this question, one of study-level data of 17 cohorts (390) and the other of individual-level data in 52,674 participants (388).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [390]
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- Authors
- Yang, L.-B., Jiang, D.-Q., Qi, W.-B., Zhang, T., Feng, Y.-L., Gao, L., & Zhao, J.
- Affiliations
- Shandong University (CN)
- Second Hospital of Shandong University (CN)
- Taian City Central Hospital (CN)
- Corresponding author
- Zhao, J.
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04-24
- Volume
- 167
- Issue
- 1
- Pages
- 75-84
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2116404465
- Cited by
- 56
- References
- 63
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 8 · 2021: 2 · 2020: 3 · 2018: 2 · 2017: 6 · 2016: 2 · 2015: 9 · 2014: 12 · 2013: 5 · 2012: 3
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hyperthyroidism, cardiovascular disease, cardiovascular mortality, all-cause mortality, convenience samples, community sample, subgroup analysis
- MeSH terms
- Cardiovascular Diseases, Humans, Hyperthyroidism, Models, Theoretical, Risk, Severity of Illness Index
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