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Subclinical Hypothyroidism Is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study
Open accessAbstract
BACKGROUND: Overt hypothyroidism has been found to be associated with cardiovascular disease. Whether subclinical hypothyroidism and thyroid autoimmunity are also risk factors for cardiovascular disease is controversial. OBJECTIVE: To investigate whether subclinical hypothyroidism and thyroid autoimmunity are associated with aortic atherosclerosis and myocardial infarction in postmenopausal women. DESIGN: Population-based cross-sectional study. SETTING: A district of Rotterdam, The Netherlands. PARTICIPANTS: Random sample of 1149 women (mean age +/- SD, 69.0 +/- 7.5 years) participating in the Rotterdam Study. MEASUREMENTS: Data on thyroid status, aortic atherosclerosis, and history of myocardial infarction were obtained at baseline. Subclinical hypothyroidism was defined as an elevated thyroid-stimulating hormone level (>4.0 mU/L) and a normal serum free thyroxine level (11 to 25 pmol/L [0.9 to 1.9 ng/dL]). In tests for antibodies to thyroid peroxidase, a serum level greater than 10 IU/mL was considered a positive result. RESULTS: Subclinical hypothyroidism was present in 10.8% of participants and was associated with a greater age-adjusted prevalence of aortic atherosclerosis (odds ratio, 1.7 [95% CI, 1.1 to 2.6]) and myocardial infarction (odds ratio, 2.3 [CI, 1.3 to 4.0]). Additional adjustment for body mass index, total and high-density lipoprotein cholesterol level, blood pressure, and smoking status, as well as exclusion of women who took beta-blockers, did not affect these estimates. Associations were slightly stronger in women who had subclinical hypothyroidism and antibodies to thyroid peroxidase (odds ratio for aortic atherosclerosis, 1.9 [CI, 1.1 to 3.6]; odds ratio for myocardial infarction, 3.1 [CI, 1.5 to 6.3]). No association was found between thyroid autoimmunity itself and cardiovascular disease. The population attributable risk percentage for subclinical hypothyroidism associated with myocardial infarction was within the range of that for known major risk factors for cardiovascular disease. CONCLUSION: Subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women.
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“Thus, in the Rotterdam Study, aortic calcification and the prevalence of myocardial infarction was higher in patients with SCH who were positive for thyroid autoantibodies than in those with SCH alone (57).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [57]
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Hollowell, J. G., Staehling, N. W., Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.2.489 · Cited by 4,279
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Metadata
- Authors
- Hak, A. E., Pols, H. A. P., Visser, T. J., Drexhage, H. A., Hofman, A., & Witteman, J. C. M.
- Affiliations
- Erasmus MC (NL)
- From Erasmus University Medical School, Rotterdam, the Netherlands.
- ORCID
- Drexhage, Hemmo A.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2000-02-15
- Volume
- 132
- Issue
- 4
- Pages
- 270-278
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2142296338
- Cited by
- 1,336
- References
- 54
- Citations by year
- 2026: 20 · 2025: 19 · 2024: 28 · 2023: 31 · 2022: 45 · 2021: 41 · 2020: 97 · 2019: 30 · 2018: 53 · 2017: 56 · 2016: 56 · 2015: 57 · 2014: 73 · 2013: 63 · 2012: 57
- FWCI
- 31.96
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- 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, atherosclerosis, myocardial infarction, thyroid autoimmunity, thyroid peroxidase antibodies, postmenopausal women, older women, cardiovascular risk factors, thyroid-stimulating hormone, population attributable risk, Rotterdam Study, cardiovascular disease prevention, beta-blockers, serum lipids, blood pressure, smoking, body mass index, cardiovascular morbidity
- MeSH terms
- Aged, Aortic Diseases, Arteriosclerosis, Autoantibodies, Autoimmune Diseases, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Hypothyroidism, Iodide Peroxidase, Myocardial Infarction, Netherlands, Regression Analysis, Risk Factors, Thyroid Diseases, Chi-Square Distribution
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- Hak, A. E., Pols, H. A. P., Visser, T. J., Drexhage, H. A., Hofman, A., & Witteman, J. C. M. (2000). Subclinical Hypothyroidism Is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-132-4-200002150-00004
