Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Jing Sun, Liang Yao, Yuan Fang, Ruifei Yang, Yaolong Chen, Kehu Yang, Limin Tian, Jing Sun, Liang Yao, Yuan Fang, Ruifei Yang, Yaolong Chen, Kehu Yang, Limin Tian

Abstract

Background: Evidence on the association between subclinical thyroid dysfunction and the risk of cardiovascular outcomes are conflicting.

Methods and results: PubMed, EMbase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) databases were searched from inception to July 10, 2016. A total of 16 studies were included for meta-analysis. We found that subclinical hypothyroidism was not correlated with coronary heart disease (CHD) (RR = 1.17; 95% CI, 0.91-1.52), total mortality (RR = 1.02; 95% CI, 0.93-1.13), cardiovascular mortality (RR = 1.06; 95% CI, 0.77-1.45), heart failure (RR = 1.17; 95% CI, 0.87-1.57), and atrial fibrillation (RR = 1.05; 95% CI, 0.91-1.21), except CHD mortality (RR = 1.37; 95% CI, 1.03-1.84). Subgroup analysis indicated a higher estimation risk in CHD (RR = 1.54; 95% CI, 1.00-2.39), cardiovascular mortality (RR = 2.14; 95% CI, 1.43-3.22), and CHD mortality (RR = 1.54; 95% CI, 1.11-2.15) among participants < 65 years. Furthermore, subclinical hyperthyroidism was found to be associated with CHD (RR = 1.20; 95% CI, 1.02-1.42), total mortality (RR = 1.27; 95% CI, 1.07-1.51), and CHD mortality (RR = 1.45; 95% CI, 1.12-1.86).

Conclusions: Subclinical hypothyroidism is likely associated with an increased risk of CHD mortality, and subclinical hyperthyroidism is likely associated with increased risk of CHD, CHD mortality, and total mortality.

Figures

Figure 1
Figure 1
Flow chart for study inclusion.
Figure 2
Figure 2
Forest plots for subclinical thyroid dysfunction. (a) Forest plots for subclinical thyroid dysfunction and risk of CHD; (b) forest plots for subclinical thyroid dysfunction and risk of total mortality; (c) forest plots for subclinical thyroid dysfunction and risk of cardiovascular mortality.
Figure 3
Figure 3
Forest plots for subclinical thyroid dysfunction. (a) Forest plots for subclinical thyroid dysfunction and CHD mortality; (b) forest plots for subclinical thyroid dysfunction and risk of heart failure; (c) forest plots for subclinical thyroid dysfunction and risk of atrial fibrillation.

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