Thyroid Antibody Status, Subclinical Hypothyroidism, and the Risk of Coronary Heart Disease: An Individual Participant Data Analysis

• Main Author: Collet, Tinh-Hai
• Publication Date: 2014
• Other Authors: Bauer, Douglas C., Cappola, Anne R., Asvold, Bjorn O., Weiler, Stefan, Vittinghoff, Eric, Gussekloo, Jacobijn, Bremner, Alexandra, den Elzen, Wendy P. J., Maciel, Rui Monteiro de Barros [UNIFESP], Vanderpump, Mark P. J., Cornuz, Jacques, Doerr, Marcus, Wallaschofski, Henri, Newman, Anne B., Sgarbi, Jose Augusto [UNIFESP], Razvi, Salman, Voelzke, Henry, Walsh, John P., Aujesky, Drahomir, Rodondi, Nicolas, Thyroid Studies Collaboration
• Format: Article
• Language: eng
• Source: Repositório Institucional da UNIFESP
• Download full: http://dx.doi.org/10.1210/jc.2014-1250; http://repositorio.unifesp.br/handle/11600/38126

Context: Subclinical hypothyroidism has been associated with increased risk of coronary heart disease (CHD), particularly with thyrotropin levels of 10.0 mIU/L or greater. the measurement of thyroid antibodies helps predict the progression to overt hypothyroidism, but it is unclear whether thyroid autoimmunity independently affects CHD risk.Objective: the objective of the study was to compare the CHD risk of subclinical hypothyroidism with and without thyroid peroxidase antibodies (TPOAbs).Data Sources and Study Selection: A MEDLINE and EMBASE search from 1950 to 2011 was conducted for prospective cohorts, reporting baseline thyroid function, antibodies, and CHD outcomes.Data Extraction: Individual data of 38 274 participants from six cohorts for CHD mortality followed up for 460 333 person-years and 33 394 participants from four cohorts for CHD events.Data Synthesis: Among 38 274 adults (median age 55 y, 63% women), 1691 (4.4%) had subclinical hypothyroidism, of whom 775 (45.8%) had positive TPOAbs. During follow-up, 1436 participants died of CHD and 3285 had CHD events. Compared with euthyroid individuals, age-and gender-adjusted risks of CHD mortality in subclinical hypothyroidism were similar among individuals with and without TPOAbs [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.87-1.53 vs HR 1.26, CI 1.01-1.58, P for interaction = .62], as were risks of CHD events (HR 1.16, CI 0.87-1.56 vs HR 1.26, CI 1.02-1.56, P for interaction = .65). Risks of CHD mortality and events increased with higher thyrotropin, but within each stratum, risks did not differ by TPOAb status.Conclusions: CHD risk associated with subclinical hypothyroidism did not differ by TPOAb status, suggesting that biomarkers of thyroid autoimmunity do not add independent prognostic information for CHD outcomes.