Subclinical Thyroid Dysfunction, Cardiac Function, and the Risk of Heart Failure. The Cardiovascular Health Study

Nicolas Rodondi, Douglas C. Bauer, Anne R. Cappola, Jacques Cornuz, John A Robbins, Linda P. Fried, Paul W. Ladenson, Eric Vittinghoff, John S. Gottdiener, Anne B. Newman

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164 Citations (Scopus)

Abstract

Objectives: The goal of this study was to determine whether subclinical thyroid dysfunction was associated with incident heart failure (HF) and echocardiogram abnormalities. Background: Subclinical hypothyroidism and hyperthyroidism have been associated with cardiac dysfunction. However, long-term data on the risk of HF are limited. Methods: We studied 3,044 adults ≥65 years of age who initially were free of HF in the Cardiovascular Health Study. We compared adjudicated HF events over a mean 12-year follow-up and changes in cardiac function over the course of 5 years among euthyroid participants, those with subclinical hypothyroidism (subdivided by thyroid-stimulating hormone [TSH] levels: 4.5 to 9.9, ≥10.0 mU/l), and those with subclinical hyperthyroidism. Results: Over the course of 12 years, 736 participants developed HF events. Participants with TSH ≥10.0 mU/l had a greater incidence of HF compared with euthyroid participants (41.7 vs. 22.9 per 1,000 person years, p = 0.01; adjusted hazard ratio: 1.88; 95% confidence interval: 1.05 to 3.34). Baseline peak E velocity, which is an echocardiographic measurement of diastolic function associated with incident HF in the CHS cohort, was greater in those patients with TSH ≥10.0 mU/l compared with euthyroid participants (0.80 m/s vs. 0.72 m/s, p = 0.002). Over the course of 5 years, left ventricular mass increased among those with TSH ≥10.0 mU/l, but other echocardiographic measurements were unchanged. Those patients with TSH 4.5 to 9.9 mU/l or with subclinical hyperthyroidism had no increase in risk of HF. Conclusions: Compared with euthyroid older adults, those adults with TSH ≥10.0 mU/l have a moderately increased risk of HF and alterations in cardiac function but not older adults with TSH <10.0 mU/l. Clinical trials should assess whether the risk of HF might be ameliorated by thyroxine replacement in individuals with TSH ≥10.0 mU/l.

Original languageEnglish (US)
Pages (from-to)1152-1159
Number of pages8
JournalJournal of the American College of Cardiology
Volume52
Issue number14
DOIs
StatePublished - Sep 30 2008

Fingerprint

Thyrotropin
Thyroid Gland
Heart Failure
Health
Hyperthyroidism
Hypothyroidism
Thyroxine
Clinical Trials
Confidence Intervals
Incidence

Keywords

  • cohort study
  • echocardiography
  • heart failure
  • subclinical thyroid dysfunction

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Subclinical Thyroid Dysfunction, Cardiac Function, and the Risk of Heart Failure. The Cardiovascular Health Study. / Rodondi, Nicolas; Bauer, Douglas C.; Cappola, Anne R.; Cornuz, Jacques; Robbins, John A; Fried, Linda P.; Ladenson, Paul W.; Vittinghoff, Eric; Gottdiener, John S.; Newman, Anne B.

In: Journal of the American College of Cardiology, Vol. 52, No. 14, 30.09.2008, p. 1152-1159.

Research output: Contribution to journalArticle

Rodondi, N, Bauer, DC, Cappola, AR, Cornuz, J, Robbins, JA, Fried, LP, Ladenson, PW, Vittinghoff, E, Gottdiener, JS & Newman, AB 2008, 'Subclinical Thyroid Dysfunction, Cardiac Function, and the Risk of Heart Failure. The Cardiovascular Health Study', Journal of the American College of Cardiology, vol. 52, no. 14, pp. 1152-1159. https://doi.org/10.1016/j.jacc.2008.07.009
Rodondi, Nicolas ; Bauer, Douglas C. ; Cappola, Anne R. ; Cornuz, Jacques ; Robbins, John A ; Fried, Linda P. ; Ladenson, Paul W. ; Vittinghoff, Eric ; Gottdiener, John S. ; Newman, Anne B. / Subclinical Thyroid Dysfunction, Cardiac Function, and the Risk of Heart Failure. The Cardiovascular Health Study. In: Journal of the American College of Cardiology. 2008 ; Vol. 52, No. 14. pp. 1152-1159.
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AU - Cornuz, Jacques

AU - Robbins, John A

AU - Fried, Linda P.

