甲状腺功能减退与心房颤动事件的关系（来自弗雷明汉心脏研究）。
Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study).
机构信息
Department of Medicine, Boston University School of Medicine, Boston, MA.
National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA; Department of Mathematics and Statistics, Boston University, Boston MA.
出版信息
Am Heart J. 2014 Jan;167(1):123-6. doi: 10.1016/j.ahj.2013.10.012. Epub 2013 Oct 19.
BACKGROUND
Hyperthyroidism has a well-described association with atrial fibrillation (AF). However, the relation of hypothyroidism to AF has had limited investigation. Hypothyroidism is associated with cardiovascular risk factors, subclinical cardiovascular disease, and overt cardiovascular disease, all of which predispose to AF. We investigated 10-year incidence of AF in a community-dwelling cohort.
METHODS
Among 6,653 Framingham heart Study participants, 5,069 participants, 52% female, with mean age of 57 ± 12 years, were eligible after excluding those with missing thyroid-stimulating hormone (TSH), TSH <0.45 μU/L (hyperthyroid), TSH >19.9 μU/L, or prevalent AF. Thyroid-stimulating hormone was categorized by range (≥0.45 to <4.5, 4.5 to <10.0, 10.0 to ≤19.9 μU/L) and by quartiles. We examined the associations between TSH and 10-year risk of AF using multivariable-adjusted Cox proportional hazards analysis.
RESULTS
Over 10-year follow-up, we observed 277 cases of incident AF. A 1-SD increase in TSH was not associated with increased risk of AF (hazard ratio 1.01, 95% CI 0.90-1.14, P = .83). In categorical analysis, using TSH ≥0.45 to <4.5 μU/L as the referent (equivalent to euthyroid state), we found no significant association between hypothyroidism and 10-year AF risk. Comparing the highest (2.6 < TSH < 19.9 μU/L) to lowest (0.45 < TSH < 1.3 μU/L) quartiles of TSH further did not identify a significant association between TSH levels and 10-year risk of AF.
CONCLUSIONS
In conclusion, we did not identify a significant association between hypothyroidism and 10-year risk of incident AF in a community-based study.
背景
甲状腺功能亢进症与心房颤动（AF）有明确的关联。然而，甲状腺功能减退症与 AF 的关系研究有限。甲状腺功能减退症与心血管危险因素、亚临床心血管疾病和显性心血管疾病相关，所有这些都会导致 AF。我们研究了一个社区居民队列中 10 年的 AF 发生率。
方法
在弗雷明汉心脏研究的 6653 名参与者中，有 5069 名参与者（52%为女性），年龄为 57 ± 12 岁，在排除了 TSH 缺失（甲状腺刺激激素）、TSH<0.45μU/L（甲状腺功能亢进）、TSH>19.9μU/L 或已有 AF 的参与者后，符合条件。TSH 按范围（≥0.45 至<4.5、4.5 至<10.0、10.0 至≤19.9μU/L）和四分位进行分类。我们使用多变量调整 Cox 比例风险分析来检查 TSH 与 10 年 AF 风险之间的关联。
结果
在 10 年的随访期间，我们观察到 277 例新发 AF。TSH 每增加 1-SD，AF 风险并无增加（风险比 1.01，95%置信区间 0.90-1.14，P=0.83）。在分类分析中，我们将 TSH≥0.45 至<4.5μU/L 作为参考（相当于甲状腺功能正常状态），发现甲状腺功能减退症与 10 年 AF 风险之间无显著关联。比较 TSH 最高（2.6<TSH<19.9μU/L）和最低（0.45<TSH<1.3μU/L）四分位的 TSH 进一步表明，TSH 水平与 10 年 AF 风险之间无显著关联。
结论
总之，在一项基于社区的研究中，我们未发现甲状腺功能减退症与 10 年新发 AF 风险之间存在显著关联。
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