Rodondi Nicolas, Aujesky Drahomir, Vittinghoff Eric, Cornuz Jacques, Bauer Douglas C
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
Am J Med. 2006 Jul;119(7):541-51. doi: 10.1016/j.amjmed.2005.09.028.
Subclinical hypothyroidism has been associated with elevated cholesterol and increased risk for atherosclerosis, but data on the risk of coronary heart disease (CHD) are conflicting. We performed a systematic review to determine whether subclinical hypothyroidism is associated with CHD in adults.
We searched MEDLINE from 1966 to April 2005, and the bibliographies of key articles to identify studies that provided risk estimates for CHD or cardiovascular mortality associated with subclinical hypothyroidism. Two authors independently reviewed each potential study for eligibility, assessed methodologic quality, and extracted the data.
We identified 14 observational studies that met eligibility criteria. Subclinical hypothyroidism increased the risk of CHD (summary odds ratio [OR]: 1.65, 95% confidence interval [CI], 1.28-2.12). The summary OR for CHD was 1.81 (CI, 1.38-2.39) in 9 studies adjusted or matched for demographic characteristics, and 2.38 (CI, 1.53-3.69) after pooling the studies that adjusted for most cardiovascular risk factors. Sensitivity analyses including only population-based studies and those with formal outcome adjudication procedures yielded similar results. Subgroup analyses by type of study design showed a similar trend, but lower risk, in the 5 prospective cohort studies (OR 1.42, CI, 0.91-2.21), compared with the case-control and cross-sectional studies (OR 1.72, CI, 1.25-2.38).
Our systematic review indicates that subclinical hypothyroidism is associated with an increased risk of CHD. Clinical trials are needed to assess whether thyroxine replacement reduces the risk of CHD in subjects with subclinical hypothyroidism.
亚临床甲状腺功能减退与胆固醇升高及动脉粥样硬化风险增加有关，但关于冠心病（CHD）风险的数据存在矛盾。我们进行了一项系统评价，以确定亚临床甲状腺功能减退是否与成年人的冠心病相关。
我们检索了1966年至2005年4月的MEDLINE以及关键文章的参考文献，以识别提供与亚临床甲状腺功能减退相关的冠心病或心血管死亡率风险估计的研究。两位作者独立审查每项潜在研究的 eligibility，评估方法学质量并提取数据。
我们确定了14项符合 eligibility 标准的观察性研究。亚临床甲状腺功能减退增加了冠心病风险（汇总比值比[OR]：1.65，95%置信区间[CI]，1.28 - 2.12）。在9项针对人口统计学特征进行调整或匹配的研究中，冠心病的汇总OR为1.81（CI，1.38 - 2.39），在汇总针对大多数心血管危险因素进行调整的研究后为2.38（CI，1.53 - 3.69）。仅包括基于人群的研究和具有正式结局判定程序的研究的敏感性分析得出了类似的结果。按研究设计类型进行的亚组分析显示出类似趋势，但与病例对照研究和横断面研究（OR 1.72，CI，1.25 - 2.38）相比，5项前瞻性队列研究中的风险较低（OR 1.42，CI，0.91 - 2.21）。
我们的系统评价表明，亚临床甲状腺功能减退与冠心病风险增加相关。需要进行临床试验来评估甲状腺素替代治疗是否能降低亚临床甲状腺功能减退患者的冠心病风险。
