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Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality
Open accessAbstract
BACKGROUND: Data on the association between subclinical thyroid dysfunction and coronary heart disease (CHD) and mortality are conflicting. PURPOSE: To summarize prospective evidence about the relationship between subclinical thyroid dysfunction and CHD and mortality. DATA SOURCES: MEDLINE (1950 to January 2008) without language restrictions and reference lists of retrieved articles were searched. STUDY SELECTION: Two reviewers screened and selected cohort studies that measured thyroid function and then followed persons prospectively to assess CHD or mortality. DATA EXTRACTION: By using a standardized protocol and forms, 2 reviewers independently abstracted and assessed studies. DATA SYNTHESIS: Ten of 12 identified studies involved population-based cohorts that included 14 449 participants. All 10 population-based cohort studies examined risks associated with subclinical hypothyroidism (2134 CHD events and 2822 deaths), whereas only 5 examined risks associated with subclinical hyperthyroidism (1392 CHD events and 1993 deaths). In a random-effects model, the relative risk (RR) for subclinical hypothyroidism for CHD was 1.20 (95% CI, 0.97 to 1.49; P for heterogeneity = 0.14; I(2 )= 33.4%). Risk estimates were lower when higher-quality studies were pooled (RR, 1.02 to 1.08) and were higher among participants younger than 65 years (RR, 1.51 [CI, 1.09 to 2.09] for studies with mean participant age <65 years and 1.05 [CI, 0.90 to 1.22] for studies with mean participant age > or =65 years). The RR was 1.18 (CI, 0.98 to 1.42) for cardiovascular mortality and 1.12 (CI, 0.99 to 1.26) for total mortality. For subclinical hyperthyroidism, the RR was 1.21 (CI, 0.88 to 1.68) for CHD, 1.19 (CI, 0.81 to 1.76) for cardiovascular mortality, and 1.12 (CI, 0.89 to 1.42) for total mortality (P for heterogeneity >0.50; I(2 )= 0% for all studies). LIMITATIONS: Individual studies adjusted for different potential confounders, and 1 study provided only unadjusted data. Publication bias or selective reporting of outcomes could not be excluded. CONCLUSION: Subclinical hypothyroidism and hyperthyroidism may be associated with a modest increased risk for CHD and mortality, with lower risk estimates when pooling higher-quality studies and larger CIs for subclinical hyperthyroidism.
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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 [91]
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“Two did not find a link between SHyper and mortality [89,90] , whereas four other meta-analyses found an association between SHyper and cardiovascular or all-cause mortality [71,[91][92][93] , especially in elderly patients and in patients with co-morbidities [91,92] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [91]
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“Thus, suppressed TSH has in population studies consistently been associated with a higher mortality and other adverse effects compared to people with normal or even higher TSH concentrations ( Table 5 ) (87–90).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [90]
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Metadata
- Authors
- Ochs, N., Auer, R., Bauer, D. C., Nanchen, D., Gussekloo, J., Cornuz, J., & Rodondi, N.
- Affiliations
- University of California, San Francisco (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2008-06-03
- Volume
- 148
- Issue
- 11
- Pages
- 832-845
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2120863778
- Cited by
- 477
- References
- 70
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 15 · 2022: 19 · 2021: 18 · 2020: 26 · 2019: 27 · 2018: 22 · 2017: 29 · 2016: 32 · 2015: 30 · 2014: 36 · 2013: 40 · 2012: 46
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- green
- iris.unil.ch
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- SERVAL (Université de Lausanne) (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 › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical thyroid dysfunction, subclinical hypothyroidism, subclinical hyperthyroidism, coronary artery disease, cardiovascular mortality, all-cause mortality, thyroid function, prospective cohort, age as confounder, study quality heterogeneity, relative risk estimation, subgroup analysis
- MeSH terms
- Coronary Disease, Female, Humans, Hyperthyroidism, Hypothyroidism, Male, Prospective Studies, Risk Factors, Thyroid Function Tests, Thyrotropin
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