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Thyroid Dysfunction and Cardiovascular Events in Patients With Dysglycemia

Reema Shah1, Steven Orlov1, Guillaume Paré1

  • 1Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.

Canadian Journal of Diabetes
|March 1, 2023
PubMed

Insights

Subclinical hypothyroidism increases cardiovascular event and mortality risk in high-risk individuals with dysglycemia. Levothyroxine use was associated with fewer deaths in this population.

Area of Science:

  • Endocrinology
  • Cardiology
  • Public Health

Background:

  • Subclinical thyroid disease is a common endocrine dysfunction.
  • Thyroid dysfunction is linked to adverse cardiovascular outcomes, particularly in high-risk individuals.
  • Individuals with dysglycemia and cardiovascular risk factors are a key population for study.

Purpose of the Study:

  • To assess the association between thyroid function and thyroid hormone replacement therapy with cardiovascular outcomes.
  • To evaluate cardiovascular outcomes in high-risk individuals with dysglycemia and thyroid dysfunction.
  • To determine the impact of subclinical hypothyroidism and levothyroxine use on cardiovascular events and mortality.

Main Methods:

  • Analysis of 8,401 participants from the ORIGIN trial with baseline thyrotropin (TSH) measurements.
  • Assessment of composite cardiovascular outcomes, including myocardial infarction, stroke, heart failure, and cardiovascular death.
  • Estimation of hazard ratios for outcomes based on baseline TSH levels (euthyroid, subclinical hypothyroidism, overt hypothyroidism) and levothyroxine use, with adjustments for clinical characteristics.

Main Results:

  • Subclinical hypothyroidism (5.5% of participants) was associated with an increased risk of an expanded cardiovascular outcome (HR=1.24) and mortality (HR=1.37).
  • Overt hypothyroidism was present in 2.2% of participants.
  • Levothyroxine use was linked to a reduction in deaths (HR=0.72).

Conclusions:

  • Subclinical hypothyroidism is a predictor of future cardiovascular events and mortality in individuals with dysglycemia and cardiovascular risk factors.
  • Thyroid hormone replacement therapy (levothyroxine) may offer a survival benefit in this population.
  • These findings highlight the importance of thyroid function assessment in cardiovascular risk stratification.
Abstract

Keywords:
cardiovascular diseasedysfonctionnement de la thyroïdedysglycemiadysglycémielevothyroxinelévothyroxinemaladie cardiovasculairethyroid dysfunction

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