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Thyroid-stimulating hormone and clinical outcomes: the CORONA trial (controlled rosuvastatin multinational study in
Ana Cristina Perez1, Pardeep S Jhund1, David J Stott2
1BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.
Insights
Thyroid status was evaluated in heart failure patients. Hypothyroidism was initially linked to worse outcomes, but this association disappeared after adjusting for other factors, indicating thyroid status is not an independent predictor.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Previous studies, like SCD-HeFT, suggested associations between thyroid dysfunction (hypo- and hyperthyroidism) and adverse clinical outcomes in heart failure patients.
- The CORONA trial provided a large cohort to investigate these associations further in patients with heart failure with reduced ejection fraction.
Purpose of the Study:
- To investigate the relationship between thyroid status (euthyroid, hypothyroid, hyperthyroid) and clinical outcomes in patients participating in the CORONA trial.
- To determine if thyroid status is an independent predictor of cardiovascular death, heart failure hospitalization, or all-cause death in this population.
Main Methods:
- Baseline thyroid-stimulating hormone (TSH) levels were measured in 4,987 CORONA study participants.
- Patients were categorized as euthyroid, hypothyroid, or hyperthyroid based on TSH levels and thyroid replacement therapy (TRT) use.
- Clinical outcomes, including a composite of cardiovascular death or heart failure hospitalization and all-cause death, were compared across thyroid status groups using multivariable regression models.
Main Results:
- The study included 91.3% euthyroid, 5.0% hypothyroid, and 3.7% hyperthyroid patients.
- Univariate analysis showed hypothyroidism was associated with increased risk for the composite outcome and all-cause death.
- However, after adjusting for known prognostic variables, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), these associations were eliminated, suggesting hypothyroidism is not an independent predictor.
Conclusions:
- Thyroid status, specifically hypothyroidism, is not an independent predictor of adverse clinical outcomes in patients with heart failure and reduced ejection fraction.
- The initial associations observed in univariate analyses were likely confounded by other clinical factors and biomarker levels.
Objectives:
This study sought to examine the association between thyroid status and clinical outcomes in patients in the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) study.
Background:
Hypo- and hyperthyroidism were associated with worse clinical outcomes in the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial).
Methods:
In CORONA, 4,987 patients underwent baseline thyroid-stimulating hormone (TSH) measurement, 237 of which (4.8%) were receiving thyroid replacement therapy (TRT). Patients were classified as euthyroid (TSH: 0.3 to 5.0 μU/ml, and no TRT), hyperthyroid (<0.3 μU/ml and no TRT), or hypothyroid (>5.0 μU/ml and no TRT). The outcome composites of cardiovascular (CV) death or hospitalization for heart failure (HF), the components of this composite, and all-cause death were compared among hyperthyroid, hypothyroid, and euthyroid states, using multivariable models adjusting for previously reported prognostic variables.
Results:
A total of 91.3% of patients were euthyroid, 5.0% were hypothyroid, and 3.7% were hyperthyroid. Compared with euthyroid patients, hypothyroid patients were more likely to have a history of stroke, had worse renal function and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, were more likely to be treated with an antiarrhythmic drug (or have an implantable cardioverter defibrillator), and were less likely to smoke or be treated with a beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. In univariate analyses, hypothyroidism was associated with an increased risk of the composite outcome of CV death or HF hospitalization (hazard ratio: 1.29; 95% confidence interval: 1.07 to 1.57; p = 0.008), as well as all-cause death (HR: 1.36; 95% confidence interval: 1.03 to 1.76; p = 0.004). However, after adjustment for other known predictors of outcome, the associations were weakened, and when NT-proBNP was added to the models, the association between hypothyroidism and all outcomes was eliminated.
Conclusions:
Thyroid status is not an independent predictor of outcome in heart failure with reduced ejection fraction. (Controlled Rosuvastatin Multinational Study in Heart Failure [CORONA]; NCT00206310).
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