PMID- 30517746
OWN - NLM
STAT- MEDLINE
DCOM- 20200227
LR  - 20200227
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Linking)
VI  - 104
IP  - 5
DP  - 2019 May 1
TI  - Long-Term Outcome in Patients With Heart Failure Treated With Levothyroxine: An 
      Observational Nationwide Cohort Study.
PG  - 1725-1734
LID - 10.1210/jc.2018-01604 [doi]
AB  - CONTEXT: Hypothyroidism has detrimental effects on the cardiovascular system, but 
      controversy remains concerning the benefits of levothyroxine (L-T4) substitution 
      in patients with heart failure (HF). OBJECTIVE: Examining the effects of L-T4 in 
      patients with HF. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 
      All Danish citizens aged >/=18 years diagnosed with HF between 1997 and 2012. L-T4 
      treatment was identified from nationwide registers. Incidence rate ratios (IRRs) 
      were calculated with Poisson regression models. MAIN OUTCOME MEASURES: All-cause 
      mortality, myocardial infarction (MI), cardiovascular death, and major adverse 
      cardiovascular events (MACEs). RESULTS: A total of 224,670 patients were 
      diagnosed with HF [mean age 70.7 (SD +/- 14.7) years, 53% male]. Of these, 6560 
      patients were treated with L-T4 at baseline, and 9007 patients initiated L-T4 
      during follow-up. A total of 209,103 patients did not receive L-T4. During a 
      median follow-up of 4.8 years [interquartile range (IQR) 9.2] 147,253 patients 
      died. Increased risk of all-cause mortality (IRR 1.25; 95% CI, 1.21 to 1.29; IRR 
      1.13; 95% CI, 1.10 to 1.16), cardiovascular death (IRR 1.23; 95% CI, 1.18 to 
      1.27; IRR 1.11; 95% CI, 1.08 to 1.15), and MACE (IRR 1.26; 95% CI, 1.22 to 1.31; 
      IRR 1.05; 95% CI, 1.02 to 1.09) was observed for treatment ongoing at baseline 
      and initiated during follow-up, respectively. Increased risk of MI (IRR 1.32; 95% 
      CI, 1.23 to 1.41) was observed for ongoing treatment, and reduced risk (IRR 0.87; 
      95% CI, 0.81 to 0.93) was observed for incident treatment. CONCLUSION: Ongoing 
      and incident L-T4 treatment in patients with HF was associated with an increased 
      risk of all-cause mortality, cardiovascular death, and MACE. Increased risk of MI 
      was observed for ongoing treatment, and reduced risk was observed for incident 
      treatment.
CI  - Copyright (c) 2019 Endocrine Society.
FAU - Einfeldt, Mette Nygaard
AU  - Einfeldt MN
AD  - Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
FAU - Olsen, Anne-Marie Schjerning
AU  - Olsen AS
AD  - Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
FAU - Kristensen, Soren Lund
AU  - Kristensen SL
AD  - Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
FAU - Khalid, Usman
AU  - Khalid U
AD  - Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
FAU - Faber, Jens
AU  - Faber J
AD  - Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, 
      Denmark.
AD  - Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
FAU - Torp-Pedersen, Christian
AU  - Torp-Pedersen C
AD  - Department of Health Science and Technology, University of Aalborg, Aalborg 
      Denmark.
FAU - Gislason, Gunnar H
AU  - Gislason GH
AD  - Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
AD  - Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
AD  - The Danish Heart Foundation, Copenhagen, Denmark.
AD  - The National Institute of Public Health, University of Southern Denmark, 
      Copenhagen, Denmark.
FAU - Selmer, Christian
AU  - Selmer C
AD  - Department of Endocrinology, Herlev-Gentofte University Hospital, Herlev, 
      Denmark.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - Q51BO43MG4 (Thyroxine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiovascular Diseases/chemically induced/*mortality/pathology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/chemically induced/*mortality/pathology
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Thyroxine/*adverse effects
MH  - Young Adult
EDAT- 2018/12/06 06:00
MHDA- 2020/02/28 06:00
CRDT- 2018/12/06 06:00
PHST- 2018/07/24 00:00 [received]
PHST- 2018/11/29 00:00 [accepted]
PHST- 2018/12/06 06:00 [pubmed]
PHST- 2020/02/28 06:00 [medline]
PHST- 2018/12/06 06:00 [entrez]
AID - 5224760 [pii]
AID - 10.1210/jc.2018-01604 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2019 May 1;104(5):1725-1734. doi: 10.1210/jc.2018-01604.