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Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality

2008; American College of Physicians; Volume: 148; Issue: 11 Linguagem: Inglês

10.7326/0003-4819-148-11-200806030-00225

1539-3704

Nicolas Ochs, Reto Auer, Douglas C. Bauer, David Nanchen, Jacobijn Gussekloo, Jacques Cornuz, Nicolas Rodondi,

Neuroscience of respiration and sleep

Background: Data on the association between subclinical thyroid dysfunction and coronary heart disease (CHD) and mortality are conflicting. Purpose: To summarize prospective evidence about the relationship between subclinical thyroid dysfunction and CHD and mortality. Data Sources: MEDLINE (1950 to January 2008) without language restrictions and reference lists of retrieved articles were searched. Study Selection: Two reviewers screened and selected cohort studies that measured thyroid function and then followed persons prospectively to assess CHD or mortality. Data Extraction: By using a standardized protocol and forms, 2 reviewers independently abstracted and assessed studies. Data Synthesis: Ten of 12 identified studies involved population-based cohorts that included 14 449 participants. All 10 population-based cohort studies examined risks associated with subclinical hypothyroidism (2134 CHD events and 2822 deaths), whereas only 5 examined risks associated with subclinical hyperthyroidism (1392 CHD events and 1993 deaths). In a random-effects model, the relative risk (RR) for subclinical hypothyroidism for CHD was 1.20 (95% CI, 0.97 to 1.49; P for heterogeneity = 0.14; I 2 = 33.4%). Risk estimates were lower when higher-quality studies were pooled (RR, 1.02 to 1.08) and were higher among participants younger than 65 years (RR, 1.51 [CI, 1.09 to 2.09] for studies with mean participant age 0.50; I 2 = 0% for all studies). Limitations: Individual studies adjusted for different potential confounders, and 1 study provided only unadjusted data. Publication bias or selective reporting of outcomes could not be excluded. Conclusion: Subclinical hypothyroidism and hyperthyroidism may be associated with a modest increased risk for CHD and mortality, with lower risk estimates when pooling higher-quality studies and larger CIs for subclinical hyperthyroidism.