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Published on: February 9, 2024
Thyroid antibody status, thyroid function, and the risk of coronary heart disease and stroke: an individual
Ola Hysaj1,2, Orestis Efthimiou1, Tinh-Hai Collet3,4
1Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland.
Insights
Thyroid peroxidase antibodies (TPOAb) status does not increase cardiovascular disease risk, even in those with subclinical hypothyroidism. TPOAb testing is not recommended for cardiovascular risk assessment.
Area of Science:
- Endocrinology and Immunology
- Cardiovascular Epidemiology
Background:
- The relationship between thyroid peroxidase antibodies (TPOAb) and cardiovascular disease (CVD) risk, independent of thyroid function, is not well-established.
- Understanding this association is crucial for accurate CVD risk stratification.
Purpose of the Study:
- To investigate the association between positive TPOAb status and CVD risk.
- To determine if TPOAb positivity increases CVD risk in individuals with subclinical hypothyroidism.
Main Methods:
- A two-stage individual participant data analysis of 14 cohort studies was conducted.
- Primary outcomes included coronary heart disease (CHD) events/mortality and stroke events/mortality.
- Cox proportional hazards models and random-effects meta-analysis were used, adjusting for age, sex, and TSH.
Main Results:
- In 100,250 adults, TPOAb-positive individuals (11.9%) showed no increased risk for CHD events, CHD mortality, stroke events, or stroke mortality compared to TPOAb-negative individuals.
- Among those with subclinical hypothyroidism (5.4%), TPOAb positivity was also not linked to a higher risk of any CVD outcomes.
Conclusions:
- Positive TPOAb status is not associated with an elevated risk of coronary heart disease or stroke.
- Current findings do not support using TPOAb testing for cardiovascular risk assessment in the general population or those with subclinical hypothyroidism.
Objective:
The association of thyroid peroxidase antibodies (TPOAb) status with cardiovascular disease (CVD) risk, independent of thyroid function, remains unclear. We aimed to determine whether positive TPOAb is associated with increased CVD risk, overall and among individuals with subclinical hypothyroidism.
Methods:
We conducted a 2-stage individual participant data analysis including cohort studies identified through the Thyroid Studies Collaboration and systematic database searches (MEDLINE, EMBASE, Cochrane Library) through November 2024. Primary outcomes were coronary heart disease (CHD) events, CHD mortality, stroke events, and stroke mortality. We used Cox proportional hazards models, adjusted for age, sex, and thyroid-stimulating hormone (TSH) within each cohort, followed by a random-effects meta-analysis to assess cardiovascular outcomes by TPOAb status, overall and in the subclinical hypothyroidism subgroup.
Results:
Among 100 250 adults from 14 cohort studies (median age 55 years, 56.7% women), 11.9% were TPOAb-positive, and 5.4% had subclinical hypothyroidism. In the overall population, we found no evidence of increased CVD risk in TPOAb-positive compared to TPOAb-negative individuals: Hazard ratio (HR) 1.00 (95% CI 0.90-1.11) for CHD events; HR 0.95 (95% CI 0.78-1.16) for CHD mortality; HR 0.98 (95% CI 0.87-1.11) for stroke events; and HR 1.06 (95% CI 0.81-1.40) for stroke mortality. In subclinical hypothyroidism, positive TPOAb was similarly not associated with increased risk for any of the CVD outcomes.
Conclusions:
Positive TPOAb status was not associated with increased risk of CHD or stroke. These findings do not support the use of TPOAb testing for cardiovascular risk assessment in the overall population or among individuals with subclinical hypothyroidism.
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