Abstract
Objectives
Subclinical thyroid disease is the most common form of thyroid dysfunction and may
be associated with adverse cardiovascular outcomes in people at high risk for cardiovascular
events. Our objective in this study was to assess the association of thyroid function
and thyroid hormone replacement with cardiovascular outcomes in high-risk individuals
with dysglycemia and additional cardiovascular risk factors.
Methods
The relationship between baseline thyrotropin (TSH) level and incidence of the composite
outcome of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death;
an expanded composite of this outcome plus revascularization or hospitalization for
heart failure; and mortality was assessed in 8,401 ORIGIN trial participants with
a baseline measurement of TSH. The hazard of each outcome according to either baseline
levothyroxine use or TSH-defined hyperthyroidism, euthyroidism, subclinical hypothyroidism
and overt hypothyroidism was estimated before and after adjustment for baseline demographic
and clinical characteristics and treatment allocation.
Results
Of all participants, 91.5% were euthyroid, 0.8% were hyperthyroid, 5.5% had subclinical
hypothyroidism and 2.2% had overt hypothyroidism. Subclinical hypothyroidism predicted
both the expanded cardiovascular outcome (hazard ratio [HR]=1.24, 95% confidence interval
[CI] 1.06 to 1.46) and mortality (HR=1.37, 95% CI 1.12 to 1.67), whereas levothyroxine
use predicted fewer deaths (HR=0.72, 95% CI 0.56 to 0.94).
Conclusion
Subclinical hypothyroidism predicts future cardiovascular events and mortality in
people with dysglycemia and other cardiovascular risk factors.
Résumé
Objectifs
La maladie thyroïdienne infraclinique qui est la forme la plus fréquente de dysfonctionnement
de la thyroïde peut être associée à des événements cardiovasculaires défavorables
chez les personnes exposées au risque d’événements cardiovasculaires. L’objectif de
notre étude était d’évaluer l’association entre le fonctionnement de la thyroïde ou
le remplacement de l’hormone thyroïdienne, et les événements cardiovasculaires chez
les individus ayant une dysglycémie et d’autres facteurs de risque cardiovasculaire.
Méthodes
Nous avons évalué la relation entre la concentration initiale de thyréostimuline (TSH)
et la fréquence de survenue du critère de jugement composite d’infarctus du myocarde
non mortel, d’accident vasculaire cérébral non mortel ou de mort d’origine cardiovasculaire;
un critère de jugement composite élargi de cet événement plus la revascularisation
ou l’hospitalisation en raison de l’insuffisance cardiaque; et la mortalité chez les
8401 participants de l’étude ORIGIN qui avaient eu un dosage initial de la TSH. Le
risque de survenue de chaque événement selon l’utilisation initiale de la lévothyroxine
ou l’hyperthyroïdie, l’euthyroïdie, l’hypothyroïdie infraclinique et l’hypothyroïdie
manifeste établies en fonction de la TSH a été estimé avant et après l’ajustement
des caractéristiques démographiques et cliniques initiales et l’administration du
traitement.
Résultats
Parmi tous les participants, 91,5 % étaient en euthyroïdie, 0,8 % étaient en hyperthyroïdie,
5,5 % avaient une hypothyroïdie infraclinique et 2,2 % avaient une hypothyroïdie manifeste.
L’hypothyroïdie infraclinique permettait de prédire un événement cardiovasculaire
(rapport de risque [RR] = 1,24, intervalle de confiance [IC] à 95 % de 1,06 à 1,46)
et la mortalité (RR = 1,37, IC à 95 % de 1,12 à 1,67), alors que l’utilisation de
la lévothyroxine permettait de prédire un moins grand nombre de décès (RR = 0,72,
IC à 95 % de 0,56 à 0,94).
Conclusion
L’hypothyroïdie infraclinique permet de prédire les futurs événements cardiovasculaires
et la mortalité chez les personnes ayant une dysglycémie et d’autres facteurs de risque
cardiovasculaire.
Keywords
Mots clés
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Article info
Publication history
Published online: January 31, 2023
Accepted:
January 24,
2023
Received in revised form:
December 9,
2022
Received:
July 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Canadian Diabetes Association.
