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Diabetes Res Clin Pract. 2019 Oct 16;157:107880. doi: 10.1016/j.diabres.2019.107880. [Epub ahead of print]

Normal-range thyroid-stimulating hormone levels and cardiovascular events and mortality in type 2 diabetes.

Author information

1
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: T.I.deVries-6@umcutrecht.nl.
2
Department of Internal Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: H.W.deValk@umcutrecht.nl.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: Y.vanderGraaf@umcutrecht.nl.
4
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: G.J.deBorst-2@umcutrecht.nl.
5
Department of Cardiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: M.J.M.Cramer@umcutrecht.nl.
6
Department of Neurology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: l.kappelle@umcutrecht.nl.
7
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: F.L.J.Visseren@umcutrecht.nl.
8
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands. Electronic address: J.Westerink-3@umcutrecht.nl.

Abstract

AIMS:

Thyroid dysfunction is a risk factor for cardiovascular disease. Whether thyroid function within the normal range is a risk factor for cardiovascular disease remains uncertain. The aim of this study is to evaluate whether plasma thyroid-stimulating hormone (TSH) levels in the normal range are a risk factor for cardiovascular disease and mortality in participants with type 2 diabetes mellitus with high cardiovascular risk.

METHODS:

We included 1265 participants with high cardiovascular risk, type 2 diabetes, and TSH within the normal range (0.35-5.00 mIU/L) from the Second Manifestations of ARTerial disease cohort. The primary outcome was major cardiovascular events (MACE; vascular death, stroke and myocardial infarction). Secondary outcomes of interest were the separate vascular outcomes and all-cause mortality. Cox proportional hazard models were used to evaluate the risk of plasma TSH levels on all outcomes.

RESULTS:

A total of 191 MACE occurred during a total follow-up of 8183 years. Plasma TSH levels were not associated with MACE (hazard ratio (HR) per mIU/L TSH increase 0.93; 95% confidence interval (95%CI) 0.80-1.08). With a total of 54 strokes during the study period, plasma TSH was associated with a lower risk of stroke (HR per mIU/L 0.64, 95% CI 0.45-0.89). There was no association between plasma TSH levels and risk of myocardial infarction, vascular death, or all-cause mortality.

CONCLUSIONS:

Higher TSH levels within the normal range are associated with a lower risk of stroke in high-risk patients with type 2 diabetes, but not associated with the risk of other cardiovascular events or mortality.

KEYWORDS:

Cardiovascular risk factors; Cohort study; Thyroid function; Thyrotropin; Type 2 diabetes mellitus

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