Relation of hypothyroidism and incident atrial fibrillation (from the Framingham heart study)
Eun-Jeong Kim, MD, Asya Lyass, PhD, Na Wang, MA, Joseph M. Massaro, PhD, Caroline S. Fox, MD, MPH, Emelia J. Benjamin, MD, ScM, and Jared W. Magnani, MD, MSc Boston, and Framingham, MA
Background Hyperthyroidism has a well-described association with atrial fibrillation (AF). However, the relation of
hypothyroidism to AF has had limited investigation. Hypothyroidism is associated with cardiovascular risk factors, subclinical
cardiovascular disease, and overt cardiovascular disease, all of which predispose to AF. We investigated 10-year incidence of
AF in a community-dwelling cohort.
Methods Among 6,653 Framingham heart Study participants, 5,069 participants, 52% female, with mean age of 57 ±
12 years, were eligible after excluding those with missing thyroid-stimulating hormone (TSH), TSH b0.45 μU/L (hyperthyroid),
TSH N19.9 μU/L, or prevalent AF. Thyroid-stimulating hormone was categorized by range (≥0.45 to b4.5, 4.5 to b10.0, 10.0
to ≤19.9 μU/L) and by quartiles. We examined the associations between TSH and 10-year risk of AF using multivariableadjusted
Cox proportional hazards analysis.
Results Over 10-year follow-up, we observed 277 cases of incident AF. A 1-SD increase in TSH was not associated with
increased risk of AF (hazard ratio 1.01, 95% CI 0.90-1.14, P = .83). In categorical analysis, using TSH ≥0.45 to b4.5 μU/L
as the referent (equivalent to euthyroid state), we found no significant association between hypothyroidism and 10-year AF
risk. Comparing the highest (2.6 b TSH b 19.9 μU/L) to lowest (0.45 b TSH b 1.3 μU/L) quartiles of TSH further did not identify
a significant association between TSH levels and 10-year risk of AF.
Conclusions In conclusion, we did not identify a significant association between hypothyroidism and 10-year risk of
incident AF in a community-based study. (Am Heart J 2014;167:123-6.)
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