| アブストラクト | Importance: There is uncertainty as to whether treatment of subclinical hypothyroidism (SCH) is associated with cardiovascular outcomes. Objectives: To determine whether levothyroxine replacement therapy decreases the risk of major adverse cardiovascular events (MACE) among individuals with SCH defined as having a thyrotropin (TSH) level between 5 and 10 mU/L. Design: We conducted a population-based cohort study using a prevalent new-user design. Setting: The study utilized data from the United Kingdom Clinical Practice Research Datalink. Participants: We identified a base cohort of individuals aged >/=18 years with incident SCH defined as having at least two TSH levels between 5 and 10 mU/L within one year between 1998 and 2018. We matched 76,946 levothyroxine treated to 76,946 untreated individuals based on age, sex, calendar time, duration of SCH, and time-conditional propensity score. We compared individuals with SCH treated with levothyroxine with individuals with no treatment. Exposure: Levothyroxine treatment versus no treatment. Main Outcome Measures: The primary outcome, MACE, was defined as a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular-related mortality. Results: The mean age of the study cohort was 62.8 years, and 76.5% were women. During a median follow-up time of 1.6 years (interquartile range: 0.5-4.2), the incidence rate for MACE among individuals treated with levothyroxine was 12.8 per 1000 person-years; confidence interval (CI): 12.2-13.3 and 13.9 per 1000 person-years; CI: 13.4-14.3 among nontreated individuals. Levothyroxine treatment was associated with a small decreased risk of MACE (hazard ratio: 0.88; CI: 0.83-0.93). Conclusions: Levothyroxine treatment of SCH was associated with a small decreased risk of MACE. However, given the observational nature of the study, residual confounding should be considered in the interpretation of this finding. |
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| ジャーナル名 | Thyroid : official journal of the American Thyroid Association |
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| 投稿日 | 2024/8/6 |
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| 投稿者 | Yu, Oriana Hoi Yun; Filliter, Christopher; Filion, Kristian B; Platt, Robert W; Grad, Roland; Renoux, Christel |
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| 組織名 | Division of Endocrinology, Jewish General Hospital, Montreal, Canada.;Department of Medicine, McGill University, Montreal, Canada.;Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Canada.;Department of Epidemiology, Biostatistics and Occupational Health, McGill;University, Montreal, Canada.;Department of Pediatrics, McGill University, Montreal, Canada.;Department of Family Medicine, McGill University, Montreal, Canada.;Department of Neurology and Neurosurgery, McGill University, Montreal, Canada. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/39104265/ |
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