TY - JOUR
T1 - Long-term Outcome in Levothyroxine Treated Patients with Subclinical Hypothyroidism and Concomitant Heart Disease
AU - Andersen, Mette Nygaard
AU - Olsen, Anne-Marie Schjerning
AU - Madsen, Jesper Clausager
AU - Kristensen, Søren Lund
AU - Faber, Jens
AU - Torp-Pedersen, Christian
AU - Gislason, Gunnar H
AU - Selmer, Christian
PY - 2016/11
Y1 - 2016/11
N2 - CONTEXT: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function.OBJECTIVE: To examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease.DESIGN: Register-based historical cohort study.SETTING AND PARTICIPANTS: Danish primary care patients and hospital outpatients aged 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997 - 2011. Patients were stratified according to whether or not they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multi-variable Poisson regression models.MAIN OUTCOME MEASURES: All-cause mortality, MACE (major adverse cardiac events) defined as cardiovascular death, fatal or non-fatal MI and stroke, and all-cause hospital admissions.RESULTS: Of 61,611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1,192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] years, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 years (IQR 6.5), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR 1.17 [95% CI: 0.90-1.52]), MACE (adjusted IRR 1.08 [95% CI: 0.80-1.45]), or hospital admission (adjusted IRR 0.94 [95% CI: 0.71-1.24]), when compared to patients not treated with levothyroxine.CONCLUSION: Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE or hospital admission in this large real-world cohort study.
AB - CONTEXT: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function.OBJECTIVE: To examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease.DESIGN: Register-based historical cohort study.SETTING AND PARTICIPANTS: Danish primary care patients and hospital outpatients aged 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997 - 2011. Patients were stratified according to whether or not they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multi-variable Poisson regression models.MAIN OUTCOME MEASURES: All-cause mortality, MACE (major adverse cardiac events) defined as cardiovascular death, fatal or non-fatal MI and stroke, and all-cause hospital admissions.RESULTS: Of 61,611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1,192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] years, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 years (IQR 6.5), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR 1.17 [95% CI: 0.90-1.52]), MACE (adjusted IRR 1.08 [95% CI: 0.80-1.45]), or hospital admission (adjusted IRR 0.94 [95% CI: 0.71-1.24]), when compared to patients not treated with levothyroxine.CONCLUSION: Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE or hospital admission in this large real-world cohort study.
U2 - 10.1210/jc.2016-2226
DO - 10.1210/jc.2016-2226
M3 - Journal article
C2 - 27571183
SN - 0021-972X
VL - 101
SP - 4170
EP - 4177
JO - The Journal of clinical endocrinology and metabolism
JF - The Journal of clinical endocrinology and metabolism
IS - 11
ER -