Ning Yu, Cheng Yun J, Liu Li J, Sara Jaskanwal D S, Cao Zhi Y, Zheng Wei P, Zhang Tian S, Han Hui J, Yang Zhen Y, Zhang Yi, Wang Fei L, Pan Rui Y, Huang Jie L, Wu Ling L, Zhang Ming, Wei Yong X
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
BMC Med. 2017 Feb 2;15(1):21. doi: 10.1186/s12916-017-0777-9.
Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality.
We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality.
Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01-1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05-1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38-2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13-1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28-3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26-1.81).
Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.
甲状腺功能减退是否为心血管事件的独立危险因素仍存在争议。我们旨在评估甲状腺功能减退与心血管事件风险及死亡率之间的关联。
我们检索了从数据库建立至2016年2月29日的PubMed和Embase。纳入队列研究，对甲状腺功能减退状态无限制。预先设定的主要结局为缺血性心脏病（IHD）、心脏死亡率、心血管死亡率和全因死亡率。
共识别出55项队列研究，涉及1,898,314名参与者。与甲状腺功能正常者相比，甲状腺功能减退患者发生IHD的风险更高（相对风险（RR）：1.13；95%置信区间（CI）：1.01 - 1.26）、心肌梗死（MI）（RR：1.15；95% CI：1.05 - 1.25）、心脏死亡率（RR：1.96；95% CI：1.38 - 2.80）和全因死亡率（RR：1.25；95% CI：1.13 - 1.39）；亚临床甲状腺功能减退（SCH；尤其是促甲状腺激素水平≥10 mIU/L时）也与IHD和心脏死亡率的较高风险相关。此外，与甲状腺功能正常的心脏病患者相比，甲状腺功能减退的心脏病患者发生心脏死亡率（RR：2.22；95% CI：1.28 - 3.83）和全因死亡率（RR：1.51；95% CI：1.26 - 1.81）的风险更高。
甲状腺功能减退是IHD和心脏死亡率的危险因素。在普通人群或心脏病患者中，与甲状腺功能正常相比，甲状腺功能减退与心脏死亡率和全因死亡率的较高风险相关。
