What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants

Abstract

BackgroundWhether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality.MethodsWe searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality.ResultsFifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01–1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05–1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38–2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13–1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28–3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26–1.81).ConclusionsHypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0777-9) contains supplementary material, which is available to authorized users.

Thyroid stimulating hormone elevation as a predictor of long‐term mortality in patients with acute myocardial infarction

“…In a meta‐analysis of 55 cohort studies, hypothyroidism is associated with higher risks of cardiac mortality and all‐cause mortality compared with ET in both the general public and cardiac patients . Recent study demonstrated that hypothyroidism was an independent predictor of cardiovascular and cerebral events in patients who received PCI; moreover, it highlighted that adequate thyroid replacement treatment could prevent cardiovascular events .…”

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

“…Among the 52 included eligible MAs, 4628–73 (46/52, 88.5%) were published in English, and the rest74–79 (6/52, 11.5%) were published in Chinese. The 52 included MAs contained 685 studies, with an average of 13.2 (range: 3–39) studies per article.…”

“…Ten39 40 43 49 57 58 65 68–70 MAs were about the associations between OH and other diseases, and 3528–36 38 42 44–47 50–56 59–64 66 67 75–79 MAs have shown the associations between SCH and other diseases. Seven37 41 48 71–74MAs have investigated the effects of both OH and SCH on other diseases.…”

Detectability of Subclinical Hypothyroidism and Thyroid Stimulating Hormone Levels Associated with Cardiovascular Diseases in Patients of North-West Region Hospital

“…Наличие СГ было ассоциировано с инфарктом миокарда в анамнезе и атеросклерозом аорты [8]. По данным метаанализа 55 когортных исследований с включением 1898314 больных было установлено, что СГ (повышенное значение тиреотропного гормона [ТТГ] при нормальном уровне свободного тироксина) повышает риск развития ишемической болезни сердца и смертности по сравнению с пациентами с эутиреоидным статусом [9]. Результаты обследования большой когорты больных ишемической болезнью сердца (ИБС, n=870), поступивших в многопрофильный стационар Санкт-Петербурга для коронарографического исследования, показали, что СГ ассоциирован с многососудистым поражением коронарных артерий и является независимым дополнительным фактором сердечно-сосудистого риска [10].…”