Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 97, Issue 3, Pages 852-861Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2011-1978
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Funding
- Netherlands Genomics Initiative/Netherlands Organization for Scientific Research (NGI/NWO) [05040202]
- Netherlands Consortium for Healthy Aging [050-060-810]
- Swiss National Science Foundation SNSF [PBLAP3-132943, 320030-138267]
- SICPA Foundation
- Societe Academique Vaudoise
- Bristol-Myers Squibb
- Chief Scientist Office [CZH/4/637] Funding Source: researchfish
- Swiss National Science Foundation (SNF) [320030_138267, PBLAP3-132943] Funding Source: Swiss National Science Foundation (SNF)
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Context: Subclinical thyroid dysfunctio n 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. 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 T-4). 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 T-4 appear at increased risk of incident heart failure. (J Clin Endocrinol Metab 97: 852-861, 2012)
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