Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
J Clin Endocrinol Metab. 2024 May 17;109(6):1550-1564. doi: 10.1210/clinem/dgad735.
Previous studies found inconsistent results on the relationship between thyroid function and cardiovascular risks.
This study aimed to investigate the association of thyroid hormone sensitivity with the risk of major adverse cardiovascular events (MACE) and cardiovascular death in a euthyroid population undergoing coronary angiography.
This prospective cohort study enrolled 1470 euthyroid participants who underwent coronary angiography between March and November of 2013. The participants were followed up from July to November in 2022. Thyrotroph thyroxine resistance index (TT4RI), TSH index (TSHI), and feedback quantile-based index (TFQI) were calculated to evaluate the sensitivity to thyroid hormone. Kaplan-Meier curve and multivariable Cox proportional hazard model were performed to analyze the association between thyroid hormone sensitivity and risk of MACE and cardiovascular death.
Among 1089 participants who completed the follow-up, 342 cases of MACE and 77 cardiovascular deaths were identified during a medium follow-up duration of 111 months. In the multivariable Cox proportional hazard model, the higher levels of TFQI (hazard ratio [HR] = 1.41; 95% CI, 1.08-1.84; P for trend = .01), TT4RI (HR = 1.40; 95% CI, 1.06-1.84; P for trend = .02) and TSHI (HR = 1.61; 95% CI, 1.22-2.13; P for trend = .001) were associated with increased risk of MACE. The higher levels of TFQI (HR = 2.21; 95% CI, 1.17-4.17; P for trend = .02) and TSHI (HR = 2.05; 95% CI; 1.08-3.91; P for trend = .03) were also associated with increased risk of cardiovascular death.
Impaired sensitivity to thyroid hormone is associated with higher risks of MACE and cardiovascular death in a euthyroid population undergoing coronary angiography.
先前的研究发现甲状腺功能与心血管风险之间的关系结果不一致。
本研究旨在探讨甲状腺激素敏感性与行冠状动脉造影的甲状腺功能正常人群中主要不良心血管事件（MACE）和心血管死亡风险的关系。
这项前瞻性队列研究纳入了 2013 年 3 月至 11 月间行冠状动脉造影的 1470 例甲状腺功能正常的参与者。参与者的随访时间为 2022 年 7 月至 11 月。计算促甲状腺激素促甲状腺素受体抵抗指数（TT4RI）、促甲状腺激素指数（TSHI）和基于反馈分位数的指数（TFQI）来评估对甲状腺激素的敏感性。采用 Kaplan-Meier 曲线和多变量 Cox 比例风险模型分析甲状腺激素敏感性与 MACE 和心血管死亡风险之间的关系。
在完成随访的 1089 例患者中，中位随访 111 个月期间，有 342 例发生 MACE，77 例发生心血管死亡。在多变量 Cox 比例风险模型中，较高水平的 TFQI（危险比[HR] = 1.41；95%CI，1.08-1.84；P 趋势=.01）、TT4RI（HR = 1.40；95%CI，1.06-1.84；P 趋势=.02）和 TSHI（HR = 1.61；95%CI，1.22-2.13；P 趋势=.001）与 MACE 风险增加相关。较高水平的 TFQI（HR = 2.21；95%CI，1.17-4.17；P 趋势=.02）和 TSHI（HR = 2.05；95%CI；1.08-3.91；P 趋势=.03）也与心血管死亡风险增加相关。
在接受冠状动脉造影的甲状腺功能正常人群中，甲状腺激素敏感性降低与 MACE 和心血管死亡风险增加相关。
