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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Medicine 1/2017

What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants

Zeitschrift:
BMC Medicine > Ausgabe 1/2017
Autoren:
Yu Ning, Yun J. Cheng, Li J. Liu, Jaskanwal D. S. Sara, Zhi Y. Cao, Wei P. Zheng, Tian S. Zhang, Hui J. Han, Zhen Y. Yang, Yi Zhang, Fei L. Wang, Rui Y. Pan, Jie L. Huang, Ling L. Wu, Ming Zhang, Yong X. Wei
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12916-017-0777-9) contains supplementary material, which is available to authorized users.

Abstract

Background

Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality.

Methods

We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality.

Results

Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01–1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05–1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38–2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13–1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28–3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26–1.81).

Conclusions

Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.
Zusatzmaterial
Additional file 1: The PRISMA checklist. (DOC 841 kb)
12916_2017_777_MOESM1_ESM.doc
Additional file 2: Summary of included cohort studies, quality assessment, the adjusting variables in each cohort study, additional subgroup analyses by TSH levels in SCH, subgroup analysis of risk of HF by mean age, and funnel plots. (DOC 63 kb)
12916_2017_777_MOESM2_ESM.doc
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