Central hypothyroidism and cardiovascular disease: a Spanish cohort observational study

Abstract

[Abstract] Purpose: Little is known about cardiovascular (CV) risk in patients with central hypothyroidism. We aimed to describe the prevalence and incidence of cardiovascular risk factors (CVRFs), cardiovascular diseases (CVDs), and mortality in adults with central hypothyroidism.

Methods and patients: This multicenter, retrospective, observational study included patients with central hypothyroidism treated at 14 tertiary hospitals in Spain.

Results: A total of 637 patients were analyzed, 339 (53.2%) of whom were male, with a median age of 54 [IQR: 40-67] years. Among them, 582 (91.4%) had combined central hypothyroidism and 55 (8.6%) isolated central hypothyroidism. At baseline, 218 (34.2%) had dyslipidemia, 200 (31.4%) hypertension, and 84 (13.2%) diabetes. In addition, 21 (3.3%) had a history of myocardial infarction, eight (1.3%) chronic coronary syndrome, nine (1.4%) heart failure, and 20 (3.1%) cerebrovascular disease. Median follow-up was 7.0 [3.3-11.8] years, and seven (1.1%) patients recovered from other hormone deficiencies. At the last visit, 575 (90.3%) had combined central hypothyroidism and 62 (9.7%) isolated central hypothyroidism. From the time of diagnosis to the last visit, incident CVRFs included dyslipidemia in 182 (43.4%), hypertension in 104 (23.8%), and diabetes in 67 (12.1%) patients. Incident CVDs included 16 (2.6%) myocardial infarctions, 11 (1.7%) chronic coronary syndromes, 17 (2.7%) heart failures, and 33 (5.3%) cerebrovascular diseases. Incident CVRFs, most CVDs, and mortality were similar between patients with combined and isolated central hypothyroidism. During follow-up, 46 (7.2%) patients died, with causes including infections (32.6%), CVDs (21.7%), and malignancies (21.7%).

Conclusions: Central hypothyroidism is associated with a high prevalence of CVRFs. The incidence of CVRFs, most CVDs, and mortality were similar in patients with isolated and combined central hypothyroidism.