Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study

Thyroid, vol. 36, pp. 674–681

Abstract

BACKGROUND: Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear. METHODS: = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry. RESULTS: SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24). CONCLUSIONS: SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.

Authors 6

1. Stan R. Ursem

   Amsterdam University Medical Centers · Amsterdam UMC Location University of Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands

   Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

2. Raymond Noordam Aachen Department of Clinical Epidemiology Health Campus The Hague/Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

   Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands

3. Anita Boelen

   Amsterdam University Medical Centers · Amsterdam UMC Location University of Amsterdam · Amsterdam Reproduction Development · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands

   Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands

   Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

4. Petra J. M. Elders

   Amsterdam University Medical Centers · Amsterdam Public Health

   Affiliation as printed

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands

5. Wendy P. J. den Elzen

   Amsterdam University Medical Centers · Amsterdam Public Health · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands

   Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

   Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands

6. Annemieke C. Heijboer

   Amsterdam University Medical Centers · Amsterdam UMC Location Vrije Universiteit Amsterdam · Amsterdam UMC Location University of Amsterdam · Amsterdam Reproduction Development · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands

   Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands

   Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands

   Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, The Netherlands