Endocrinol Metab.  2020 Dec;35(4):786-800. 10.3803/EnM.2020.728.

The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies

• Sohn SY
• Lee E
• Lee MK
• Lee JH

• KMID: 2511006
• DOI: http://doi.org/10.3803/EnM.2020.728

Abstract

Background
Whether hyperthyroidism is an independent risk factor for cardiovascular events remains controversial. We aimed to evaluate the association of overt and subclinical hyperthyroidism with the risk of ischemic heart disease (IHD), stroke, heart failure, and cardiovascular mortality.
Methods
Studies regarding the association between hyperthyroidism and cardiovascular events were searched on PubMed and Embase databases. The cardiovascular disease (CVD) risk was classified as high and low, based on pre-existing diseases, including history of coronary, cerebral, or peripheral artery disease; heart failure; atrial fibrillation; diabetes mellitus; or chronic kidney disease.
Results
Thirty-seven cohort studies were included in this meta-analysis. The pooled hazard ratio for subjects with overt hyperthyroidism compared with the control group was 1.11 (95% confidence interval [CI], 1.03 to 1.19) for IHD, 1.35 (95% CI, 1.03 to 1.75) for stroke, and 1.20 (95% CI, 1.00 to 1.46) for cardiovascular mortality. For subjects with subclinical hyperthyroidism, the pooled hazard ratio was 1.24 (95% CI, 1.07 to 1.45) for IHD, when compared with the control group. Subgroup analysis by CVD risk showed that the risk of stroke in overt hyperthyroidism was increased in the low CVD risk group; however, these association was not observed in the high CVD risk group. Similarly, the risk of IHD in subjects with subclinical hyperthyroidism was significantly increased in the low CVD risk group.
Conclusion
Overt hyperthyroidism is associated with increased risk of IHD, stroke, and cardiovascular mortality, and subclinical hyperthyroidism is associated with increased risk of IHD. These associations were particularly observed in the low risk CVD group without underlying CVD.

Keyword

Hyperthyroidism; Myocardial infarction; Stroke; Heart failure; Mortality; Meta-analysis

Figure

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  Fig. 1 Flowchart of study screening and selection.

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  Fig. 2 Forest plots for hyperthyroidism and risk of ischemic heart disease (IHD). (A) Overt hyperthyroidism and IHD. (B) Subclinical hyperthyroidism and IHD. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.

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  Fig. 3 Forest plots for hyperthyroidism with the risk of stroke. (A) Overt hyperthyroidism and stroke. (B) Subclinical hyperthyroidism and stroke. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.

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  Fig. 4 Forest plots for hyperthyroidism with the risk of heart failure. (A) Overt hyperthyroidism and heart failure. (B) Subclinical hyperthyroidism and heart failure. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.

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  Fig. 5 Forest plots for hyperthyroidism with the risk of cardiovascular (CV) mortality. (A) Overt hyperthyroidism and CV mortality. (B) Subclinical hyperthyroidism and CV mortality. TE, total effect; SE, standard error; IV, inverse variance; CI, confidence interval.

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