Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk (VSports最新版本)

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 VSports app下载.

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 T4).

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 T4 appear at increased risk of incident heart failure.