Relationship between subclinical hyperthyroidism and the incidence of coronary heart disease: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Jing ¹ , NIU Huiqin ² , SUN Peiwei ³ , YAO Liang ⁴ , FANG Yuan ⁵ , YANG Ruifei ⁵ ,  YANG Kehu ⁶ ,  TIAN Limin ⁵

1. Ningxia Medical University, Yinchuan, 750000, P.R.China;
2. Department of Endocrinology in Cadre Ward, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
3. School of Medicine, Zhejiang University, Hangzhou, 310000, P.R.China;
4. Clinical Evidence Based Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
5. Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
6. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

YANG Kehu, Email: kehuyangebm2006@126.com; TIAN Limin, Email: tlm6666@sina.com

Keywords：

Subclinical hyperthyroidism; Coronary heart disease; Mortality; Meta-analysis

DOI：

10.7507/1672-2531.201612038

Video：

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Objectives To assess the relationship between subclinical hyperthyroidism and the incidence of coronary heart disease (CHD). Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, VIP, WanFang Data and CBM databases were searched for studies on the relationship between subclinical hyperthyroidism and the incidence of CHD from inception to October 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results In total, 14 cohort studies were included. The results of meta-analysis showed that subclinical hyperthyroidism was associated with the incidence of coronary heart disease (RR=1.19, 95%CI 1.01 to 1.40, P=0.04) and all-cause mortality (RR=1.36, 95%CI 1.11 to 1.67, P=0.003). Conclusions Subclinical hyperthyroidism is associated with an increased risk of CHD and all-cause mortality. Due to the limitation of quality and quantity of the studies, the above conclusions are required to be verified by large-scale and high quality research.

Citation： SUN Jing, NIU Huiqin, SUN Peiwei, YAO Liang, FANG Yuan, YANG Ruifei, YANG Kehu, TIAN Limin. Relationship between subclinical hyperthyroidism and the incidence of coronary heart disease: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(12): 1442-1449. doi: 10.7507/1672-2531.201612038 Copy

