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Meta-Analysis
. 2017 Feb 2;15(1):21.
doi: 10.1186/s12916-017-0777-9.

What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants

Yu Ning  1 , Yun J Cheng  2 , Li J Liu  2 , Jaskanwal D S Sara  3 , Zhi Y Cao  4 , Wei P Zheng  5 , Tian S Zhang  6 , Hui J Han  7 , Zhen Y Yang  8 , Yi Zhang  9 , Fei L Wang  1 , Rui Y Pan  10 , Jie L Huang  11 , Ling L Wu  12 , Ming Zhang  13 , Yong X Wei  14
Affiliations
Meta-Analysis

What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants

Yu Ning et al. BMC Med. .

Abstract

Background: Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality.

Methods: We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality.

Results: Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01-1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05-1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38-2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13-1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28-3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26-1.81).

Conclusions: Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.

Keywords: Cardiovascular events; Hypothyroidism; Meta-analysis; Mortality.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Relative risk (RR) of ischemic heart disease (IHD) associated with hypothyroidism compared with euthyroidism. The dotted line in forest plot represents pooled RR value in random effects model. CI confidence interval
Fig. 3
Fig. 3
Relative risk (RR) of cardiac mortality associated with hypothyroidism compared with euthyroidism. The dotted line in forest plot represents pooled RR value in random effects model. CI confidence interval
Fig. 4
Fig. 4
Relative risk (RR) of cardiovascular mortality associated with hypothyroidism compared with euthyroidism. The dotted line in forest plot represents pooled RR value in random effects model. CI confidence interval
Fig. 5
Fig. 5
Relative risk (RR) of all-cause mortality associated with hypothyroidism compared with euthyroidism. *Two cohort studies by McQuade et al. [45] and Mitchell et al. [46] did not provide the number of all-cause mortality events; we contacted the authors by email but didn’t receive a reply. The dotted line in forest plot represents pooled RR value in random effects model. CI confidence interval
Fig. 6
Fig. 6
Relative risk (RR) of stroke and heart failure (HF) associated with hypothyroidism compared with euthyroidism. The dotted line in forest plot represents pooled RR value in random effects model. CI confidence interval
Fig. 7
Fig. 7
Relative risks of MI, AF and total cardiovascular events in hypothyroidism compared with euthyroidism. The dotted line in forest plot represents pooled RR value in random effects model. AF atrial fibrillation; CI confidence interval; CV cardiovascular; MI myocardial infarction; RR Relative risks
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