Subclinical Thyroid Dysfunction and the Risk of Heart Failure in Older Persons at High Cardiovascular Risk

Author(s):
Nanchen, D.; Gussekloo, J. (0000-0001-7186-8278); Westendorp, R.G.J. (0000-0002-0672-8372); Stott, D.J.; Jukema, J.W. (0000-0002-3246-8359); Trompet, S.; Ford, I.; Welsh, P.; Sattar, N.; Macfarlane, P.W.; Mooijaart, S.P.; Rodondi, N.; Craen, A.J.M. de (0000-0001-9314-123X); PROSPER Grp
Published
2012
Publication type
Article / Letter to editor

Abstract

Context:Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain.Objective:Our objective was to determine the extent to which subclinical hyperthyroidism and hypothyroidism influence the risk of heart failure and cardiovascular diseases in older people.Setting and Design:The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study.Patients:Patients included men and women aged 70-82 yr (n = 5316) with known cardiovascular risk factors or previous cardiovascular disease.Main Outcome Measures:Incidence rate of heart failure hospitalization, atrial fibrillation, and cardiovascular events and mortality according to baseline thyroid status were evaluated. Euthyroid participants (TSH =0.45-4.5 mIU/liter) were compared with those with subclinical hyperthyroidism (TSH <0.45 mIU/liter) and those with subclinical hypothyroidism (TSH ≥4.5 mIU/liter, both with normal free T(4)).Results:Subclinical hyperthyroidism was present in 71 participants and subclinical hypothyroidism in 199 participants. Over 3.2 yr follow-up, the rate of heart failure was higher for subclinical hyperthyroidism compared with euthyroidism [age- and sex-adjusted hazard ratio (HR) = 2.93, 95% confidence interval (CI) = 1.37-6.24, P = 0.005; multivariate-adjusted HR = 3.27, 95% CI = 1.52-7.02, P = 0.002). Subclinical hypothyroidism (only at threshold >10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR = 3.01, 95% CI = 1.12-8.11, P = 0.029; multivariate HR = 2.28, 95% CI = 0.84-6.23). There were no strong evidence of an association between subclinical thyroid dysfunction and cardiovascular events or mortality, except in those with TSH below 0.1 or over 10 mIU/liter and not taking pravastatin.Conclusion:Older people at high cardiovascular risk with low or very high TSH along with normal free T(4) appear at increased risk of incident heart failure.

Date issued
2012-01-11
Language
English
hdl
1887/120215
doi
10.1210/jc.2011-1978