Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation.

Moutzouri, Elisavet; Lyko, Christina; Feller, Martin; Blum, Manuel Raphael; Adam, Luise; Blum, Steffen; Aeschbacher, Stefanie; Fischer, Urs; Roten, Laurent; Del Giovane, Cinzia; Meyer-Zuern, Christine S; Conte, Giulio; Bonati, Leo H; Moschovitis, Giorgio; Kuehne, Michael; Beer, Juerg; Aujesky, Drahomir; Osswald, Stefan; Conen, David and Rodondi, Nicolas (2021). Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation. European journal of endocrinology, 185(3), pp. 375-385. BioScientifica Ltd. 10.1530/EJE-20-1442

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OBJECTIVE

To evaluate if subclinical thyroid dysfunction is associated with cardiovascular (CV) risk in patients with atrial fibrillation (AF).

METHODS

Swiss-AF is a prospective cohort of community-dwelling participants aged ≥ 65 years with AF. Primary outcome was a composite endpoint of CV events (myocardial infarctions, stroke/transitory ischemic events, systemic embolism, heart failure (HF) hospitalizations, CV deaths). Secondary outcomes were component endpoints, total mortality and AF-progression. Exposures were thyroid dysfunction categories, TSH and fT4. Sensitivity analyses were performed for amiodarone use, thyroid hormones use and competing events.

RESULTS

2415 patients were included (mean age 73.2 years; 27% women). 196 (8.4%) had subclinical hypothyroidism and 53 (2.3%) subclinical hyperthyroidism. Subclinical thyroid dysfunction was not associated with CV events, during a median follow-up of 2.1 years (max 5 years): age- and sex- adjusted hazard ratio (adjHR) of 0.99 (95% confidence interval (CI) 0.69-1.41) for subclinical hypothyroidism; and 0.55 (95%CI 0.23-1.32) for subclinical hyperthyroidism. Results remained robust following multivariable adjustment and sensitivity analyses. In euthyroid patients, fT4 levels were associated with an increased risk for the composite endpoint and HF (adjHR 1.46 95%CI 1.04- 2.05; adjHR 1.70 95%CI 1.08-2.66, respectively, for the highest quintile versus the middle quintile). Results remained similar following multivariable adjustment. Results remained significant for HF in sensitivity analyses. No association between subclinical thyroid dysfunction and total mortality or AF-progression was found.

CONCLUSIONS

Subclinical hypothyroidism was not associated with increased CV risk in AF patients. Higher levels of fT4 with normal TSH were associated with higher risk for HF.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Moutzouri Beifuss, Elisavet; Lyko, Christina; Feller, Martin; Blum, Manuel; Adam, Luise Leonore; Fischer, Urs; Roten, Laurent; Del Giovane, Cinzia; Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0804-4643

Publisher:

BioScientifica Ltd.

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

28 Jul 2021 15:36

Last Modified:

17 Aug 2021 10:26

Publisher DOI:

10.1530/EJE-20-1442

PubMed ID:

34228632

BORIS DOI:

10.48350/157525

URI:

https://boris.unibe.ch/id/eprint/157525

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