Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis

被引：150

作者：

Chaker, Layal ^{[1
,2
,3
]}

Baumgartner, Christine ^{[4
]}

den Elzen, Wendy P. J. ^{[5
,6
]}

Ikram, M. Arfan ^{[3
,7
,8
]}

Blum, Manuel R. ^{[4
]}

Collet, Tinh-Hai ^{[9
]}

Bakker, Stephan J. L. ^{[10
]}

Dehghan, Abbas ^{[3
]}

Drechsler, Christiane ^{[11
]}

Luben, Robert N. ^{[12
]}

Hofman, Albert ^{[3
]}

Portegies, Marileen L. P. ^{[3
,8
]}

Medici, Marco ^{[1
,2
]}

Iervasi, Giorgio ^{[13
]}

Stott, David J. ^{[14
]}

Ford, Ian ^{[15
]}

Bremner, Alexandra ^{[16
]}

Wanner, Christoph ^{[11
]}

Ferrucci, Luigi ^{[17
]}

Newman, Anne B. ^{[18
]}

Dullaart, Robin P. ^{[10
]}

Sgarbi, Jose A. ^{[19
,20
]}

Ceresini, Graziano ^{[21
]}

Maciel, Rui M. B. ^{[20
]}

Westendorp, Rudi G. ^{[22
]}

Jukema, J. Wouter ^{[23
,24
]}

Imaizumi, Misa ^{[25
]}

Franklyn, Jayne A. ^{[26
]}

Bauer, Douglas C. ^{[27
,28
,29
]}

Walsh, John P. ^{[30
,31
,32
]}

Razvi, Salman ^{[33
]}

Khaw, Kay-Tee ^{[12
]}

Cappola, Anne R. ^{[34
]}

Voelzke, Henry ^{[35
]}

Franco, Oscar H. ^{[3
]}

Gussekloo, Jacobijn ^{[5
,6
]}

Rodondi, Nicolas ^{[4
]}

Peeters, Robin P. ^{[1
,2
]}

机构：

[1] Erasmus MC, Dept Internal Med, NL-3000 CA Rotterdam, Netherlands

[2] Erasmus MC, Rotterdam Thyroid Ctr, NL-3000 CA Rotterdam, Netherlands

[3] Erasmus MC, Dept Epidemiol, NL-3000 CA Rotterdam, Netherlands

[4] Univ Hosp Bern, Inselspital, Dept Gen Internal Med, CH-3010 Bern, Switzerland

[5] Leiden Univ, Med Ctr, Dept Epidemiol, NL-2333 ZA Leiden, Netherlands

[6] Leiden Univ, Med Ctr, Dept Publ Hlth & Primary Care, NL-2333 ZA Leiden, Netherlands

[7] Erasmus MC, Dept Radiol, NL-3000 CA Rotterdam, Netherlands

[8] Erasmus MC, Dept Neurol, NL-3000 CA Rotterdam, Netherlands

[9] Univ Lausanne Hosp, Serv Endocrinol Diabet & Metab, CH-1011 Lausanne, Switzerland

[10] Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, NL-9700 RB Groningen, Netherlands

[11] Univ Hosp Wurzburg, Germany Comprehens Heart Failure Ctr, Div Nephrol, Dept Med, D-97080 Wurzburg, Germany

[12] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge CB2 1TN, England

[13] CNR, Inst Clin Physiol, I-56124 Pisa, Italy

[14] Univ Glasgow, Fac Med, Inst Cardiovasc & Med Sci, Glasgow G12 8QQ, Lanark, Scotland

[15] Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8QQ, Lanark, Scotland

[16] Univ Western Australia, Sch Populat Hlth, Crawley, WA 6009, Australia

[17] NIA, Bethesda, MD 20892 USA

[18] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15260 USA

[19] Fac Med Marilia, Div Endocrinol, BR-17519 Sao Paulo, Brazil

[20] Univ Fed Sao Paulo, Dept Med, Div Endocrinol, BR-04021001 Sao Paulo, Brazil

[21] Univ Parma, Dept Clin & Expt Med, I-43125 Parma, Italy

[22] Univ Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, DK-1165 Copenhagen, Denmark

[23] Leiden Univ, Med Ctr, Dept Cardiol, NL-2333 ZA Leiden, Netherlands

[24] Interuniv Cardiol Inst Netherlands, NL-3511 EP Utrecht, Netherlands

[25] Radiat Effects Res Fdn, Dept Clin Studies, Nagasaki 8500013, Japan

[26] Univ Birmingham, Coll Med & Dent Sci, Sch Clin & Expt Med, Birmingham B15 2TT, W Midlands, England

[27] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA

[28] Univ Calif San Francisco, Dept Epidemiol, San Francisco, CA 94143 USA

[29] Univ Calif San Francisco, Dept Biostat & Med, San Francisco, CA 94143 USA

[30] Sir Charles Gairdner Hosp, Dept Endocrinol & Diabet, Nedlands, WA 6009, Australia

[31] Univ Western Australia, Sch Med, Crawley, WA 6009, Australia

[32] Univ Western Australia, Sch Pharmacol, Crawley, WA 6009, Australia

[33] Gateshead Hlth Fdn NHS Trust, Dept Endocrinol, Gateshead NE9 6SX, England

[34] Univ Penn, Sch Med, Dept Med, Div Endocrinol Diabet & Metab, Philadelphia, PA 19104 USA

[35] Univ Med, Clin Epidemiol Research SHIP, Inst Community Med, D-17489 Greifswald, Germany

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2015年 / 100卷 / 06期

基金：

美国国家卫生研究院; 瑞士国家科学基金会; 巴西圣保罗研究基金会;

关键词：

ISCHEMIC-HEART-DISEASE; THYROID-DYSFUNCTION; CARDIOVASCULAR EVENTS; OSTEOPOROTIC FRACTURES; MYOCARDIAL-INFARCTION; SERUM THYROTROPIN; ALL-CAUSE; MORTALITY; POPULATION; FAILURE;

D O I：

10.1210/jc.2015-1438

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. Data Sources and Study Selection: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T-4 levels. Data Extraction and Synthesis: We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 personyears). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or >= 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. Conclusions: Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

引用

页码：2181 / 2191

页数：11

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