Thyroid‐stimulating hormone and risk of sudden cardiac death, total mortality and cardiovascular morbidity

Summary Background Previous data on the association of thyroid function with total mortality, cardiovascular disease (CVD) outcomes and sudden cardiac death (SCD) are conflicting or limited. We investigated associations of thyroid‐stimulating hormone (TSH) with these outcomes in a nationwide populat...

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Veröffentlicht in:Clinical endocrinology (Oxford) Jg. 88; H. 1; S. 105 - 113
Hauptverfasser: Langén, Ville L., Niiranen, Teemu J., Puukka, Pauli, Lehtonen, Arttu O., Hernesniemi, Jussi A., Sundvall, Jouko, Salomaa, Veikko, Jula, Antti M.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Wiley Subscription Services, Inc 01.01.2018
Schlagworte:
adult population
Blood pressure
Cardiovascular disease
Cardiovascular diseases
Cholesterol
Coronary artery disease
Defibrillators
Diabetes mellitus
Fibrillation
Health risk assessment
Heart diseases
Morbidity
Mortality
Population studies
Regression analysis
Risk factors
Smoking
sudden cardiac death
Thyroid
Thyroid gland
Thyroid-stimulating hormone
thyroid-stimulating hormone
cardiovascular disease
sudden cardiac death
adult population
ISSN:0300-0664, 1365-2265, 1365-2265
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Zusammenfassung:Summary Background Previous data on the association of thyroid function with total mortality, cardiovascular disease (CVD) outcomes and sudden cardiac death (SCD) are conflicting or limited. We investigated associations of thyroid‐stimulating hormone (TSH) with these outcomes in a nationwide population‐based prospective cohort study. Methods We examined 5211 participants representative of the Finnish population aged ≥30 years in 2000‐2001 and followed them for a median of 13.2 years. Using Cox proportional hazards regression models adjusted for baseline age, gender, smoking, diabetes, systolic blood pressure and total and high‐density lipoprotein cholesterol, we assessed the associations of continuous baseline TSH and TSH categories (low [<0.4 mU/L], reference range [0.4‐3.4 mU/L] and high [>3.4 mU/L]) with incident total mortality, SCD, coronary heart disease events, stroke, CVD, major adverse cardiac events and atrial fibrillation. Results High TSH at baseline was related to a greater risk of total mortality (HR 1.34, 95% CI 1.02‐1.76) and SCD (HR 2.28, 95% CI 1.13‐4.60) compared with TSH within the reference range. High TSH was not associated with the other outcomes (P ≥ .51), whereas low TSH was not associated with any of the outcomes (P ≥ .09). TSH at baseline over the full range did not have a linear relation with any of the outcomes (P ≥ .17). TSH showed a U‐shaped association with total mortality after a restricted cubic spline transformation (P = .01). Conclusions Thyroid function abnormalities could be linked with higher risks of total mortality and SCD. Large‐scale randomized studies are needed for evidence‐based recommendations regarding treatment of mild thyroid failure.
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ISSN:0300-0664
1365-2265
1365-2265
DOI:10.1111/cen.13472