Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
Eur J Endocrinol. 2021 Aug 3;185(3):375-385. doi: 10.1530/EJE-20-1442.
To evaluate if subclinical thyroid dysfunction is associated with cardiovascular (CV) risk in patients with atrial fibrillation (AF).
Swiss-AF is a prospective cohort of community-dwelling participants aged ≥ 65 years with AF. Primary outcome was a composite endpoint of CV events (myocardial infarctions, stroke/transitory ischemic events, systemic embolism, heart failure (HF) hospitalizations, CV deaths). Secondary outcomes were component endpoints, total mortality, and AF-progression. Exposures were thyroid dysfunction categories, TSH and fT4. Sensitivity analyses were performed for amiodarone use, thyroid hormones use, and competing events.
2415 patients were included (mean age: 73.2 years; 27% women). 196 (8.4%) had subclinical hypothyroidism and 53 (2.3%) subclinical hyperthyroidism. Subclinical thyroid dysfunction was not associated with CV events, during a median follow-up of 2.1 years (max 5 years): age- and sex-adjusted hazard ratio (adjHR) of 0.99 (95% CI: 0.69-1.41) for subclinical hypothyroidism and 0.55 (95% CI: 0.23-1.32) for subclinical hyperthyroidism. Results remained robust following multivariable adjustment and sensitivity analyses. In euthyroid patients, fT4 levels were associated with an increased risk for the composite endpoint and HF (adjHR: 1.46, 95% CI: 1.04-2.05; adjHR: 1.70, 95% CI: 1.08-2.66, respectively, for the highest quintile vs the middle quintile). Results remained similar following multivariable adjustment and remained significant for HF in sensitivity analyses. No association between subclinical thyroid dysfunction and total mortality or AF-progression was found.
Subclinical hypothyroidism was not associated with increased CV risk in AF patients. Higher levels of fT4 with normal TSH were associated with a higher risk for HF.
评估亚临床甲状腺功能障碍与心房颤动（AF）患者心血管（CV）风险之间的关系。
瑞士-AF 是一项前瞻性队列研究，纳入了年龄≥65 岁、社区居住的 AF 患者。主要结局是 CV 事件（心肌梗死、中风/短暂性脑缺血事件、系统性栓塞、心力衰竭（HF）住院、CV 死亡）的复合终点。次要结局是各组成部分终点、总死亡率和 AF 进展。暴露是甲状腺功能障碍类别、TSH 和游离 T4。进行了胺碘酮使用、甲状腺激素使用和竞争事件的敏感性分析。
共纳入 2415 例患者（平均年龄 73.2 岁，27%为女性）。196 例（8.4%）患有亚临床甲状腺功能减退，53 例（2.3%）患有亚临床甲状腺功能亢进。在中位随访 2.1 年（最长 5 年）期间，亚临床甲状腺功能障碍与 CV 事件无关：年龄和性别调整后的风险比（adjHR）分别为 0.99（95%CI：0.69-1.41）和 0.55（95%CI：0.23-1.32）。多变量调整和敏感性分析后结果仍然可靠。在甲状腺功能正常的患者中，fT4 水平与复合终点和 HF 的风险增加相关（adjHR：1.46，95%CI：1.04-2.05；adjHR：1.70，95%CI：1.08-2.66，最高五分位数与中间五分位数相比）。多变量调整后结果相似，HF 的敏感性分析结果仍然显著。未发现亚临床甲状腺功能障碍与总死亡率或 AF 进展之间存在关联。
亚临床甲状腺功能减退与 AF 患者的 CV 风险增加无关。正常 TSH 下的 fT4 水平升高与 HF 的风险增加相关。
