Møllehave Line Tang, Skaaby Tea, Linneberg Allan, Knudsen Nils, Jørgensen Torben, Thuesen Betina Heinsbæk
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Endocrine. 2020 May;68(2):358-367. doi: 10.1007/s12020-020-02216-5. Epub 2020 Feb 10.
Thyroid dysfunction may affect the risk of cardiovascular disease and mortality through effects on myocardial and vascular tissue and metabolism. Levels of thyroid stimulating hormone (TSH) indicates thyroid function. We aimed to assess the association between TSH-levels and incident ischemic heart disease (IHD), incident stroke, and all-cause mortality.
We included 13,865 participants (18-71 years, 51.6% women) from five cohort studies conducted during 1974-2008 were included. TSH was measured at the baseline examination and classified as <0.4; 0.4-2.5 (ref.); 2.5-5.0; 5.0-10, or >10 mU/l. Incident IHD, incident stroke, and all-cause mortality were identified in registries until ultimo 2013. Data were analysed by multivariate Cox regression with age as underlying time axis. Results from the individual cohorts were pooled by random-effects meta-analysis.
The crude incidence rate was for IHD 7.8 cases/1000 person years (PY); stroke 5.4 cases/1000 PY; and all-cause mortality 11.3 deaths/1000 PY (mean follow-up: 14 years). Analyses showed no statistically significant associations between TSH-levels and incident IHD or incident stroke in the partly or fully adjusted models. There was a statistically significant association between TSH of 2.5-5 mU/l and all-cause mortality (hazard ratio 1.145 (95% CI 1.004-1.306) compared with TSH of 0.4-2.5 mU/l in the fully adjusted model.
The results do not provide evidence of a harmful effect of decreased or increased TSH on IHD or stroke in the general population. However, there is some indication of an elevated risk for all-cause mortality with TSH 2.5-5 mU/l compared with 0.4-2.5 mU/l.
甲状腺功能障碍可能通过影响心肌、血管组织及代谢，进而影响心血管疾病风险及死亡率。促甲状腺激素（TSH）水平可反映甲状腺功能。我们旨在评估TSH水平与缺血性心脏病（IHD）、中风及全因死亡率之间的关联。
我们纳入了1974年至2008年期间开展的五项队列研究中的13,865名参与者（年龄18 - 71岁，女性占51.6%）。在基线检查时测量TSH，并将其分类为<0.4；0.4 - 2.5（参照值）；2.5 - 5.0；5.0 - 10或>10 mU/l。通过登记系统确定直至2013年底的新发IHD、新发中风及全因死亡率。以年龄为基础时间轴，采用多变量Cox回归分析数据。各队列研究结果通过随机效应荟萃分析进行汇总。
IHD的粗发病率为7.8例/1000人年（PY）；中风为5.4例/1000 PY；全因死亡率为11.3例/1000 PY（平均随访时间：14年）。分析表明，在部分或完全调整模型中，TSH水平与新发IHD或新发中风之间无统计学显著关联。在完全调整模型中，TSH为2.5 - 5 mU/l与全因死亡率之间存在统计学显著关联（风险比1.145（95%可信区间1.004 - 1.306）），而参照值为TSH 0.4 - 2.5 mU/l。
结果未提供证据表明TSH降低或升高对普通人群的IHD或中风有有害影响。然而，有迹象表明，与TSH 0.4 - 2.5 mU/l相比，TSH 2.5 - 5 mU/l时全因死亡风险升高。
