Liu Lijia, Zhang Haiqing, Chen Xiaowei, Liu Zuoxiang, Zhao Houyu, Ma Shizhan, Zhao Meng, Shen Peng, Sun Yexiang, Lin Hongbo, Zhan Siyan, Zhao Jiajun, Sun Feng
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Key Laboratory of Major Disease Epidemiology, Ministry of Education (Peking University), Beijing, China.
Front Endocrinol (Lausanne). 2025 Aug 26;16:1640086. doi: 10.3389/fendo.2025.1640086. eCollection 2025.
This study aimed to evaluate the effectiveness of levothyroxine, compared to non-levothyroxine treatment, in preventing adverse cardiovascular events and mortality in patients with hypothyroidism and cardiovascular disease (CVD).
This is a retrospective study utilizing medical record data from the Yinzhou Regional Health Care Database. The analysis included patients newly diagnosed with hypothyroidism between July 2006 and December 2021 who also had pre-existing CVD at the time when they received the first hypothyroidism diagnosis. The primary outcome measure was the occurrence of three-point major adverse cardiovascular events (3P-MACE), which included cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes comprised all-cause mortality, all-cause hospitalization, and cardiovascular-related hospitalization. Propensity score matching was used to match levothyroxine users with non-users on a 1:1 basis. Cox proportional hazard models were employed to compare the risk of outcomes between users and non-users, with hazard ratios (HRs) and 95% confidence intervals (CIs) reported.
In the matched cohort ( = 1,332 in each group), 417 patients experienced 3P-MACE. Compared to those not treated with levothyroxine, patients receiving levothyroxine showed a significantly reduced risk of 3P-MACE (HR, 0.67; 95% CI, 0.55-0.82, < 0.01), all-cause death (HR, 0.24; 95% CI, 0.16-0.35, < 0.01), all-cause hospitalization (HR, 0.23; 95% CI, 0.21-0.26, < 0.01), and cardiovascular-related hospitalization (HR, 0.69; 95% CI, 0.59-0.82, < 0.01).
Levothyroxine may improve major cardiovascular outcomes and decrease all-cause hospital admissions in patients with hypothyroidism and CVD.
本研究旨在评估左甲状腺素与非左甲状腺素治疗相比，在预防甲状腺功能减退合并心血管疾病（CVD）患者发生不良心血管事件及死亡方面的有效性。
这是一项利用鄞州区域医疗保健数据库中的病历数据进行的回顾性研究。分析纳入了2006年7月至2021年12月期间新诊断为甲状腺功能减退且在首次诊断甲状腺功能减退时已患有CVD的患者。主要结局指标是三点主要不良心血管事件（3P-MACE）的发生情况，包括心血管死亡、非致命性心肌梗死和非致命性中风。次要结局包括全因死亡、全因住院和心血管相关住院。采用倾向评分匹配法将左甲状腺素使用者与非使用者按1:1进行匹配。使用Cox比例风险模型比较使用者和非使用者的结局风险，并报告风险比（HRs）和95%置信区间（CIs）。
在匹配队列中（每组n = 1332），417例患者发生了3P-MACE。与未接受左甲状腺素治疗的患者相比，接受左甲状腺素治疗的患者发生3P-MACE的风险显著降低（HR，0.67；95%CI，0.55 - 0.82，P < 0.01），全因死亡风险（HR，0.24；95%CI，0.16 - 0.35，P < 0.01），全因住院风险（HR，0.23；95%CI，0.21 - 0.26，P < 0.01），以及心血管相关住院风险（HR，0.69；95%CI，0.59 - 0.82，P < 0.01）。
左甲状腺素可能改善甲状腺功能减退合并CVD患者的主要心血管结局，并减少全因住院率。
