1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea.
2 Department of Internal Medicine, Graduate School, Hanyang University , Seoul, Republic of Korea.
Thyroid. 2018 Sep;28(9):1101-1110. doi: 10.1089/thy.2017.0414. Epub 2018 Aug 17.
To determine the impact of subclinical hypothyroidism (SCH) on the risk of cardiovascular disease (CVD) and all-cause mortality, a comprehensive meta-analysis was performed according to the age or coexisting CVD risk status of the participants.
Studies regarding the association of SCH with all-cause mortality from PubMed and Embase databases were included. The pooled relative risk (RR) of CVD and all-cause mortality was calculated using the Mantel-Haenszel method. A subgroup analysis of participants with high CVD risk was conducted, including history of coronary, cerebral, or peripheral artery disease; dilated cardiomyopathy; heart failure; atrial fibrillation; venous thromboembolism; diabetes mellitus; or chronic kidney disease.
In total, 35 eligible articles incorporating 555,530 participants were included. SCH was modestly associated with CVD and all-cause mortality (RR for CVD = 1.33 [confidence interval (CI) 1.14-1.54]; RR for all-cause mortality = 1.20 [CI 1.07-1.34]). However, the association was not observed in participants aged ≥65 years. Subgroup analysis showed that participants with SCH and high CVD risk showed a significantly higher risk of all-cause mortality (RR for CVD = 2.20 [CI 1.28-3.77]; RR for all-cause mortality = 1.66 [CI 1.41-1.94]), whereas those with SCH and low CVD risk did not. Additional subgroup analysis of six studies with a mean participant age of ≥65 years and high CVD risk showed a significant high risk of all-cause mortality in the SCH group (RR = 1.41 [CI 1.08-1.85]; I = 0%).
SCH is associated with an increased CVD risk and all-cause mortality, particularly in participants with high CVD risk.
根据参与者的年龄或并存的心血管疾病（CVD）风险状况，进行综合荟萃分析，以确定亚临床甲状腺功能减退症（SCH）对心血管疾病（CVD）和全因死亡率风险的影响。
纳入了来自 PubMed 和 Embase 数据库中关于 SCH 与全因死亡率相关性的研究。使用 Mantel-Haenszel 法计算 CVD 和全因死亡率的合并相对风险（RR）。对 CVD 风险较高的参与者进行了亚组分析，包括冠心病、脑或外周动脉疾病、扩张型心肌病、心力衰竭、心房颤动、静脉血栓栓塞、糖尿病或慢性肾脏病的病史。
共有 35 篇符合条件的文章纳入了 555530 名参与者。SCH 与 CVD 和全因死亡率呈中度相关（CVD 的 RR=1.33[1.14-1.54]；全因死亡率的 RR=1.20[1.07-1.34]）。然而，这一关联在年龄≥65 岁的参与者中并未观察到。亚组分析显示，SCH 且 CVD 风险较高的参与者全因死亡率的风险显著增加（CVD 的 RR=2.20[1.28-3.77]；全因死亡率的 RR=1.66[1.41-1.94]），而 CVD 风险较低的参与者则没有。对六项研究进行的进一步亚组分析显示，参与者的平均年龄≥65 岁且 CVD 风险较高，SCH 组的全因死亡率风险显著升高（RR=1.41[1.08-1.85]；I=0%）。
SCH 与 CVD 风险增加和全因死亡率升高相关，尤其在 CVD 风险较高的患者中。
