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The association of thyroid stimulation hormone levels with incident ischemic heart disease, incident stroke, and all-cause mortality

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Abstract

Purpose

Thyroid dysfunction may affect the risk of cardiovascular disease and mortality through effects on myocardial and vascular tissue and metabolism. Levels of thyroid stimulating hormone (TSH) indicates thyroid function. We aimed to assess the association between TSH-levels and incident ischemic heart disease (IHD), incident stroke, and all-cause mortality.

Methods

We included 13,865 participants (18–71 years, 51.6% women) from five cohort studies conducted during 1974–2008 were included. TSH was measured at the baseline examination and classified as <0.4; 0.4–2.5 (ref.); 2.5–5.0; 5.0–10, or >10 mU/l. Incident IHD, incident stroke, and all-cause mortality were identified in registries until ultimo 2013. Data were analysed by multivariate Cox regression with age as underlying time axis. Results from the individual cohorts were pooled by random-effects meta-analysis.

Results

The crude incidence rate was for IHD 7.8 cases/1000 person years (PY); stroke 5.4 cases/1000 PY; and all-cause mortality 11.3 deaths/1000 PY (mean follow-up: 14 years). Analyses showed no statistically significant associations between TSH-levels and incident IHD or incident stroke in the partly or fully adjusted models. There was a statistically significant association between TSH of 2.5–5 mU/l and all-cause mortality (hazard ratio 1.145 (95% CI 1.004–1.306) compared with TSH of 0.4–2.5 mU/l in the fully adjusted model.

Conclusion

The results do not provide evidence of a harmful effect of decreased or increased TSH on IHD or stroke in the general population. However, there is some indication of an elevated risk for all-cause mortality with TSH 2.5–5 mU/l compared with 0.4–2.5 mU/l.

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Acknowledgements

The authors acknowledge support from the DanThyr group. The study received financial support from Helsefonden, grant no. 19-B-0379. Also, this project received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 634453. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the paper.

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Authors and Affiliations

  1. Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark

    Line Tang Møllehave, Tea Skaaby, Allan Linneberg, Torben Jørgensen & Betina Heinsbæk Thuesen

  2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Allan Linneberg

  3. Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark

    Nils Knudsen

  4. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Torben Jørgensen

  5. Faculty of Medicine, Aalborg University, Aalborg, Denmark

    Torben Jørgensen

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Møllehave, L.T., Skaaby, T., Linneberg, A. et al. The association of thyroid stimulation hormone levels with incident ischemic heart disease, incident stroke, and all-cause mortality. Endocrine 68, 358–367 (2020). https://doi.org/10.1007/s12020-020-02216-5

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