Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Sun, Jing; Yao, Liang; Fang, Yuan; Yang, Rong; Chen, Yaolong; Yang, Kun; Tian, Limin

doi:10.1155/2017/8130796

Cited by 60 publications

(61 citation statements)

References 55 publications

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“…Among the 52 included eligible MAs, 4628–73 (46/52, 88.5%) were published in English, and the rest74–79 (6/52, 11.5%) were published in Chinese. The 52 included MAs contained 685 studies, with an average of 13.2 (range: 3–39) studies per article.…”

Section: Resultsmentioning

confidence: 99%

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

Tian¹,

Shao²,

Qin³

et al. 2019

BMJ Open

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ObjectivesThere is an increasing prevalence of hypothyroidism and there is a growing body of meta-analyses (MAs) on the association between hypothyroidism and other diseases. However, the methodological quality of the MAs significantly varies. Thus, this study aimed to evaluate and summarise data on the methodological quality of MAs on the associations between hypothyroidism and other diseases using the Assessment of Multiple Systematic Reviews (AMSTAR) scale, providing suggestions for clinical decision-making processes.DesignTo assess the methodological quality of MAs using the AMSTAR scale.Data sourcesA systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, web of science and Chinese Biomedicine Literature Database.Eligibility criteriaWe included MAs that had assessed the association between hypothyroidism and other diseases in humans and that had full texts regardless of the publication status. No restriction applied on language or date.Data extraction and synthesisTwo reviewers independently screened the titles and abstracts of all searched literature to acquire potentially eligible publications. The full texts of possible eligible publications were downloaded and assessed. Inconsistent comments were resolved through discussions with a third reviewer.Results52 studies were included. The average AMSTAR score of the included articles was 8.6 (range: 5–10), and those of English and Chinese MAs were 8.8 and 7.0, respectively. A total of 52 MAs were evaluated, and 19 (36.5%) and 33 (63.5%) of these MAs were of moderate and high quality, respectively. None of the MAs were of low quality. Only two MAs had an a priori design. Items 3, 5 and 9 had the highest compliance (50/52, 96.2%), and aside from item 1, items 7 and 8 had the lowest compliance (33/52,63.5%). According to the results of these MAs, hypothyroidism was significantly associated with cardiovascular diseases, metabolic diseases, neuropsychiatric disorders, breast cancer and pregnancy outcome.ConclusionsThe methodological quality of the included MAs on the association between hypothyroidism and other diseases was moderate to high. MAs with high qualities confirmed that hypothyroidism was significantly associated with cardiovascular diseases, metabolic syndrome, preterm birth and neonatal outcomes. Consideration of scientific quality when formulating conclusions should be made explicit and more attention should be paid to improving the methodological quality of MAs, and increasing their applicability for clinical decision-making.

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Section: Resultsmentioning

confidence: 99%

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

Tian¹,

Shao²,

Qin³

et al. 2019

BMJ Open

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“…In contrast, a recent retrospective study by Grossman et al demonstrated that SCH is associated with increased mortality in the elderly [11] . A recent review reported that SCH was not associated with increased risk of cardiovascular mortality or total mortality in the elderly [16] . However, owing to the relatively few studies, the result should be interpreted carefully and con rmed by further studies.…”

Section: Discussionmentioning

confidence: 99%

“…A recent cohort study on 80,490 persons found that the association between SCH between all-cause or vascular mortality was stronger in men below 60 years compared to older males [23] . Another meta-analysis showed that the risk of the cardiovascular and all-cause mortality is higher in those mean age < 65 years than for those of average age ≥ 65 years [16] . All these results suggested that there may be age-related mortality difference associated with SCH, with stronger association in younger patients that attenuated advancing age.…”

Section: Discussionmentioning

confidence: 99%

The impact of subclinical hypothyroidism on long-term outcomes in older patients undergoing percutaneous coronary intervention

Liu

Wei

Wang

et al. 2020

Preprint

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Abstract BackgroundSubclinical hypothyroidism (SCH) is reportedly associated with an increased risk of adverse events in patients undergoing percutaneous coronary intervention (PCI). The prognostic significance of SCH in the elderly was poorly defined. The purpose of this study was to evaluate the association between SCH and long-term outcomes in older patients undergoing PCI. Methods and Results 3168 patients aged 65 years or older who underwent PCI from January 2012 to October 2013 were included. Patients were divided into SCH group (n = 320) and euthyroidism (ET) group (n = 2848) based on thyroid function test. Cox proportional hazard regression analyses were used to estimate the relative risks (RRs) of all-cause death and cardiac death for patients with SCH during a 4-year follow-up period. There were 227 deaths during the follow-up period including 124 deaths caused by cardiac events. There was no significant difference in mortality rate between the SCH group and the ET group (p > 0.05). After adjustment for covariates, compared with patients with ET, the RRs of death from all-cause and cardiac in patients with SCH were 1.261 (95%CI: 0.802–1.982, p = 0.315) and 1.231 (95%CI: 0.650–2.334, p = 0.524), respectively. When SCH was stratified by age, gender, and degree of thyroid-stimulating hormone elevation, no significant associations were also found in any stratum. Conclusion Our investigation revealed that SCH was negatively associated with the outcome of PCI in older patients.

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“…Numerous studies have reported improvement in vascular and cardiac function and arterial stiffness in patients with SH 26, 27 . A meta-analysis showed a possible relationship between SH and an increased risk of coronary heart disease mortality compared with euthyroidism 28 . TRT was observed beneficial in preventing major adverse cardiovascular and cerebral events for hypothyroidism patients undergoing percutaneous coronary intervention 15 .…”

Section: Subclinical Hypothyroidismmentioning

confidence: 99%

Outcomes of Cardiac Resynchronization Therapy in Patients with Hypothyroidism and Heart Failure

YANG

Morris

et al. 2020

Preprint

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Background Hypothyroidism is known to be associated with adverse clinical outcomes in heart failure. The association between hypothyroidism and cardiac resynchronization therapy outcomes in patients with severe heart failure is not clear. Methods The study included 1,316 patients who received cardiac resynchronization therapy between 2002 and 2015. Baseline demographics and cardiac resynchronization therapy outcomes, including left ventricular ejection fraction, New York Heart Association class, appropriate implantable cardioverter-defibrillator therapy, and all-cause mortality, were collected from the electronic health record. Results Of the study cohort, 349 patients (26.5%) were classified as the hypothyroidism group. The median duration of follow-up was 3.6 years (interquartile range, 1.7-6.2). Hypothyroidism was associated with a greater all-cause mortality than euthyroidism (hazard ratio, 1.19; 95% CI, 1.01-1.38; P=0.04). In this group, the risk of appropriate implantable cardioverter-defibrillator therapy significantly increased in association with increased baseline thyroid-stimulating hormone level (hazard ratio, 1.27 per 5 mIU/L increase, 95% CI, 1.00-1.53, P=0.04). Conclusions Cardiac resynchronization therapy improves cardiac function in hypothyroid patients. Hypothyroidism has adverse effects on cardiac resynchronization therapy outcomes with reduced survival and increased implantable cardioverter-defibrillator therapies for ventricular arrhythmic events.

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Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Cited by 60 publications

References 55 publications

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

The impact of subclinical hypothyroidism on long-term outcomes in older patients undergoing percutaneous coronary intervention

Outcomes of Cardiac Resynchronization Therapy in Patients with Hypothyroidism and Heart Failure

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