Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults

Cappola, Anne R.; Fried, Linda P.; Arnold, Alice M.; Danese, Mark D.; Kuller, Lewis H.; Burke, Gregory L.; Tracy, Russell P.; Ladenson, Paul W.

doi:10.1001/jama.295.9.1033

Cited by 745 publications

(696 citation statements)

References 41 publications

Supporting

Mentioning

637

Contrasting

Unclassified

Order By: Relevance

“…In the last few years, an increased number of prospective population-based cohort studies (100,138,140,158,(161)(162)(163)(164)(165)(166)(167) (A,A,A,A,A,A,A,A,A,B,B), have reported conflicting results on the potential relationship bet ween SH and cardiovascular disease and mortality. These discrepancies may be due to differences in the populations studied in terms of age, sex, race/ethnicity, life style, TSH cutoffs, differences in confounders adjustments, follow-up period, and selection bias (1) (D).…”

Section: Is Subclinical Hypothyroidism Associated To Cardiovascular Rmentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

125

123

View full text Add to dashboard Cite

Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

show abstract

Section: Is Subclinical Hypothyroidism Associated To Cardiovascular Rmentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

125

123

View full text Add to dashboard Cite

show abstract

“…Investigators have previously developed prognostic indices within segments of the population (e.g., hospitalized elders 12 and nursing home residents 13 ). Others have examined the influence of specific comorbid diseases or functional status on mortality [14][15][16] , and one study examined the influence of laboratory measures of subclinical and clinical disease (e.g., fasting glucose level) on 5-year mortality. 17 Only one study examined the influence of several self-reported characteristics (e.g., age, comorbid conditions) on 4-year mortality in a nationally representative sample of US adults aged 50 and older.…”

Section: Introductionmentioning

confidence: 99%

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

et al. 2009

View full text Add to dashboard Cite

BACKGROUND: Prognostic information is becoming increasingly important for clinical decision-making.OBJECTIVE: To develop and validate an index to predict 5-year mortality among community-dwelling older adults. DESIGN AND PARTICIPANTS:A total of 24,115 individuals aged >65 who responded to the 1997-2000 National Health Interview Survey (NHIS) with follow-up through 31 December 2002 from the National Death Index; 16,077 were randomly selected for the development cohort and 8,038 for the validation cohort.MEASUREMENTS: 39 risk factors (functional measures, illnesses, behaviors, demographics) were included in a multivariable Cox proportional hazards model to determine factors independently associated with mortality. Risk scores were calculated for participants using points derived from the final model's beta coefficients. To evaluate external validity, we compared survival by quintile of risk between the development and validation cohorts.RESULTS: Seventeen percent of participants had died by the end of the study. The final model included 11 variables: age (1 point for 70-74 up to 7 points for >85); male: 3 points; BMI <25: 2 points; perceived health (good: 1 point, fair/poor: 2 points); emphysema: 2 points; cancer: 2 points; diabetes: 2 points; dependent in instrumental activities of daily living: 2 points; difficulty walking: 3 points; smoker-former: 1 point, smoker-current: 3 points; past year hospitalizationsone: 1 point, >2: 3 points. We observed close agreement between 5-year mortality in the two cohorts; which ranged from 5% in the lowest risk quintile to 50% in the highest risk quintile in the validation cohort.CONCLUSIONS: This validated mortality index can be used to account for participant life expectancy in analyses using NHIS data.

show abstract

“…Its prevalence is also related to the degree of TSH suppression, with the age of the population studied being higher in subjects above the age of 60-70 years with low serum TSH levels (1). It is well recognized that the risk of adverse effects of SHyper is higher in elderly subjects because this disease could increase the risk of atrial fibrillation in the presence of subnormal (3) and undetectable serum TSH levels (3,4). Studies on the relationship between cardiovascular morbidity and mortality in exogenous SHyper (5)(6)(7)(8) induced by long-term treatment with L-T 4 have yielded conflicting results (9).…”

mentioning

confidence: 99%

“…Thus far, only a few studies have examined the risk of cardiovascular mortality in patients with endogenous SHyper (3,10,11); these were performed in middle-aged (11) and elderly subjects (3,10). Three studies have been performed in patients with co-morbidity associated with SHyper (12)(13)(14).…”

mentioning

confidence: 99%

Invited Commentary: Cardiovascular mortality in subclinical hyperthyroidism: an ongoing dilemma

Biondi¹

2010

European Journal of Endocrinology

View full text Add to dashboard Cite

The association of endogenous subclinical hyperthyroidism (SHyper) with cardiovascular mortality is controversial. This may reflect the different causes of endogenous SHyper in the population studied due to differences in iodine intake, and different selection criteria, e.g. sex, age, and race, the cutoff for serum TSH level, the duration of follow-up, and the presence of co-morbidities. A small sample size of SHyper patients could have caused a low statistical power in some of these studies. In other studies, the results were not adjusted for relevant confounders. Importantly, various meta-analyses have also given conflicting results. This issue of the European Journal of Endocrinology contains two articles that address the association between endogenous SHyper and cardiovascular and total mortality: one study was conducted in a north-eastern German population and the other in a Japanese-Brazilian population. After adjusting for relevant confounders, there was no association between decreased serum TSH levels and all-cause and cardiovascular mortality in the Pomerania study; on the contrary, all-cause mortality and cardiovascular mortality were significantly higher for individuals with SHyper in the Japanese-Brazilian population. Interestingly, both studies had similar characteristics in terms of selection criteria and duration of follow-up. It remains controversial whether or not to treat middle-aged patients with low serum TSH levels. Large prospective randomized controlled doubleblind studies of young and middle-aged patients with SHyper and without underlying cardiac disease are required to assess the potential benefits of treating endogenous SHyper in these age groups.

show abstract

Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults

Abstract: Our data show an association between subclinical hyperthyroidism and development of atrial fibrillation but do not support the hypothesis that unrecognized subclinical hyperthyroidism or subclinical hypothyroidism is associated with other cardiovascular disorders or mortality.

Cited by 745 publications

References 41 publications

Clinical practice guidelines for the management of hypothyroidism

Clinical practice guidelines for the management of hypothyroidism

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

Invited Commentary: Cardiovascular mortality in subclinical hyperthyroidism: an ongoing dilemma

Contact Info

Product

Resources

About