Department of Preventive Medicine, College of Medicine; Graduate School; Korea University, Seoul, Republic of Korea.
National Health Institute Service, Health Insurance Policy Research Institute, Wonju, Republic of Korea.
Thyroid. 2020 Jul;30(7):955-965. doi: 10.1089/thy.2019.0543. Epub 2020 Mar 26.
Hyperthyroidism is associated with various cardiovascular risk factors. However, the relationship between hyperthyroidism and myocardial infarction (MI) or stroke has not been fully elucidated; only a few studies have investigated the association of hyperthyroidism with survival after MI or stroke. We included 59,021 hyperthyroid patients and a control cohort with 1,180,420 age- and sex-matched subjects from the Korean National Health Insurance database. Blood pressure, body mass index (BMI), glucose and cholesterol levels, and smoking history were obtained during National Health screening examination. We compared the incidence of MI, stroke, and survival after cardiovascular events between subjects with hyperthyroidism and the control cohort. Subjects with hyperthyroidism had higher blood pressure, fasting glucose, and smoking rate, but lower cholesterol levels and a lower obesity rate compared with the control cohort. After adjusting these differences, as well as atrial fibrillation, hyperthyroidism was associated with increased risk of MI and ischemic stroke. Adjusted hazard ratios (HRs) for MI and ischemic stroke with hyperthyroidism was 1.16 [95% confidence interval, CI 1.03-1.30] and 1.12 [CI 1.04-1.20], respectively. In age-, sex-, and BMI-stratified analyses, an increased risk of MI and ischemic stroke remained significant in females, the older age group (≥50 years), and nonobese subjects (BMI <25 kg/m), but not in males, the younger age group (<50 years), and obese subjects (BMI ≥25 kg/m). The risk of hemorrhagic stroke was not different between subjects with hyperthyroidism and controls. Adjusted HRs for mortality in subjects with hyperthyroidism who developed MI, ischemic stroke, and hemorrhagic stroke were 1.11 ([CI 0.86-1.43], = 0.44), 0.89 ([CI 0.75-1.05], = 0.16), and 1.13 ([CI 0.88-1.47], = 0.34), respectively. Hyperthyroidism is associated with increased risk of MI and ischemic stroke, independent of cardiovascular risk factors. This association is prominent in subjects with age ≥50 years, in females, and in the nonobese group. Hyperthyroidism did not significantly affect the mortality secondary to cardiovascular events.
甲状腺功能亢进与多种心血管危险因素相关。然而，甲状腺功能亢进与心肌梗死（MI）或中风之间的关系尚未完全阐明；仅有少数研究调查了甲状腺功能亢进与 MI 或中风后生存的关系。我们从韩国国家健康保险数据库中纳入了 59021 例甲状腺功能亢进患者和 1180420 例年龄和性别匹配的对照组。在国家健康检查期间获得了血压、体重指数（BMI）、血糖和胆固醇水平以及吸烟史。我们比较了甲状腺功能亢进患者和对照组的 MI、中风以及心血管事件后生存的发生率。与对照组相比，甲状腺功能亢进患者的血压、空腹血糖和吸烟率较高，但胆固醇水平较低，肥胖率较低。在调整这些差异以及心房颤动后，甲状腺功能亢进与 MI 和缺血性中风风险增加相关。甲状腺功能亢进患者发生 MI 和缺血性中风的调整后的危险比（HR）分别为 1.16（95%置信区间，CI 1.03-1.30）和 1.12（CI 1.04-1.20）。在年龄、性别和 BMI 分层分析中，女性、年龄较大组（≥50 岁）和非肥胖组（BMI＜25kg/m）中 MI 和缺血性中风的风险增加仍然显著，但在男性、年龄较小组（＜50 岁）和肥胖组（BMI≥25kg/m）中则不然。甲状腺功能亢进患者与对照组之间的出血性中风风险无差异。甲状腺功能亢进患者发生 MI、缺血性中风和出血性中风后的死亡率调整后的 HR 分别为 1.11（CI 0.86-1.43），0.89（CI 0.75-1.05），和 1.13（CI 0.88-1.47）。甲状腺功能亢进与 MI 和缺血性中风风险增加相关，独立于心血管危险因素。这种关联在年龄≥50 岁的患者、女性和非肥胖组中更为明显。甲状腺功能亢进并未显著影响心血管事件后的死亡率。