1.	Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev, 2008, 29(1): 76-131.
2.	Cooper DS, Biondi B. Subclinical thyroid disease. Lancet, 2012, 379(9821): 1142-1154.
3.	Zhyzhneuskaya S, Addison C, Tsatlidis V, et al. The natural history of subclinical hyperthyroidism in graves' disease: the rule of thirds. Thyroid, 2016, 26(6): 765-769.
4.	Mitchell AL, Pearce SH. Subclinical hyperthyroidism: first do no harm. Clin Endocrinol (Oxf), 2016, 85(1): 15-16.
5.	Boekholdt SM, Titan SM, Wiersinga WM, et al. Initial thyroid status and cardiovascular risk factors: the EPIC-Norfolk prospective population study. Clin Endocrinol (Oxf), 2010, 72(3): 404-410.
6.	Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction and blood pressure: a community-based study. Clin Endocrinol (Oxf), 2006, 65(4): 486-491.
7.	Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med, 2000, 160(4): 526-534.
8.	Sawin CT, Geller A, Kaplan MM, et al. Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med, 1991, 151(1): 165-168.
9.	Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol, 2010, 6(8): 431-443.
10.	Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Effects of thyroid hormones on the heart. Clin Investig Arterioscler, 2014, 26(6): 296-309.
11.	Tadic M, Celic V, Cuspidi C, et al. How does subclinical hyperthyroidism affect right heart function and mechanics? J Ultrasound Med, 2016, 35(2): 287-295.
12.	Kaminski G, Michalkiewicz D, Makowski K, et al. Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism. Clin Endocrinol (Oxf), 2011, 74(4): 501-507.
13.	Mark PD, Andreassen M, Petersen CL, et al. Treatment of subclinical hyperthyroidism: effect on left ventricular mass and function of the heart using magnetic resonance imaging technique. Endocr Connect, 2015, 4(1): 37-42.
14.	Poplawska-Kita A, Siewko K, Telejko B, et al. The changes in the endothelial function and haemostatic and inflammatory parameters in subclinical and overt hyperthyroidism. Int J Endocrinol, 2013: 981638.
15.	Tadic M, Ilic S, Cuspidi C, et al. Subclinical hyperthyroidism impacts left ventricular deformation: 2D and 3D echocardiographic study. Scand Cardiovasc J, 2015, 49(2): 74-81.
16.	Kaminski G, Makowski K, Michalkiewicz D, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid, 2012, 22(5): 454-460.
17.	Floriani C, Gencer B, Collet TH, et al. Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update. Eur Heart J, 2017. doi: 10.1093/eurheartj/ehx050.
18.	Gencer B, Collet TH, Virgini V, et al. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation, 2012, 126(9): 1040-9.
19.	Hosseini SM, Bakhtyari EK, Heshmat-Ghahdarijani K, et al. Evaluation of endothelial function in exogenous subclinical hyperthyroidism and the effect of treatment. Adv Biomed Res, 2016, 5(1): 173.
20.	Parle JV, Maisonneuve P, Sheppard MC, et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet, 2001, 358(9285): 861-5.
21.	Sgarbi JA, Matsumura LK, Kasamatsu TS, et al. Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese-Brazilian thyroid study. Eur J Endocrinol, 2010, 162(3): 569-77.
22.	Ceresini G, Ceda GP, Lauretani F, et al. Thyroid status and 6-year mortality in elderly people living in a mildly iodine-deficient area: the aging in the Chianti Area Study. J Am Geriatr Soc, 2013, 61(6): 868-874.
23.	Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9), 1033-1041.
24.	de Jongh RT, Lips P, van Schoor NM, et al. Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals. Eur J Endocrinol, 2011, 165(4): 545-554.
25.	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
26.	Canfield SE, Dahm P. Rating the quality of evidence and the strength of recommendations using GRADE. World J Urol, 2011, 29(3): 311-317.
27.	Gussekloo J, van E, de C, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA, 2004, 292(21), 2591-2599.
28.	Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med, 2005, 165(21), 2467-2472.
29.	Bauer DC, Rodondi N, Stone KL, et al.Study of osteoporotic fractures research group: universities of california PM, kaiser permanente center for health research P. thyroid hormone use, hyperthyroidism and mortality in older women. Am J Med, 2007, 120(4): 343-349.
30.	Asvold BO, Bjøro T, Nilsen TI, et al. Thyrotropin levels and risk of fatal coronary heart disease:the HUNT study. Arch Intern Med, 2008, 168(8),855-860.
31.	Ittermann T, Haring R, Sauer S, et al. Decreased serum TSH levels are not associated with mortality in the adult northeast German population. Eur J Endocrinol, 2010, 162(3): 579-585.
32.	Schultz M, Kistorp C, Raymond I, et al. Cardiovascular events in thyroid disease: a population based, prospective study. Horm Metab Res, 2011, 43(9): 653-659.
33.	Asvold BO, Bjoro T, Platou C, et al. Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT study in Norway. Clin Endocrinol (Oxf), 2012, 77(6): 911-917.
34.	Nanchen D, Gussekloo J, Westendorp RG, et al. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. Clin Endocrinol (Oxf), 2012, 97(3): 852-61.
35.	Effraimidis G, Wiersinga WM. Mechanisms in endocrinology: autoimmune thyroid disease: old and new players. Eur J Endocrinol, 2014, 170(6): R241-252.
36.	Mathews JD, Whittingham S, Mackay IR. Autoimmune mechanisms in human vascular disease. Lancet, 1974, 2(7894): 1423-1427.
37.	Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med, 2015, 162(1): 35-45.
38.	Biondi B, Bartalena L, Cooper DS, et al. The 2015 European thyroid association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism. Eur Thyroid J, 2015, 4(3): 149-163.

1. Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev, 2008, 29(1): 76-131.
2. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet, 2012, 379(9821): 1142-1154.
3. Zhyzhneuskaya S, Addison C, Tsatlidis V, et al. The natural history of subclinical hyperthyroidism in graves' disease: the rule of thirds. Thyroid, 2016, 26(6): 765-769.
4. Mitchell AL, Pearce SH. Subclinical hyperthyroidism: first do no harm. Clin Endocrinol (Oxf), 2016, 85(1): 15-16.
5. Boekholdt SM, Titan SM, Wiersinga WM, et al. Initial thyroid status and cardiovascular risk factors: the EPIC-Norfolk prospective population study. Clin Endocrinol (Oxf), 2010, 72(3): 404-410.
6. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction and blood pressure: a community-based study. Clin Endocrinol (Oxf), 2006, 65(4): 486-491.
7. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med, 2000, 160(4): 526-534.
8. Sawin CT, Geller A, Kaplan MM, et al. Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med, 1991, 151(1): 165-168.
9. Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol, 2010, 6(8): 431-443.
10. Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Effects of thyroid hormones on the heart. Clin Investig Arterioscler, 2014, 26(6): 296-309.
11. Tadic M, Celic V, Cuspidi C, et al. How does subclinical hyperthyroidism affect right heart function and mechanics? J Ultrasound Med, 2016, 35(2): 287-295.
12. Kaminski G, Michalkiewicz D, Makowski K, et al. Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism. Clin Endocrinol (Oxf), 2011, 74(4): 501-507.
13. Mark PD, Andreassen M, Petersen CL, et al. Treatment of subclinical hyperthyroidism: effect on left ventricular mass and function of the heart using magnetic resonance imaging technique. Endocr Connect, 2015, 4(1): 37-42.
14. Poplawska-Kita A, Siewko K, Telejko B, et al. The changes in the endothelial function and haemostatic and inflammatory parameters in subclinical and overt hyperthyroidism. Int J Endocrinol, 2013: 981638.
15. Tadic M, Ilic S, Cuspidi C, et al. Subclinical hyperthyroidism impacts left ventricular deformation: 2D and 3D echocardiographic study. Scand Cardiovasc J, 2015, 49(2): 74-81.
16. Kaminski G, Makowski K, Michalkiewicz D, et al. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias. Thyroid, 2012, 22(5): 454-460.
17. Floriani C, Gencer B, Collet TH, et al. Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update. Eur Heart J, 2017. doi: 10.1093/eurheartj/ehx050.
18. Gencer B, Collet TH, Virgini V, et al. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation, 2012, 126(9): 1040-9.
19. Hosseini SM, Bakhtyari EK, Heshmat-Ghahdarijani K, et al. Evaluation of endothelial function in exogenous subclinical hyperthyroidism and the effect of treatment. Adv Biomed Res, 2016, 5(1): 173.
20. Parle JV, Maisonneuve P, Sheppard MC, et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet, 2001, 358(9285): 861-5.
21. Sgarbi JA, Matsumura LK, Kasamatsu TS, et al. Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese-Brazilian thyroid study. Eur J Endocrinol, 2010, 162(3): 569-77.
22. Ceresini G, Ceda GP, Lauretani F, et al. Thyroid status and 6-year mortality in elderly people living in a mildly iodine-deficient area: the aging in the Chianti Area Study. J Am Geriatr Soc, 2013, 61(6): 868-874.
23. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9), 1033-1041.
24. de Jongh RT, Lips P, van Schoor NM, et al. Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals. Eur J Endocrinol, 2011, 165(4): 545-554.
25. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
26. Canfield SE, Dahm P. Rating the quality of evidence and the strength of recommendations using GRADE. World J Urol, 2011, 29(3): 311-317.
27. Gussekloo J, van E, de C, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA, 2004, 292(21), 2591-2599.
28. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med, 2005, 165(21), 2467-2472.
29. Bauer DC, Rodondi N, Stone KL, et al.Study of osteoporotic fractures research group: universities of california PM, kaiser permanente center for health research P. thyroid hormone use, hyperthyroidism and mortality in older women. Am J Med, 2007, 120(4): 343-349.
30. Asvold BO, Bjøro T, Nilsen TI, et al. Thyrotropin levels and risk of fatal coronary heart disease:the HUNT study. Arch Intern Med, 2008, 168(8),855-860.
31. Ittermann T, Haring R, Sauer S, et al. Decreased serum TSH levels are not associated with mortality in the adult northeast German population. Eur J Endocrinol, 2010, 162(3): 579-585.
32. Schultz M, Kistorp C, Raymond I, et al. Cardiovascular events in thyroid disease: a population based, prospective study. Horm Metab Res, 2011, 43(9): 653-659.
33. Asvold BO, Bjoro T, Platou C, et al. Thyroid function and the risk of coronary heart disease: 12-year follow-up of the HUNT study in Norway. Clin Endocrinol (Oxf), 2012, 77(6): 911-917.
34. Nanchen D, Gussekloo J, Westendorp RG, et al. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. Clin Endocrinol (Oxf), 2012, 97(3): 852-61.
35. Effraimidis G, Wiersinga WM. Mechanisms in endocrinology: autoimmune thyroid disease: old and new players. Eur J Endocrinol, 2014, 170(6): R241-252.
36. Mathews JD, Whittingham S, Mackay IR. Autoimmune mechanisms in human vascular disease. Lancet, 1974, 2(7894): 1423-1427.
37. Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med, 2015, 162(1): 35-45.
38. Biondi B, Bartalena L, Cooper DS, et al. The 2015 European thyroid association guidelines on diagnosis and treatment of endogenous subclinical hyperthyroidism. Eur Thyroid J, 2015, 4(3): 149-163.

Chinese Journal of Evidence-Based Medicine

Relationship between subclinical hyperthyroidism and the incidence of coronary heart disease: a meta-analysis

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