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Higher thyroid hormone levels linked to atherosclerotic CVD, mortality
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High and high-normal levels of free thyroxine were associated with atherosclerotic CVD and mortality in middle-aged and elderly adults, study results show.
“Atherosclerosis progresses insidiously from a subclinical condition to the clinical onset of vascular events to death,” Arjola Bano, MD, MSc, DSc, of Erasmus University in the Netherlands, and colleagues wrote. “Despite advances in prevention and treatment, atherosclerotic disease remains a leading cause of death, with a considerable clinical and economic burden worldwide. Hence, the identification of additional modifiable risk factors for atherosclerosis is of major importance.”
Bano and colleagues analyzed data from 9,420 participants (mean age, 65 years; 57% women) in the Rotterdam Study to investigate thyroid-stimulating hormone and free thyroxine and the link to atherosclerotic CVD.
Primary outcomes were presence of subclinical atherosclerosis (coronary artery calcification score > 100 Agatston units), atherosclerotic CV events (MI, CHD mortality or stroke) and death due to atherosclerosis CVD. Thyroid hormone levels were assessed at baseline through serum samples.
In a median follow-up of 8.8 years, 612 atherosclerosis-related CV deaths and 934 first-time atherosclerosis-related CV events were reported.
Increased levels of free thyroxine were associated with increased CAC (OR = 2.28; 95% CI, 1.3-4.02) and increased atherosclerotic CV events (HR = 1.87; 95% CI, 1.34-2.59).
Higher free thyroxine levels (HR = 2.41 per 1 ng/dL; 95% CI, 1.68-3.47) and lower thyroid-stimulating hormone levels (HR = 0.92 per 1 logTSH; 95% CI, 0.84-1) were associated with increased risk for mortality.
“These findings suggest that [free thyroxine] measurement can be a predictive marker of atherosclerotic mortality. Furthermore, our findings underscore the importance of identifying the modifiable mediators of the association between thyroid function and atherogenesis,” the researchers wrote. “Preventive strategies targeting thyroid function or certain mediators could further lead to a reduction in atherosclerotic events. Lastly, our findings provide supporting evidence for a re-evaluation of the current reference ranges of [thyroid-stimulating hormone] and [free thyroxine] tests, which are based on arbitrary statistical approaches rather than on clinical outcomes such as atherosclerotic morbidity and mortality.” by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.
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