Levothyroxine Treated Patients with Subclinical Hypothyroidism and Concomitant Heart Disease

Long-term Outcome in Levothyroxine Treated Patients with Subclinical Hypothyroidism and Concomitant Heart Disease: The Journal of Clinical Endocrinology &Metabolism, Early Release.







Mette Nygaard Andersen1, Anne-Marie Schjerning Olsen1, Jesper Clausager Madsen2, Søren Lund Kristensen1, Jens Faber3,4, Christian Torp-Pedersen5, Gunnar H Gislason1,4,6,7, and Christian Selmer8



Address all correspondence and requests for reprints to: Corresponding author and person to whom reprint requests should be addressed: Mette Nygaard Andersen, MD,

Department of Cardiology, Gentofte University Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark

, Phone: +45 60388285 - E-mail: mette.nygaard.andersen@gmail.com.

DOI: http://ift.tt/2bO5zRj



Abstract

Context:

Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function.

Objective:

To examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease.

Design:

Register-based historical cohort study.

Setting and Participants:

Danish primary care patients and hospital outpatients aged 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997 – 2011. Patients were stratified according to whether or not they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multi-variable Poisson regression models.

Main Outcome Measures:

All-cause mortality, MACE (major adverse cardiac events) defined as cardiovascular death, fatal or non-fatal MI and stroke, and all-cause hospital admissions.

Results:

Of 61,611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1,192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] years, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 years (IQR 6.5), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR 1.17 [95% CI: 0.90–1.52]), MACE (adjusted IRR 1.08 [95% CI: 0.80–1.45]), or hospital admission (adjusted IRR 0.94 [95% CI: 0.71–1.24]), when compared to patients not treated with levothyroxine.

Conclusion:

Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE or hospital admission in this large real-world cohort study.

Affiliations

1Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark;

2Elective Laboratory of the Capital Region, Copenhagen, Denmark;

3Department of Endocrinology, Herlev University Hospital, Herlev, Denmark;

4Faculty of Health Sciences, University of Copenhagen, Denmark;

5Department of Health Science and Technology, University of Aalborg, Denmark;

6The Danish Heart Foundation, Copenhagen, Denmark;

7The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark;

8Department of Endocrinology, Amager and Hvidovre University Hospital, Copenhagen, Denmark

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