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Relation between thyroid-stimulating hormone and the occurrence of cardiovascular events and mortality in patients with manifest vascular diseases.

Abstract：

AIMS:To investigate whether levels of thyroid-stimulating hormone (TSH) within the normal range are associated with an increased risk of new vascular events and mortality in patients with clinical manifest vascular diseases and whether this relation is influenced by adiposity. METHODS AND RESULTS:Prospective cohort study in 2443 patients (1790 men and 653 women) with clinical manifest vascular disease and TSH levels in the normal range. Median follow up was 2.7 (interquartile range 1.4-3.9) years. Clinical endpoints of interest were: myocardial infarction, stroke, vascular death, and all-cause mortality. In patients with manifest vascular disease, the prevalence of (subclinical) hypothyroidism was 5.7%, while 3.6% had (subclinical) hyperthyroidism. An increase in 1 unit of TSH was associated with a 33% higher risk (HR 1.33; 95% CI 1.03-1.73) for the occurrence of myocardial infarction, adjusted for age, gender, renal function, and smoking. In patients with a body mass index (BMI) below the median of 26.7 kg/m(2) the HR per unit TSH for myocardial infarction was 1.55 (95% CI 1.08-2.21) compared to 1.18 (95% CI 0.81-1.71) in patients with a BMI ≥26.7 kg/m(2). Visceral adipose tissue thickness below the median (≤8.8 cm) was associated with higher HR per unit TSH for myocardial infarction (HR 1.69; 95% CI 1.21-2.35) compared to visceral adipose tissue thickness >8.9 cm (HR 1.00; 95% CI 0.66-1.49). There was no relation between TSH and risk of stroke, vascular death, the combined endpoint, or all-cause mortality. CONCLUSION:Higher TSH levels within the normal range are associated with an increased risk of myocardial infarction, in patients with clinical manifest vascular disease. This relation is most prominent in patients without visceral obesity.

journal_name

Eur J Prev Cardiol

journal_title

European journal of preventive cardiology

authors

Westerink J,van der Graaf Y,Faber DR,Spiering W,Visseren FL,SMART study group.

doi

10.1177/1741826711416045

subject

Has Abstract

pub_date

2012-08-01 00:00:00

pages

864-73

issue

eissn

2047-4873

issn

2047-4881

pii

1741826711416045

journal_volume

pub_type

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Relation between thyroid-stimulating hormone and the occurrence of cardiovascular events and mortality in patients with manifest vascular diseases.