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Background <p>Both hypothyroidism and hyperthyroidism have been associated with an increased risk of cardiovascular morbidity and mortality. However, the association between subclinical thyroid dysfunction and cardiovascular disease (CVD) continues to be debated.</p> Objective <p>This study aimed to examine the association between different thyroid-stimulating hormone (TSH) levels and the incidence of CVD during a 10-year follow-up in individuals aged 40&#xa0;years and older.</p> Methods <p>A total of 7179 residents aged 40&#xa0;years or older residing in urban Guiyang, who were participants in the 2011 "Risk Evaluation of cAncers in Chinese diabetic Individuals: A lONgitudinal (REACTION) study" were enrolled. Baseline demographic and clinical information, including sex, age, and smoking status, along with medical history, physical examination, and TSH testing, were collected. Participants were stratified into three groups based on TSH levels: TSH-reduced (&lt; 0.55&#xa0;mU/L, 144 individuals), TSH-normal (0.55–4.78&#xa0;mU/L, 5613 individuals), and TSH-elevated (&gt; 4.78&#xa0;mU/L, 1422 individuals). The TSH-elevated group was further subdivided into mildly elevated (4.78–10&#xa0;mU/L, 1208 individuals) and severely elevated (≥ 10&#xa0;mU/L, 214 individuals) subgroups. Participants were followed for 10&#xa0;years to document the incidence of CVD, including coronary heart disease, myocardial infarction, heart failure, and stroke. Logistic regression was applied to assess the effects of varying TSH levels on CVD incidence.</p> Results <p>CVD incidence was 9.0% (13/144) in the TSH-reduced group, 3.3% (186/5613) in the TSH-normal group, and 3.2% (46/1422) in the TSH-elevated group. In the TSH-elevated group, the incidence was 2.1% (25/1208) in the mildly elevated subgroup and 9.8% (21/214) in the severely elevated subgroup. Compared with the normal TSH group, the incidence of CVD was significantly higher in the TSH-reduced and severely elevated TSH groups, with odds ratios (ORs) of 3.09 (95% CI: 1.62–5.44) and 3.32 (95% CI: 1.99–5.29), respectively (both P &lt; 0.001) after adjustment for potential confounding factors. Interestingly, among participants aged 60–69&#xa0;years, the mildly elevated TSH group had a lower CVD incidence, with an OR of 0.41 (adjusted 95% CI: 0.17–0.84, P = 0.026).</p> Conclusions <p>The findings indicate a U-shaped association between TSH levels and the 10-year incidence of CVD, with both reduced and elevated TSH levels associated with increased CVD risk. In addition, for individuals aged 60–69, mildly elevated TSH may have a potentially protective effect on CVD development, indicating potential age-related heterogeneity in thyroid-related cardiovascular risk.</p>

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Association of Thyroid-Stimulating Hormone Levels with Incident Cardiovascular Events in People Aged 40 Years and Older: A 10-Year Prospective Cohort Study

  • 期刊论文

  • 发表日期：

    2025年7月7日

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  • Sai Yan,
  • Miao Zhang,
  • Ying Hu,
  • Rui Wang,
  • Juan He,
  • Qiao Zhang,
  • Lixin Shi,
  • Nianchun Peng

摘要

Background

Both hypothyroidism and hyperthyroidism have been associated with an increased risk of cardiovascular morbidity and mortality. However, the association between subclinical thyroid dysfunction and cardiovascular disease (CVD) continues to be debated.

Objective

This study aimed to examine the association between different thyroid-stimulating hormone (TSH) levels and the incidence of CVD during a 10-year follow-up in individuals aged 40 years and older.

Methods

A total of 7179 residents aged 40 years or older residing in urban Guiyang, who were participants in the 2011 "Risk Evaluation of cAncers in Chinese diabetic Individuals: A lONgitudinal (REACTION) study" were enrolled. Baseline demographic and clinical information, including sex, age, and smoking status, along with medical history, physical examination, and TSH testing, were collected. Participants were stratified into three groups based on TSH levels: TSH-reduced (< 0.55 mU/L, 144 individuals), TSH-normal (0.55–4.78 mU/L, 5613 individuals), and TSH-elevated (> 4.78 mU/L, 1422 individuals). The TSH-elevated group was further subdivided into mildly elevated (4.78–10 mU/L, 1208 individuals) and severely elevated (≥ 10 mU/L, 214 individuals) subgroups. Participants were followed for 10 years to document the incidence of CVD, including coronary heart disease, myocardial infarction, heart failure, and stroke. Logistic regression was applied to assess the effects of varying TSH levels on CVD incidence.

Results

CVD incidence was 9.0% (13/144) in the TSH-reduced group, 3.3% (186/5613) in the TSH-normal group, and 3.2% (46/1422) in the TSH-elevated group. In the TSH-elevated group, the incidence was 2.1% (25/1208) in the mildly elevated subgroup and 9.8% (21/214) in the severely elevated subgroup. Compared with the normal TSH group, the incidence of CVD was significantly higher in the TSH-reduced and severely elevated TSH groups, with odds ratios (ORs) of 3.09 (95% CI: 1.62–5.44) and 3.32 (95% CI: 1.99–5.29), respectively (both P < 0.001) after adjustment for potential confounding factors. Interestingly, among participants aged 60–69 years, the mildly elevated TSH group had a lower CVD incidence, with an OR of 0.41 (adjusted 95% CI: 0.17–0.84, P = 0.026).

Conclusions

The findings indicate a U-shaped association between TSH levels and the 10-year incidence of CVD, with both reduced and elevated TSH levels associated with increased CVD risk. In addition, for individuals aged 60–69, mildly elevated TSH may have a potentially protective effect on CVD development, indicating potential age-related heterogeneity in thyroid-related cardiovascular risk.