Onat Altan, Aydın Mesut, Can Günay, Çelik Etem, Altay Servet, Karagöz Ahmet, Ademoğlu Evin
Cerrahpaşa Faculty of Medicine, Nisbetiye cad. 59/24 Etiler, 34335, Istanbul, Turkey,
Endocrine. 2015 Feb;48(1):218-26. doi: 10.1007/s12020-014-0269-z. Epub 2014 May 3.
Whether euthyroid status affects cardiovascular disease risk is unclear. We aimed to investigate whether serum thyroid-stimulating hormone (TSH) levels within the normal range are related to the risk of coronary heart disease (CHD). In participants of the Turkish Adult Risk Factor Study (mean age 52.7±11.5), in whom TSH was measured in the 2004/05 survey, cross-sectional and longitudinal analyses were performed. Subjects with TSH concentrations<0.3 and >4.2 mIU/L were excluded to ensure euthyroid status leaving 956 individuals as the study sample. Mean follow-up was 4.81±1.3 years. Men had 18% lower (p<0.001) geometric mean TSH levels (1.10 mIU/L) than women (1.35 mIU/L). Correlations of TSH with risk variables were notably virtually absent except weakly positive ones in men with age and systolic blood pressure (SBP). The age-adjusted TSH mid-tertile in men was associated with lowest lipoprotein Lp, apoB, and total cholesterol values. Incident CHD was predicted in Cox regression analyses in men [HR of 2.45 (95 %CI 1.05; 5.74] and in combined sexes by the lowest compared with the highest TSH tertile, after adjustment for age, smoking status, SBP, and LDL-cholesterol. Analysis for combined prevalent and incident CHD stratified by metabolic syndrome (MetS) confirmed the independent association with the lowest TSH tertile in men, specifically in men without MetS. TSH levels within normal range, low due to partial assay failure, may manifest as independent predictors of incident CHD, particularly in middle-aged men. Autoimmune responses involving serum Lp(a) under oxidative stress might be implicated mechanistically.
甲状腺功能正常状态是否会影响心血管疾病风险尚不清楚。我们旨在研究正常范围内的血清促甲状腺激素（TSH）水平是否与冠心病（CHD）风险相关。在土耳其成人风险因素研究的参与者（平均年龄52.7±11.5岁）中，于2004/05年调查中测量了TSH水平，并进行了横断面和纵向分析。排除TSH浓度<0.3和>4.2 mIU/L的受试者以确保甲状腺功能正常状态，剩余956人作为研究样本。平均随访时间为4.81±1.3年。男性的几何平均TSH水平（1.10 mIU/L）比女性（1.35 mIU/L）低18%（p<0.001）。TSH与风险变量之间的相关性几乎不存在，仅在男性中与年龄和收缩压（SBP）存在弱正相关。男性中年龄调整后的TSH三分位数中位数与最低的脂蛋白Lp、载脂蛋白B和总胆固醇值相关。在Cox回归分析中，调整年龄、吸烟状态、SBP和低密度脂蛋白胆固醇后，男性中TSH三分位数最低组与最高组相比，预测冠心病发病的风险比为2.45（95%CI 1.05；5.74），在男女合并分析中也有类似结果。按代谢综合征（MetS）分层对冠心病患病率和发病率合并分析证实，男性中TSH三分位数最低组存在独立相关性，特别是在无MetS的男性中。正常范围内因部分检测失败而较低的TSH水平可能表现为冠心病发病的独立预测因素，尤其是在中年男性中。氧化应激下涉及血清Lp(a)的自身免疫反应可能在机制上起作用。
