Thyroid Function within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis
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Thyroid Function within the Reference Range and the Risk of Stroke : An Individual Participant Data Analysis. / Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J; Collet, Tinh-Hai; Ikram, M Arfan; Blum, Manuel R; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N; Portegies, Marileen L P; Iervasi, Giorgio; Medici, Marco; Stott, David J; Dullaart, Robin P; Ford, Ian; Bremner, Alexandra; Newman, Anne B; Wanner, Christoph; Sgarbi, José A; Dörr, Marcus; Longstreth, W T; Psaty, Bruce M; Ferrucci, Luigi; Maciel, Rui M B; Westendorp, Rudi G; Jukema, J Wouter; Ceresini, Graziano; Imaizumi, Misa; Hofman, Albert; Bakker, Stephan J L; Franklyn, Jayne A; Khaw, Kay-Tee; Bauer, Douglas C; Walsh, John P; Razvi, Salman; Gussekloo, Jacobijn; Völzke, Henry; Franco, Oscar H; Cappola, Anne R; Rodondi, Nicolas; Peeters, Robin P; Thyroid Studies Collaboration.
I: The Journal of Clinical Endocrinology & Metabolism, Bind 101, Nr. 11, jc20162255, 11.2016, s. 4270 – 4282.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Thyroid Function within the Reference Range and the Risk of Stroke
T2 - An Individual Participant Data Analysis
AU - Chaker, Layal
AU - Baumgartner, Christine
AU - den Elzen, Wendy P J
AU - Collet, Tinh-Hai
AU - Ikram, M Arfan
AU - Blum, Manuel R
AU - Dehghan, Abbas
AU - Drechsler, Christiane
AU - Luben, Robert N
AU - Portegies, Marileen L P
AU - Iervasi, Giorgio
AU - Medici, Marco
AU - Stott, David J
AU - Dullaart, Robin P
AU - Ford, Ian
AU - Bremner, Alexandra
AU - Newman, Anne B
AU - Wanner, Christoph
AU - Sgarbi, José A
AU - Dörr, Marcus
AU - Longstreth, W T
AU - Psaty, Bruce M
AU - Ferrucci, Luigi
AU - Maciel, Rui M B
AU - Westendorp, Rudi G
AU - Jukema, J Wouter
AU - Ceresini, Graziano
AU - Imaizumi, Misa
AU - Hofman, Albert
AU - Bakker, Stephan J L
AU - Franklyn, Jayne A
AU - Khaw, Kay-Tee
AU - Bauer, Douglas C
AU - Walsh, John P
AU - Razvi, Salman
AU - Gussekloo, Jacobijn
AU - Völzke, Henry
AU - Franco, Oscar H
AU - Cappola, Anne R
AU - Rodondi, Nicolas
AU - Peeters, Robin P
AU - Thyroid Studies Collaboration
PY - 2016/11
Y1 - 2016/11
N2 - CONTEXT: The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously.DESIGN AND SETTING: We identified studies through systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline thyroid-stimulating hormone (TSH), free thyroxine (FT4) and stroke outcomes were included and we collected Individual Participant Data (IPD) from each study, including thyroid function measurements and incident all stroke (combined fatal and non-fatal) and fatal stroke. The applied reference range for TSH levels was between 0.45-4.49 mIU/L.RESULTS: We collected IPD on 43,598 adults with TSH within the reference range from 17 cohorts, with median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449,908 person-years. Age- and sex-adjusted pooled HR for TSH was 0.78 (95% Confidence Interval [CI], 0.65-0.95, across the reference range of TSH) for all stroke and 0.83 (95% CI, 0.62-1.09) for fatal stroke. For the FT4 analyses, the HR was 1.08 (95% CI, 0.99-1.15, per SD increase) for all stroke and 1.10 (95% CI, 1.04-1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking and prevalent diabetes.CONCLUSION: Higher levels of TSH within the reference range may decrease risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function.
AB - CONTEXT: The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously.DESIGN AND SETTING: We identified studies through systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline thyroid-stimulating hormone (TSH), free thyroxine (FT4) and stroke outcomes were included and we collected Individual Participant Data (IPD) from each study, including thyroid function measurements and incident all stroke (combined fatal and non-fatal) and fatal stroke. The applied reference range for TSH levels was between 0.45-4.49 mIU/L.RESULTS: We collected IPD on 43,598 adults with TSH within the reference range from 17 cohorts, with median follow-up of 11.6 years (interquartile range 5.1-13.9), including 449,908 person-years. Age- and sex-adjusted pooled HR for TSH was 0.78 (95% Confidence Interval [CI], 0.65-0.95, across the reference range of TSH) for all stroke and 0.83 (95% CI, 0.62-1.09) for fatal stroke. For the FT4 analyses, the HR was 1.08 (95% CI, 0.99-1.15, per SD increase) for all stroke and 1.10 (95% CI, 1.04-1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking and prevalent diabetes.CONCLUSION: Higher levels of TSH within the reference range may decrease risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function.
U2 - 10.1210/jc.2016-2255
DO - 10.1210/jc.2016-2255
M3 - Journal article
C2 - 27603906
VL - 101
SP - 4270
EP - 4282
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 11
M1 - jc20162255
ER -
ID: 166450036