TY - JOUR
T1 - The spectrum of thyroid disease and risk of new onset atrial fibrillation
T2 - a large population cohort study
AU - Selmer, Christian
AU - Olesen, Jonas Bjerring
AU - Hansen, Morten Lock
AU - Lindhardsen, Jesper
AU - Olsen, Anne-Marie Schjerning
AU - Madsen, Jesper Clausager
AU - Faber, Jens
AU - Hansen, Peter Riis
AU - Pedersen, Ole Dyg
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar Hilmar
PY - 2012/12/1
Y1 - 2012/12/1
N2 - Objectives: To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients. Design: Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level. Setting: Primary care patients in the city of Copenhagen. Subjects: Registry data for 586 460 adults who had their thyroid function evaluated for the first time by their general practitioner during 2000-10 and who were without previously recorded thyroid disease or atrial fibrillation. Main outcome measure: Poisson regression models used to estimate risk of atrial fibrillation by thyroid function. Results: Of the 586 460 individuals in the study population (mean (SD) age 50.2 (16.9) years, 39% men), 562 461 (96.0%) were euthyroid, 1670 (0.3%) had overt hypothyroidism, 12 087 (2.0%) had subclinical hypothyroidism, 3966 (0.7%) had overt hyperthyroidism, and 6276 (1.0%) had subclinical hyperthyroidism. Compared with the euthyroid individuals, the risk of atrial fibrillation increased with decreasing levels of thyroid stimulating hormone (TSH) from high normal euthyroidism (incidence rate ratio 1.12 (95% CI 1.03 to 1.21)) to subclinical hyperthyroidism with reduced TSH (1.16 (0.99 to 1.36)) and subclinical hyperthyroidism with supressed TSH (1.41 (1.25 to 1.59)). Both overt and subclinical hypothyroidism were associated with a lower risk of atrial fibrillation. Conclusion: The risk of atrial fibrillation was closely associated with thyroid activity, with a low risk in overt hypothyroidism, high risk in hyperthyroidism, and a TSH level dependent association with risk of atrial fibrillation across the spectrum of subclinical thyroid disease.
AB - Objectives: To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients. Design: Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level. Setting: Primary care patients in the city of Copenhagen. Subjects: Registry data for 586 460 adults who had their thyroid function evaluated for the first time by their general practitioner during 2000-10 and who were without previously recorded thyroid disease or atrial fibrillation. Main outcome measure: Poisson regression models used to estimate risk of atrial fibrillation by thyroid function. Results: Of the 586 460 individuals in the study population (mean (SD) age 50.2 (16.9) years, 39% men), 562 461 (96.0%) were euthyroid, 1670 (0.3%) had overt hypothyroidism, 12 087 (2.0%) had subclinical hypothyroidism, 3966 (0.7%) had overt hyperthyroidism, and 6276 (1.0%) had subclinical hyperthyroidism. Compared with the euthyroid individuals, the risk of atrial fibrillation increased with decreasing levels of thyroid stimulating hormone (TSH) from high normal euthyroidism (incidence rate ratio 1.12 (95% CI 1.03 to 1.21)) to subclinical hyperthyroidism with reduced TSH (1.16 (0.99 to 1.36)) and subclinical hyperthyroidism with supressed TSH (1.41 (1.25 to 1.59)). Both overt and subclinical hypothyroidism were associated with a lower risk of atrial fibrillation. Conclusion: The risk of atrial fibrillation was closely associated with thyroid activity, with a low risk in overt hypothyroidism, high risk in hyperthyroidism, and a TSH level dependent association with risk of atrial fibrillation across the spectrum of subclinical thyroid disease.
U2 - 10.1136/bmj.e7895
DO - 10.1136/bmj.e7895
M3 - Journal article
SN - 0959-8146
VL - 345
SP - e7895
JO - The BMJ
JF - The BMJ
ER -