title: Long-Term Outcome in Levothyroxine Treated Patients With Subclinical Hypothyroidism and Concomitant Heart Disease.
abstract: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function.
  
  
  
  This study sought to examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease.
  
  
  
  This was a register-based historical cohort study.
  
  
  
  The study was composed of Danish primary care patients and hospital outpatients age 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997-2011. Patients were stratified according to whether they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multivariable Poisson regression models.
  
  
  
  Measures included all-cause mortality and major adverse cardiac events (MACEs), defined as cardiovascular death, fatal or nonfatal myocardial infaction and stroke, and all-cause hospital admissions.
  
  
  
  Of 61 611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] y, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 y (interquartile range, 6.5 y), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR, 1.17; 95% confidence interval [CI], 0.90-1.52), MACE (adjusted IRR, 1.08; 95% CI, 0.80-1.45), or hospital admission (adjusted IRR, 0.94; 95% CI, 0.71-1.24), when compared with patients not treated with levothyroxine.
  
  
  
  Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE, or hospital admission in this large real-world cohort study.
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Mette Nygaard
authors: MN
authors: Andersen
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Anne-Marie Schjerning
authors: AS
authors: Olsen
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Jesper Clausager
authors: JC
authors: Madsen
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Søren Lund
authors: SL
authors: Kristensen
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Jens
authors: J
authors: Faber
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Christian
authors: C
authors: Torp-Pedersen
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Gunnar H
authors: GH
authors: Gislason
authors: Department of Cardiology (M.N.A., A.-M.S.O., S.L.K., G.H.G.), Gentofte University Hospital, 2900 Hellerup, Denmark; Elective Laboratory of the Capital Region (J.C.M.), 1112 Copenhagen, Denmark; Department of Endocrinology (J.F.), Herlev University Hospital, 2730 Herlev, Denmark; Faculty of Health Sciences (J.F., G.H.G.), University of Copenhagen, 1165 Copenhagen, Denmark; Department of Health Science and Technology (C.T.-P.), University of Aalborg, 9100 Aalborg, Denmark; The Danish Heart Foundation (G.H.G.), 1120 Copenhagen, Denmark; The National Institute of Public Health (G.H.G.), University of Southern Denmark, 1399 Copenhagen, Denmark; and Department of Endocrinology (C.S.), Amager and Hvidovre University Hospital, 2650 Copenhagen, Denmark.
authors: Christian
authors: C
authors: Selmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000009:adverse effects / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D013972:Thyrotropin; D013974:Thyroxine