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. 2006 Mar 1;295(9):1033-41.
doi: 10.1001/jama.295.9.1033.

Thyroid status, cardiovascular risk, and mortality in older adults

Anne R Cappola  1 , Linda P Fried, Alice M Arnold, Mark D Danese, Lewis H Kuller, Gregory L Burke, Russell P Tracy, Paul W Ladenson
Affiliations

Thyroid status, cardiovascular risk, and mortality in older adults

Anne R Cappola et al. JAMA. .

Abstract

Context: Previous studies have suggested that subclinical abnormalities in thyroid-stimulating hormone levels are associated with detrimental effects on the cardiovascular system.

Objective: To determine the relationship between baseline thyroid status and incident atrial fibrillation, incident cardiovascular disease, and mortality in older men and women not taking thyroid medication.

Design, setting, and participants: A total of 3233 US community-dwelling individuals aged 65 years or older with baseline serum thyroid-stimulating hormone levels were enrolled in 1989-1990 in the Cardiovascular Health Study, a large, prospective cohort study.

Main outcome measures: Incident atrial fibrillation, coronary heart disease, cerebrovascular disease, cardiovascular death, and all-cause death assessed through June 2002. Analyses are reported for 4 groups defined according to thyroid function test results: subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism.

Results: Individuals with overt thyrotoxicosis (n = 4) were excluded because of small numbers. Eighty-two percent of participants (n = 2639) had normal thyroid function, 15% (n = 496) had subclinical hypothyroidism, 1.6% (n = 51) had overt hypothyroidism, and 1.5% (n = 47) had subclinical hyperthyroidism. After exclusion of those with prevalent atrial fibrillation, individuals with subclinical hyperthyroidism had a greater incidence of atrial fibrillation compared with those with normal thyroid function (67 events vs 31 events per 1000 person-years; adjusted hazard ratio, 1.98; 95% confidence interval, 1.29-3.03). No differences were seen between the subclinical hyperthyroidism group and euthyroidism group for incident coronary heart disease, cerebrovascular disease, cardiovascular death, or all-cause death. Likewise, there were no differences between the subclinical hypothyroidism or overt hypothyroidism groups and the euthyroidism group for cardiovascular outcomes or mortality. Specifically, individuals with subclinical hypothyroidism had an adjusted hazard ratio of 1.07 (95% confidence interval, 0.90-1.28) for incident coronary heart disease.

Conclusion: Our data show an association between subclinical hyperthyroidism and development of atrial fibrillation but do not support the hypothesis that unrecognized subclinical hyperthyroidism or subclinical hypothyroidism is associated with other cardiovascular disorders or mortality.

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Figures

Figure
Figure
Cumulative incidence of A. atrial fibrillation, B. coronary heart disease, C. cerebrovascular disease, and D. death from all causes over the 13 years of follow-up, according to thyroid status. Number at risk for atrial fibrillation plot: n=47 for subclinical hyperthyroid, 2502 for euthyroid, 472 for subclinical hypothyroid, and 49 for hypothyroid. Number at risk for coronary heart disease, cerebrovascular disease, and mortality plots: n=31 for subclinical hyperthyroid, 1838 for euthyroid, 347 for subclinical hypothyroid, and 30 for hypothyroid. P<.001 for comparison of atrial fibrillation incidence between subclinical hyperthyroid and euthyroid groups. P=.02 for comparison of mortality between subclinical hyperthyroid and euthyroid groups. All other comparisons are not statistically significant.
Figure
Figure
Cumulative incidence of A. atrial fibrillation, B. coronary heart disease, C. cerebrovascular disease, and D. death from all causes over the 13 years of follow-up, according to thyroid status. Number at risk for atrial fibrillation plot: n=47 for subclinical hyperthyroid, 2502 for euthyroid, 472 for subclinical hypothyroid, and 49 for hypothyroid. Number at risk for coronary heart disease, cerebrovascular disease, and mortality plots: n=31 for subclinical hyperthyroid, 1838 for euthyroid, 347 for subclinical hypothyroid, and 30 for hypothyroid. P<.001 for comparison of atrial fibrillation incidence between subclinical hyperthyroid and euthyroid groups. P=.02 for comparison of mortality between subclinical hyperthyroid and euthyroid groups. All other comparisons are not statistically significant.
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