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The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 7 3365-3370
Copyright © 2004 by The Endocrine Society

Risk for Ischemic Heart Disease and All-Cause Mortality in Subclinical Hypothyroidism

Misa Imaizumi, Masazumi Akahoshi, Shinichiro Ichimaru, Eiji Nakashima, Ayumi Hida, Midori Soda, Toshiro Usa, Kiyoto Ashizawa, Naokata Yokoyama, Renju Maeda, Shigenobu Nagataki and Katsumi Eguchi

Departments of Clinical Studies (M.I., M.A., S.I., A.H., M.S., R.M.) and Statistics (E.N.), Radiation Effects Research Foundation, Nagasaki 850-0013, Japan; First Department of Internal Medicine, Graduate School of Biomedical Sciences (M.I., T.U., K.E.) and Department of Molecular Medicine, Atomic Bomb Disease Institute (K.A.), Nagasaki University, Nagasaki 852-8523, Japan; Nagasaki Saiseikai Hospital (N.Y.), Nagasaki 850-0003, Japan; and Japan Radioisotope Association (S.N.), Tokyo 113-8941, Japan

Address all correspondence and requests for reprints to: Misa Imaizumi, Radiation Effects Research Foundation, 1-8-6 Nakagawa, Nagasaki 850-0013, Japan. E-mail: misaima{at}rerf.or.jp.

We investigated possible associations between subclinical hypothyroidism and atherosclerotic diseases (ischemic heart disease and cerebrovascular disease) and mortality. Of 2856 participants (mean age 58.5 yr) in a thyroid disease screening between 1984 and 1987, 257 subjects with subclinical hypothyroidism (TSH > 5.0 mU/liter) and 2293 control subjects (TSH range 0.6–5.0 mU/liter) were analyzed. In the baseline cross-sectional analysis, subclinical hypothyroidism was associated with ischemic heart disease independent of age, systolic blood pressure, body mass index, cholesterol, smoking, erythrocyte sedimentation rate, or presence of diabetes mellitus [odds ratio (OR), 2.5; 95% confidence interval (95% CI), 1.1–5.4 in total subjects and OR, 4.0; 95% CI, 1.4–11.5 in men] but not in women. However, there was no association with cerebrovascular disease (OR, 0.9; 95% CI, 0.4–2.4). We were unable to detect an influence of thyroid antibody presence on the association between subclinical hypothyroidism and ischemic heart disease. In a 10-yr follow-up study until 1998, increased mortalities from all causes in yr 3–6 after baseline measurement were apparent in men with subclinical hypothyroidism (hazard ratio, 1.9–2.1) but not in women, although specific causes of death were not determined. Our results indicate that subclinical hypothyroidism is associated with ischemic heart disease and might affect all-cause mortality in men.

This work was supported by RERF Research Protocol 01-83. The RERF, Hiroshima and Nagasaki, Japan, is a private, nonprofit foundation funded by the Japanese Ministry of Health, Labor, and Welfare and the U.S. Department of Energy, with the latter funding provided through the National Academy of Sciences.

Abbreviations: BMI, Body mass index; CI, confidence interval; ESR, erythrocyte sedimentation rate; HR, hazard ratio; ICD9, International Classification of Diseases, ninth version; OR, odds ratio.




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