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Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts.
Circulation. 2012 Aug 28; 126(9):1040-9.Circ

Abstract

BACKGROUND

American College of Cardiology/American Heart Association guidelines for the diagnosis and management of heart failure recommend investigating exacerbating conditions such as thyroid dysfunction, but without specifying the impact of different thyroid-stimulation hormone (TSH) levels. Limited prospective data exist on the association between subclinical thyroid dysfunction and heart failure events.

METHODS AND RESULTS

We performed a pooled analysis of individual participant data using all available prospective cohorts with thyroid function tests and subsequent follow-up of heart failure events. Individual data on 25 390 participants with 216 248 person-years of follow-up were supplied from 6 prospective cohorts in the United States and Europe. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L, subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L, and subclinical hyperthyroidism as TSH <0.45 mIU/L, the last two with normal free thyroxine levels. Among 25 390 participants, 2068 (8.1%) had subclinical hypothyroidism and 648 (2.6%) had subclinical hyperthyroidism. In age- and sex-adjusted analyses, risks of heart failure events were increased with both higher and lower TSH levels (P for quadratic pattern <0.01); the hazard ratio was 1.01 (95% confidence interval, 0.81-1.26) for TSH of 4.5 to 6.9 mIU/L, 1.65 (95% confidence interval, 0.84-3.23) for TSH of 7.0 to 9.9 mIU/L, 1.86 (95% confidence interval, 1.27-2.72) for TSH of 10.0 to 19.9 mIU/L (P for trend <0.01) and 1.31 (95% confidence interval, 0.88-1.95) for TSH of 0.10 to 0.44 mIU/L and 1.94 (95% confidence interval, 1.01-3.72) for TSH <0.10 mIU/L (P for trend=0.047). Risks remained similar after adjustment for cardiovascular risk factors.

CONCLUSION

Risks of heart failure events were increased with both higher and lower TSH levels, particularly for TSH ≥10 and <0.10 mIU/L.

Authors+Show Affiliations

Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22821943

Citation

Gencer, Baris, et al. "Subclinical Thyroid Dysfunction and the Risk of Heart Failure Events: an Individual Participant Data Analysis From 6 Prospective Cohorts." Circulation, vol. 126, no. 9, 2012, pp. 1040-9.
Gencer B, Collet TH, Virgini V, et al. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation. 2012;126(9):1040-9.
Gencer, B., Collet, T. H., Virgini, V., Bauer, D. C., Gussekloo, J., Cappola, A. R., Nanchen, D., den Elzen, W. P., Balmer, P., Luben, R. N., Iacoviello, M., Triggiani, V., Cornuz, J., Newman, A. B., Khaw, K. T., Jukema, J. W., Westendorp, R. G., Vittinghoff, E., Aujesky, D., & Rodondi, N. (2012). Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation, 126(9), 1040-9.
Gencer B, et al. Subclinical Thyroid Dysfunction and the Risk of Heart Failure Events: an Individual Participant Data Analysis From 6 Prospective Cohorts. Circulation. 2012 Aug 28;126(9):1040-9. PubMed PMID: 22821943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. AU - Gencer,Baris, AU - Collet,Tinh-Hai, AU - Virgini,Vanessa, AU - Bauer,Douglas C, AU - Gussekloo,Jacobijn, AU - Cappola,Anne R, AU - Nanchen,David, AU - den Elzen,Wendy P J, AU - Balmer,Philippe, AU - Luben,Robert N, AU - Iacoviello,Massimo, AU - Triggiani,Vincenzo, AU - Cornuz,Jacques, AU - Newman,Anne B, AU - Khaw,Kay-Tee, AU - Jukema,J Wouter, AU - Westendorp,Rudi G J, AU - Vittinghoff,Eric, AU - Aujesky,Drahomir, AU - Rodondi,Nicolas, AU - ,, Y1 - 2012/07/19/ PY - 2012/7/24/entrez PY - 2012/7/24/pubmed PY - 2012/11/14/medline SP - 1040 EP - 9 JF - Circulation JO - Circulation VL - 126 IS - 9 N2 - BACKGROUND: American College of Cardiology/American Heart Association guidelines for the diagnosis and management of heart failure recommend investigating exacerbating conditions such as thyroid dysfunction, but without specifying the impact of different thyroid-stimulation hormone (TSH) levels. Limited prospective data exist on the association between subclinical thyroid dysfunction and heart failure events. METHODS AND RESULTS: We performed a pooled analysis of individual participant data using all available prospective cohorts with thyroid function tests and subsequent follow-up of heart failure events. Individual data on 25 390 participants with 216 248 person-years of follow-up were supplied from 6 prospective cohorts in the United States and Europe. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L, subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L, and subclinical hyperthyroidism as TSH <0.45 mIU/L, the last two with normal free thyroxine levels. Among 25 390 participants, 2068 (8.1%) had subclinical hypothyroidism and 648 (2.6%) had subclinical hyperthyroidism. In age- and sex-adjusted analyses, risks of heart failure events were increased with both higher and lower TSH levels (P for quadratic pattern <0.01); the hazard ratio was 1.01 (95% confidence interval, 0.81-1.26) for TSH of 4.5 to 6.9 mIU/L, 1.65 (95% confidence interval, 0.84-3.23) for TSH of 7.0 to 9.9 mIU/L, 1.86 (95% confidence interval, 1.27-2.72) for TSH of 10.0 to 19.9 mIU/L (P for trend <0.01) and 1.31 (95% confidence interval, 0.88-1.95) for TSH of 0.10 to 0.44 mIU/L and 1.94 (95% confidence interval, 1.01-3.72) for TSH <0.10 mIU/L (P for trend=0.047). Risks remained similar after adjustment for cardiovascular risk factors. CONCLUSION: Risks of heart failure events were increased with both higher and lower TSH levels, particularly for TSH ≥10 and <0.10 mIU/L. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/22821943/Subclinical_thyroid_dysfunction_and_the_risk_of_heart_failure_events:_an_individual_participant_data_analysis_from_6_prospective_cohorts_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.112.096024?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -