Chaker Layal, van den Berg Marten E, Niemeijer Maartje N, Franco Oscar H, Dehghan Abbas, Hofman Albert, Rijnbeek Peter R, Deckers Jaap W, Eijgelsheim Mark, Stricker Bruno H C, Peeters Robin P
From Rotterdam Thyroid Center (L.C., R.P.P.), Department of Internal Medicine (L.C., B.H.C.S., R.P.P.), and Department of Epidemiology (L.C., M.E.v.d.B., M.N.N., O.H.F., A.D., A.H., M.E., B.H.C.S., R.P.P.), Erasmus University Medical Center; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Departments of Medical Informatics (P.R.R.) and Cardiology (J.W.D.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Inspectorate of Health Care, Utrecht, The Netherlands (B.H.C.S.).
Circulation. 2016 Sep 6;134(10):713-22. doi: 10.1161/CIRCULATIONAHA.115.020789.
The association between thyroid function and cardiovascular disease is well established, but no study to date has assessed whether it is a risk factor for sudden cardiac death (SCD). Therefore, we studied the association of thyroid function with SCD in a prospective population-based cohort.
Participants from the Rotterdam Study ≥45 years with thyroid-stimulating hormone or free thyroxine (FT4) measurements and clinical follow-up were eligible. We assessed the association of thyroid-stimulating hormone and FT4 with the risk of SCD by using an age- and sex-adjusted Cox proportional-hazards model, in all participants and also after restricting the analysis to euthyroid participants (defined by thyroid-stimulating hormone 0.4-4.0 mIU/L). Additional adjustment included cardiovascular risk factors, notably hypertension, serum cholesterol, and smoking. We stratified by age and sex and performed sensitivity analyses by excluding participants with abnormal FT4 values (reference range of 0.85-1.95 ng/dL) and including only witnessed SCDs as outcome. Absolute risks were calculated in a competing risk model by taking death by other causes into account.
We included 10 318 participants with 261 incident SCDs (median follow-up, 9.1 years). Higher levels of FT4 were associated with an increased SCD risk, even in the normal range of thyroid function (hazard ratio, 2.28 per 1 ng/dL FT4; 95% confidence interval, 1.31-3.97). Stratification by age or sex and sensitivity analyses did not change the risk estimates substantially. The absolute 10-year risk of SCD increased in euthyroid participants from 1% to 4% with increasing FT4 levels.
Higher FT4 levels are associated with an increased risk of SCD, even in euthyroid participants.
甲状腺功能与心血管疾病之间的关联已得到充分证实，但迄今为止尚无研究评估其是否为心源性猝死（SCD）的危险因素。因此，我们在一项基于人群的前瞻性队列研究中，探讨了甲状腺功能与SCD之间的关联。
鹿特丹研究中年龄≥45岁且有促甲状腺激素或游离甲状腺素（FT4）测量值及临床随访资料的参与者符合条件。我们使用年龄和性别校正的Cox比例风险模型，在所有参与者中以及将分析限制在甲状腺功能正常的参与者（促甲状腺激素定义为0.4 - 4.0 mIU/L）后，评估促甲状腺激素和FT4与SCD风险的关联。额外的校正包括心血管危险因素，尤其是高血压、血清胆固醇和吸烟。我们按年龄和性别进行分层，并通过排除FT4值异常（参考范围为0.85 - 1.95 ng/dL）的参与者以及仅将目击的心源性猝死作为结局进行敏感性分析。通过竞争风险模型计算绝对风险，同时考虑其他原因导致的死亡。
我们纳入了10318名参与者，其中有261例SCD事件（中位随访时间为9.1年）。即使在甲状腺功能正常范围内，FT4水平升高也与SCD风险增加相关（风险比为每1 ng/dL FT4 2.28；95%置信区间为1.31 - 3.97）。按年龄或性别分层以及敏感性分析并未显著改变风险估计值。随着FT4水平升高，甲状腺功能正常的参与者10年SCD绝对风险从1%增加到4%。
即使在甲状腺功能正常的参与者中，较高的FT4水平也与SCD风险增加相关。
