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Meta-Analysis
. 2020 Dec;35(4):786-800.
doi: 10.3803/EnM.2020.728. Epub 2020 Nov 25.

The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies

Seo Young Sohn  1 , Eunyoung Lee  2 , Min Kyung Lee  1 , Jae Hyuk Lee  1
Affiliations
Meta-Analysis

The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies

Seo Young Sohn et al. Endocrinol Metab (Seoul). 2020 Dec.

Abstract

Background: Whether hyperthyroidism is an independent risk factor for cardiovascular events remains controversial. We aimed to evaluate the association of overt and subclinical hyperthyroidism with the risk of ischemic heart disease (IHD), stroke, heart failure, and cardiovascular mortality.

Methods: Studies regarding the association between hyperthyroidism and cardiovascular events were searched on PubMed and Embase databases. The cardiovascular disease (CVD) risk was classified as high and low, based on pre-existing diseases, including history of coronary, cerebral, or peripheral artery disease; heart failure; atrial fibrillation; diabetes mellitus; or chronic kidney disease.

Results: Thirty-seven cohort studies were included in this meta-analysis. The pooled hazard ratio for subjects with overt hyperthyroidism compared with the control group was 1.11 (95% confidence interval [CI], 1.03 to 1.19) for IHD, 1.35 (95% CI, 1.03 to 1.75) for stroke, and 1.20 (95% CI, 1.00 to 1.46) for cardiovascular mortality. For subjects with subclinical hyperthyroidism, the pooled hazard ratio was 1.24 (95% CI, 1.07 to 1.45) for IHD, when compared with the control group. Subgroup analysis by CVD risk showed that the risk of stroke in overt hyperthyroidism was increased in the low CVD risk group; however, these association was not observed in the high CVD risk group. Similarly, the risk of IHD in subjects with subclinical hyperthyroidism was significantly increased in the low CVD risk group.

Conclusion: Overt hyperthyroidism is associated with increased risk of IHD, stroke, and cardiovascular mortality, and subclinical hyperthyroidism is associated with increased risk of IHD. These associations were particularly observed in the low risk CVD group without underlying CVD.

Keywords: Heart failure; Hyperthyroidism; Meta-analysis; Mortality; Myocardial infarction; Stroke.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flowchart of study screening and selection.
Fig. 2
Fig. 2
Forest plots for hyperthyroidism and risk of ischemic heart disease (IHD). (A) Overt hyperthyroidism and IHD. (B) Subclinical hyperthyroidism and IHD. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.
Fig. 3
Fig. 3
Forest plots for hyperthyroidism with the risk of stroke. (A) Overt hyperthyroidism and stroke. (B) Subclinical hyperthyroidism and stroke. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.
Fig. 4
Fig. 4
Forest plots for hyperthyroidism with the risk of heart failure. (A) Overt hyperthyroidism and heart failure. (B) Subclinical hyperthyroidism and heart failure. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.
Fig. 5
Fig. 5
Forest plots for hyperthyroidism with the risk of cardiovascular (CV) mortality. (A) Overt hyperthyroidism and CV mortality. (B) Subclinical hyperthyroidism and CV mortality. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.
See this image and copyright information in PMC

References

    1. Kwon H, Jung JH, Han KD, Park YG, Cho JH, Lee DY, et al. Prevalence and annual incidence of thyroid disease in Korea from 2006 to 2015: a nationwide population-based cohort study. Endocrinol Metab (Seoul) 2018;33:260–7. - PMC - PubMed
    1. Jabbar A, Pingitore A, Pearce SH, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol. 2017;14:39–55. - PubMed
    1. Bano A, Chaker L, Mattace-Raso FUS, van der Lugt A, Ikram MA, Franco OH, et al. Thyroid function and the risk of atherosclerotic cardiovascular morbidity and mortality: the Rotterdam Study. Circ Res. 2017;121:1392–400. - PubMed
    1. Selmer C, Olesen JB, Hansen ML, Lindhardsen J, Olsen AM, Madsen JC, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ. 2012;345:e7895. - PMC - PubMed
    1. Asvold BO, Bjoro T, Platou C, Vatten LJ. Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT study in Norway. Clin Endocrinol (Oxf) 2012;77:911–7. - PubMed

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