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Thyroid function within the normal range and risk of coronary heart disease: an individual participant data analysis of 14 cohorts.

Friday,2015-08-28 10:15 America/Los_Angeles — zdrager
TitleThyroid function within the normal range and risk of coronary heart disease: an individual participant data analysis of 14 cohorts.
Publication TypeJournal Article
Year of Publication2015
AuthorsAsvold, BO, Vatten, LJ, Bjøro, T, Bauer, DC, Bremner, A, Cappola, AR, Ceresini, G, Elzen, WPJ den, Ferrucci, L, Franco, OH, Franklyn, JA, Gussekloo, J, Iervasi, G, Imaizumi, M, Kearney, PM, Khaw, K-T, Maciel, RMB, Newman, AB, Peeters, RP, Psaty, BM, Razvi, S, Sgarbi, JA, Stott, DJ, Trompet, S, Vanderpump, MPJ, Völzke, H, Walsh, JP, Westendorp, RGJ, Rodondi, N
Corporate/Institutional AuthorsThyroid Studies Collaboration,
JournalJAMA Intern Med
Volume175
Issue6
Pagination1037-47
Date Published2015 Jun
ISSN2168-6114
KeywordsCohort Studies, Coronary Disease, Humans, Hypothyroidism, Thyrotropin
Abstract<p><b>IMPORTANCE: </b>Some experts suggest that serum thyrotropin levels in the upper part of the current reference range should be considered abnormal, an approach that would reclassify many individuals as having mild hypothyroidism. Health hazards associated with such thyrotropin levels are poorly documented, but conflicting evidence suggests that thyrotropin levels in the upper part of the reference range may be associated with an increased risk of coronary heart disease (CHD).</p><p><b>OBJECTIVE: </b>To assess the association between differences in thyroid function within the reference range and CHD risk.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>Individual participant data analysis of 14 cohorts with baseline examinations between July 1972 and April 2002 and with median follow-up ranging from 3.3 to 20.0 years. Participants included 55,412 individuals with serum thyrotropin levels of 0.45 to 4.49 mIU/L and no previously known thyroid or cardiovascular disease at baseline.</p><p><b>EXPOSURES: </b>Thyroid function as expressed by serum thyrotropin levels at baseline.</p><p><b>MAIN OUTCOMES AND MEASURES: </b>Hazard ratios (HRs) of CHD mortality and CHD events according to thyrotropin levels after adjustment for age, sex, and smoking status.</p><p><b>RESULTS: </b>Among 55,412 individuals, 1813 people (3.3%) died of CHD during 643,183 person-years of follow-up. In 10 cohorts with information on both nonfatal and fatal CHD events, 4666 of 48,875 individuals (9.5%) experienced a first-time CHD event during 533,408 person-years of follow-up. For each 1-mIU/L higher thyrotropin level, the HR was 0.97 (95% CI, 0.90-1.04) for CHD mortality and 1.00 (95% CI, 0.97-1.03) for a first-time CHD event. Similarly, in analyses by categories of thyrotropin, the HRs of CHD mortality (0.94 [95% CI, 0.74-1.20]) and CHD events (0.97 [95% CI, 0.83-1.13]) were similar among participants with the highest (3.50-4.49 mIU/L) compared with the lowest (0.45-1.49 mIU/L) thyrotropin levels. Subgroup analyses by sex and age group yielded similar results.</p><p><b>CONCLUSIONS AND RELEVANCE: </b>Thyrotropin levels within the reference range are not associated with risk of CHD events or CHD mortality. This finding suggests that differences in thyroid function within the population reference range do not influence the risk of CHD. Increased CHD risk does not appear to be a reason for lowering the upper thyrotropin reference limit.</p>
DOI10.1001/jamainternmed.2015.0930
Alternate JournalJAMA Intern Med
PubMed ID25893284
PubMed Central IDPMC4732559
Grant ListAG-023629 / AG / NIA NIH HHS / United States
AG-032317 / AG / NIA NIH HHS / United States
G1000143 / / Medical Research Council / United Kingdom
HHSN268200800007C / HL / NHLBI NIH HHS / United States
HHSN268200800007C / / PHS HHS / United States
HHSN268201200036C / HL / NHLBI NIH HHS / United States
HHSN268201200036C / / PHS HHS / United States
HL080295 / HL / NHLBI NIH HHS / United States
K24 AG042765 / AG / NIA NIH HHS / United States
N01 AG062101 / AG / NIA NIH HHS / United States
N01 AG062103 / AG / NIA NIH HHS / United States
N01 AG062106 / AG / NIA NIH HHS / United States
N01 HC55222 / HC / NHLBI NIH HHS / United States
N01-AG-6-2101 / AG / NIA NIH HHS / United States
N01-AG-6-2103 / AG / NIA NIH HHS / United States
N01-AG-6-2106 / AG / NIA NIH HHS / United States
N01HC55222 / HL / NHLBI NIH HHS / United States
N01HC85079 / HC / NHLBI NIH HHS / United States
N01HC85079 / HL / NHLBI NIH HHS / United States
N01HC85080 / HC / NHLBI NIH HHS / United States
N01HC85080 / HL / NHLBI NIH HHS / United States
N01HC85081 / HC / NHLBI NIH HHS / United States
N01HC85081 / HL / NHLBI NIH HHS / United States
N01HC85082 / HC / NHLBI NIH HHS / United States
N01HC85082 / HL / NHLBI NIH HHS / United States
N01HC85083 / HC / NHLBI NIH HHS / United States
N01HC85083 / HL / NHLBI NIH HHS / United States
N01HC85086 / HC / NHLBI NIH HHS / United States
N01HC85086 / HL / NHLBI NIH HHS / United States
R01 AG023629 / AG / NIA NIH HHS / United States
R01 AG028050 / AG / NIA NIH HHS / United States
R01 AG032317 / AG / NIA NIH HHS / United States
R01 HL080295 / HL / NHLBI NIH HHS / United States
R01 NR012459 / NR / NINR NIH HHS / United States
R01-NR012459 / NR / NINR NIH HHS / United States
R10-AG028050 / AG / NIA NIH HHS / United States
U01 AG027810 / AG / NIA NIH HHS / United States
U01 AG027810 / AG / NIA NIH HHS / United States
U01 AG042124 / AG / NIA NIH HHS / United States
U01 AG042124 / AG / NIA NIH HHS / United States
U01 AG042139 / AG / NIA NIH HHS / United States
U01 AG042139 / AG / NIA NIH HHS / United States
U01 AG042140 / AG / NIA NIH HHS / United States
U01 AG042140 / AG / NIA NIH HHS / United States
U01 AG042143 / AG / NIA NIH HHS / United States
U01 AG042143 / AG / NIA NIH HHS / United States
U01 AG042145 / AG / NIA NIH HHS / United States
U01 AG042145 / AG / NIA NIH HHS / United States
U01 AG042168 / AG / NIA NIH HHS / United States
U01 AG042168 / AG / NIA NIH HHS / United States
U01 AR066160 / AR / NIAMS NIH HHS / United States
U01 AR066160 / AR / NIAMS NIH HHS / United States
UL1 TR000128 / TR / NCATS NIH HHS / United States
UL1 TR000128 / TR / NCATS NIH HHS / United States
/ / Intramural NIH HHS / United States
/ / Department of Health / United Kingdom
/ / Cancer Research UK / United Kingdom
/ / Medical Research Council / United Kingdom

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