AU - Ladenson, Paul W.

AU - Vittinghoff, Eric

AU - Gottdiener, John S.

AU - Newman, Anne B.

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N2 - Objectives: The goal of this study was to determine whether subclinical thyroid dysfunction was associated with incident heart failure (HF) and echocardiogram abnormalities. Background: Subclinical hypothyroidism and hyperthyroidism have been associated with cardiac dysfunction. However, long-term data on the risk of HF are limited. Methods: We studied 3,044 adults ≥65 years of age who initially were free of HF in the Cardiovascular Health Study. We compared adjudicated HF events over a mean 12-year follow-up and changes in cardiac function over the course of 5 years among euthyroid participants, those with subclinical hypothyroidism (subdivided by thyroid-stimulating hormone [TSH] levels: 4.5 to 9.9, ≥10.0 mU/l), and those with subclinical hyperthyroidism. Results: Over the course of 12 years, 736 participants developed HF events. Participants with TSH ≥10.0 mU/l had a greater incidence of HF compared with euthyroid participants (41.7 vs. 22.9 per 1,000 person years, p = 0.01; adjusted hazard ratio: 1.88; 95% confidence interval: 1.05 to 3.34). Baseline peak E velocity, which is an echocardiographic measurement of diastolic function associated with incident HF in the CHS cohort, was greater in those patients with TSH ≥10.0 mU/l compared with euthyroid participants (0.80 m/s vs. 0.72 m/s, p = 0.002). Over the course of 5 years, left ventricular mass increased among those with TSH ≥10.0 mU/l, but other echocardiographic measurements were unchanged. Those patients with TSH 4.5 to 9.9 mU/l or with subclinical hyperthyroidism had no increase in risk of HF. Conclusions: Compared with euthyroid older adults, those adults with TSH ≥10.0 mU/l have a moderately increased risk of HF and alterations in cardiac function but not older adults with TSH <10.0 mU/l. Clinical trials should assess whether the risk of HF might be ameliorated by thyroxine replacement in individuals with TSH ≥10.0 mU/l.

AB - Objectives: The goal of this study was to determine whether subclinical thyroid dysfunction was associated with incident heart failure (HF) and echocardiogram abnormalities. Background: Subclinical hypothyroidism and hyperthyroidism have been associated with cardiac dysfunction. However, long-term data on the risk of HF are limited. Methods: We studied 3,044 adults ≥65 years of age who initially were free of HF in the Cardiovascular Health Study. We compared adjudicated HF events over a mean 12-year follow-up and changes in cardiac function over the course of 5 years among euthyroid participants, those with subclinical hypothyroidism (subdivided by thyroid-stimulating hormone [TSH] levels: 4.5 to 9.9, ≥10.0 mU/l), and those with subclinical hyperthyroidism. Results: Over the course of 12 years, 736 participants developed HF events. Participants with TSH ≥10.0 mU/l had a greater incidence of HF compared with euthyroid participants (41.7 vs. 22.9 per 1,000 person years, p = 0.01; adjusted hazard ratio: 1.88; 95% confidence interval: 1.05 to 3.34). Baseline peak E velocity, which is an echocardiographic measurement of diastolic function associated with incident HF in the CHS cohort, was greater in those patients with TSH ≥10.0 mU/l compared with euthyroid participants (0.80 m/s vs. 0.72 m/s, p = 0.002). Over the course of 5 years, left ventricular mass increased among those with TSH ≥10.0 mU/l, but other echocardiographic measurements were unchanged. Those patients with TSH 4.5 to 9.9 mU/l or with subclinical hyperthyroidism had no increase in risk of HF. Conclusions: Compared with euthyroid older adults, those adults with TSH ≥10.0 mU/l have a moderately increased risk of HF and alterations in cardiac function but not older adults with TSH <10.0 mU/l. Clinical trials should assess whether the risk of HF might be ameliorated by thyroxine replacement in individuals with TSH ≥10.0 mU/l.

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