Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIANG Yuping ^1,2 , LUO Tianhui ^1,2 ,  QIAN Yongjun ³ , ZENG Ling ^1,2

1. Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. West China School of Nursing, Sichuan University, Chengdu 610041, P.R.China;
3. Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Subclinical hypothyroidism; Subclinical hyperthyroidism; Atrial fibrillation; Correlation; Meta-analysis

DOI：

10.7507/1672-2531.202101035

Video：

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Objective To systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.Methods Databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). Conclusions Subclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.

Citation： XIANG Yuping, LUO Tianhui, QIAN Yongjun, ZENG Ling. Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(7): 810-815. doi: 10.7507/1672-2531.202101035 Copy

1.	Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
2.	Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation, 2004, 110(9): 1042-1046.
3.	Lee HY, Yang PS, Kim TH, et al. Atrial fibrillation and the risk of myocardial infarction: a nation-wide propensity-matched study. Sci Rep, 2017, 7(1): 12716.
4.	Conen D, Chae CU, Glynn RJ, et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA, 2011, 305(20): 2080-2087.
5.	Chen LY, Sotoodehnia N, Bůžková P, et al. Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study. JAMA Intern Med, 2013, 173(1): 29-35.
6.	Kalantarian S, Ay H, Gollub RL, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med, 2014, 161(9): 650-658.
7.	Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA, 1994, 271(11): 840-844.
8.	Zacharias A, Schwann TA, Riordan CJ, et al. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation, 2005, 112(21): 3247-3255.
9.	Ahmari SA, Bunch TJ, Chandra A, et al. Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter. J Heart Lung Transplant, 2006, 25(1): 53-60.
10.	Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol, 2014, 64(21): 2222-2231.
11.	Martínez-González MÁ, Toledo E, Arós F, et al. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation, 2014, 130(1): 18-26.
12.	Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA, 2013, 310(19): 2050-2060.
13.	N J, Francis J. Atrial fibrillation and hyperthyroidism. Indian Pacing Electrophysiol J, 2005, 5(4): 305-311.
14.	Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab, 2002, 87(2): 489-499.
15.	Collet TH, Gussekloo J, Bauer DC, et al. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med, 2012, 172(10): 799-809.
16.	Sun J, Yao L, Fang Y, et al. Relationship between subclinical thyroid dysfunction and the risk of cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. Int J Endocrinol, 2017, 2017: 8130796.
17.	Nanchen D, Gussekloo J, Westendorp RG, et al. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab, 2012, 97(3): 852-861.
18.	Park YJ, Yoon JW, Kim KI, et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg, 2009, 87(6): 1846-1852.
19.	Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9): 1033-1041.
20.	Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
21.	单忠艳. 《中国甲状腺疾病诊治指南》导读. 中国实用内科杂志, 2008, 28(4): 260-261.
22.	Gammage MD, Parle JV, Holder RL, et al. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med, 2007, 167(9): 928-934.
23.	Auer J, Scheibner P, Mische T, et al. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J, 2001, 142(5): 838-842.
24.	Kong SH, Yoon JW, Kim SY, et al. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting. Am J Cardiol, 2018, 122(11): 1862-1870.
25.	Martínez-Comendador J, Marcos-Vidal JM, Gualis J, et al. Subclinical hypothyroidism might increase the risk of postoperative atrial fibrillation after aortic valve replacement. Thorac Cardiovasc Surg, 2016, 64(5): 427-433.
26.	Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med, 1994, 331(19): 1249-1252.

1. Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
2. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation, 2004, 110(9): 1042-1046.
3. Lee HY, Yang PS, Kim TH, et al. Atrial fibrillation and the risk of myocardial infarction: a nation-wide propensity-matched study. Sci Rep, 2017, 7(1): 12716.
4. Conen D, Chae CU, Glynn RJ, et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA, 2011, 305(20): 2080-2087.
5. Chen LY, Sotoodehnia N, Bůžková P, et al. Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study. JAMA Intern Med, 2013, 173(1): 29-35.
6. Kalantarian S, Ay H, Gollub RL, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med, 2014, 161(9): 650-658.
7. Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA, 1994, 271(11): 840-844.
8. Zacharias A, Schwann TA, Riordan CJ, et al. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation, 2005, 112(21): 3247-3255.
9. Ahmari SA, Bunch TJ, Chandra A, et al. Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter. J Heart Lung Transplant, 2006, 25(1): 53-60.
10. Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol, 2014, 64(21): 2222-2231.
11. Martínez-González MÁ, Toledo E, Arós F, et al. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation, 2014, 130(1): 18-26.
12. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA, 2013, 310(19): 2050-2060.
13. N J, Francis J. Atrial fibrillation and hyperthyroidism. Indian Pacing Electrophysiol J, 2005, 5(4): 305-311.
14. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab, 2002, 87(2): 489-499.
15. Collet TH, Gussekloo J, Bauer DC, et al. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med, 2012, 172(10): 799-809.
16. Sun J, Yao L, Fang Y, et al. Relationship between subclinical thyroid dysfunction and the risk of cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. Int J Endocrinol, 2017, 2017: 8130796.
17. Nanchen D, Gussekloo J, Westendorp RG, et al. Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk. J Clin Endocrinol Metab, 2012, 97(3): 852-861.
18. Park YJ, Yoon JW, Kim KI, et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg, 2009, 87(6): 1846-1852.
19. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9): 1033-1041.
20. Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
21. 单忠艳. 《中国甲状腺疾病诊治指南》导读. 中国实用内科杂志, 2008, 28(4): 260-261.
22. Gammage MD, Parle JV, Holder RL, et al. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med, 2007, 167(9): 928-934.
23. Auer J, Scheibner P, Mische T, et al. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J, 2001, 142(5): 838-842.
24. Kong SH, Yoon JW, Kim SY, et al. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting. Am J Cardiol, 2018, 122(11): 1862-1870.
25. Martínez-Comendador J, Marcos-Vidal JM, Gualis J, et al. Subclinical hypothyroidism might increase the risk of postoperative atrial fibrillation after aortic valve replacement. Thorac Cardiovasc Surg, 2016, 64(5): 427-433.
26. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med, 1994, 331(19): 1249-1252.

Chinese Journal of Evidence-Based Medicine

Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis

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