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Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. The Cardiovascular Health study

Nicolas Rodondi1, Douglas C Bauer, Anne R Cappola

  • 1Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. Nicolas.Rodondi@hospvd.ch

Journal of the American College of Cardiology
|September 23, 2008
PubMed

Insights

Older adults with high thyroid-stimulating hormone (TSH) levels (≥10.0 mU/l) face a higher risk of heart failure (HF) and cardiac dysfunction. Lower TSH levels or subclinical hyperthyroidism did not show increased HF risk.

Area of Science:

  • Cardiology
  • Endocrinology
  • Geriatrics

Background:

  • Subclinical hypothyroidism and hyperthyroidism are linked to cardiac dysfunction.
  • Limited long-term data exist on the association between subclinical thyroid dysfunction and heart failure (HF) risk.

Purpose of the Study:

  • To investigate the association between subclinical thyroid dysfunction and incident heart failure (HF).
  • To determine if subclinical thyroid dysfunction is linked to echocardiogram abnormalities.

Main Methods:

  • A cohort of 3,044 adults aged 65+ years, initially HF-free, was studied over a 12-year follow-up.
  • Participants were categorized as euthyroid, subclinically hypothyroid (TSH 4.5-9.9 or ≥10.0 mU/l), or subclinically hyperthyroid.
  • HF events and cardiac function changes (echocardiography) were compared across groups.

Main Results:

  • A total of 736 HF events occurred over 12 years.
  • Participants with TSH ≥10.0 mU/l had a significantly higher HF incidence (41.7 vs. 22.9 per 1,000 person-years) and increased risk (adjusted HR: 1.88).
  • Elevated TSH ≥10.0 mU/l was associated with impaired diastolic function (higher peak E velocity) and increased left ventricular mass over 5 years.

Conclusions:

  • Older adults with TSH ≥10.0 mU/l exhibit a moderately increased risk of HF and cardiac function alterations.
  • Subclinical hypothyroidism with TSH <10.0 mU/l and subclinical hyperthyroidism were not associated with increased HF risk.
  • Further clinical trials are warranted to evaluate thyroxine replacement therapy for individuals with TSH ≥10.0 mU/l to potentially mitigate HF risk.
Abstract

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