A Major New Risk Marker for Atherosclerosis?
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Background: Thyroid Function and Atherosclerotic Cardiovascular Disease Risk
Thyroid dysfunction has long been known to affect certain cardiovascular conditions. Measuring thyroid function to discover occult hyperthyroidism is recommended to evaluate causal factors for new-onset atrial fibrillation.1 Similarly, thyroid function testing is advocated to exclude hypothyroidism as a secondary cause of dyslipidemia before initiating lipid-lowering therapy.2 However, the effect of thyroid hormone on atherothrombosis, the major cause of cardiovascular morbidity and mortality, remains controversial, with various studies showing no effect on cardiovascular risk,3,4 increased risk associated with low thyroid function,5,6 and greater risk associated with high thyroid function,7–9 in some cases within the reference range. Thus, whether variations in thyroid function both without and within the normal reference range can impact atherosclerotic cardiovascular disease (ASCVD) risk is unresolved.
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Summary of the Current Study
In this issue of Circulation Research, Bano et al10 examine the relationship of 3 metrics of thyroid function to 3 measures of atherosclerosis, spanning its spectrum from preclinical disease (defined by coronary artery calcification), to clinical ASCVD events, to ASCVD-related mortality. To examine this association, they turned to the well-known prospective population-based Rotterdam Cohort Study—an ongoing investigation of the determinants of chronic disease occurrence and progression in middle-aged and older adults. The Rotterdam Study enrolled its first cohort in 1989 and added a second cohort in 2000 and a third in 2006, with clinical follow-up for health outcomes every 3 to 5 years.
The present study included 9420 subjects, including those seen at the third visit for cohort 1 and the first visits for cohorts 2 and 3, who had complete baseline thyroid function measurements for thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies, and who also had complete information on ASCVD. Over a mean follow-up of 8.8 …