Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study

Christian Selmer; Jonas Bjerring Olesen; Morten Lock Hansen; Lene Mia von Kappelgaard; Jesper Clausager Madsen; Peter Riis Hansen; Ole Dyg Pedersen; Jens Faber; Christian Torp-Pedersen; Gunnar Hilmar Gislason

doi:10.1210/jc.2013-4184

Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study

Christian Selmer, Jonas Bjerring Olesen, Morten Lock Hansen, Lene Mia von Kappelgaard, Jesper Clausager Madsen, Peter Riis Hansen, Ole Dyg Pedersen, Jens Faber, Christian Torp-Pedersen, Gunnar Hilmar Gislason

Department of Clinical Medicine

140 Citations (Scopus)

Abstract

CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.

OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.

DESIGN: This was a retrospective cohort study.

SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.

MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.

RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].

CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.

Original language	English
Journal	Journal of Clinical Endocrinology & Metabolism
Volume	99
Issue number	7
Pages (from-to)	2372-2382
Number of pages	11
ISSN	0021-972X
DOIs	https://doi.org/10.1210/jc.2013-4184
Publication status	Published - Jul 2014

Keywords

Adult
Asymptomatic Diseases
Cardiovascular Diseases
Cause of Death
Denmark
Female
Humans
Incidence
Male
Middle Aged
Registries
Retrospective Studies
Risk Factors
Thyroid Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Selmer, C., Olesen, J. B., Hansen, M. L., von Kappelgaard, L. M., Madsen, J. C., Hansen, P. R., Pedersen, O. D., Faber, J., Torp-Pedersen, C., & Gislason, G. H. (2014). Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study. Journal of Clinical Endocrinology & Metabolism, 99(7), 2372-2382. https://doi.org/10.1210/jc.2013-4184

Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events : A Large Population Study. / Selmer, Christian; Olesen, Jonas Bjerring; Hansen, Morten Lock et al.

In: Journal of Clinical Endocrinology & Metabolism, Vol. 99, No. 7, 07.2014, p. 2372-2382.

Research output: Contribution to journal › Journal article › Research › peer-review

Selmer, C, Olesen, JB, Hansen, ML, von Kappelgaard, LM, Madsen, JC, Hansen, PR, Pedersen, OD, Faber, J, Torp-Pedersen, C & Gislason, GH 2014, 'Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study', Journal of Clinical Endocrinology & Metabolism, vol. 99, no. 7, pp. 2372-2382. https://doi.org/10.1210/jc.2013-4184

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title = "Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study",

abstract = "CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.DESIGN: This was a retrospective cohort study.SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.",

keywords = "Adult, Asymptomatic Diseases, Cardiovascular Diseases, Cause of Death, Denmark, Female, Humans, Incidence, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Thyroid Diseases",

author = "Christian Selmer and Olesen, {Jonas Bjerring} and Hansen, {Morten Lock} and {von Kappelgaard}, {Lene Mia} and Madsen, {Jesper Clausager} and Hansen, {Peter Riis} and Pedersen, {Ole Dyg} and Jens Faber and Christian Torp-Pedersen and Gislason, {Gunnar Hilmar}",

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doi = "10.1210/jc.2013-4184",

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journal = "Journal of Clinical Endocrinology and Metabolism",

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T1 - Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events

T2 - A Large Population Study

AU - Selmer, Christian

AU - Olesen, Jonas Bjerring

AU - Hansen, Morten Lock

AU - von Kappelgaard, Lene Mia

AU - Madsen, Jesper Clausager

AU - Hansen, Peter Riis

AU - Pedersen, Ole Dyg

AU - Faber, Jens

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

PY - 2014/7

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N2 - CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.DESIGN: This was a retrospective cohort study.SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.

AB - CONTEXT: Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.OBJECTIVE: The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.DESIGN: This was a retrospective cohort study.SETTING AND PARTICIPANTS: Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000-2009 in Copenhagen, Denmark.MAIN OUTCOME MEASURE: All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.RESULTS: A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ± 18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15-1.36] and 1.23 (95% CI 1.16-1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05-1.27) and 1.09 (95% CI 1.02-1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99-1.32) and 1.20 (95% CI 1.10-1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)].CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality.

KW - Adult

KW - Asymptomatic Diseases

KW - Cardiovascular Diseases

KW - Cause of Death

KW - Denmark

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Thyroid Diseases

U2 - 10.1210/jc.2013-4184

DO - 10.1210/jc.2013-4184

M3 - Journal article

C2 - 24654753

SN - 0021-972X

VL - 99

SP - 2372

EP - 2382

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 7

ER -

Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study

Abstract

Keywords

UN SDGs

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