Hypothyroidism and risk of atrial fibrillation: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIANG Yuping ¹ , ZENG Ling ¹ , LUO Tianhui ¹ , ZHAO Qin ¹ ,  QIAN Yongjun ²

1. Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Hypothyroidism; Atrial fibrillation; Meta-analysis; Systematic review; Cohort study; Case-control study

DOI：

10.7507/1672-2531.201909003

Video：

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Objectives To systematically review the relationship between hypothyroidism and the risk of atrial fibrillation.Method PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cohort and case-control studies on the association between hypothyroidism and atrial fibrillation from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 5 cohort studies involving 574 268 subjects and 18 059 atrial fibrillation cases were included. The results of meta-analysis showed that hypothyroidism was not associated with atrial fibrillation (OR=1.10, 95%CI 0.75 to 1.61, P=0.62). From subgroup analysis, no relationship was identified in community population (OR=0.97, 95%CI 0.72 to 1.29, P=0.82) and cardiac surgery patients (OR=1.22, 95%CI 0.58 to 2.53, P=0.60).Conclusions Hypothyroidism does not increase the risk of atrial fibrillation. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： XIANG Yuping, ZENG Ling, LUO Tianhui, ZHAO Qin, QIAN Yongjun. Hypothyroidism and risk of atrial fibrillation: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 556-561. doi: 10.7507/1672-2531.201909003 Copy

1.	Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
2.	Lip GYH, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest, 2012, 142(6): 1489-1498.
3.	Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
4.	Guttmann OP, Rahman S, O'Mahony C, et al. Systematic review of atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy. Europ Heart J, 2013, 34(1): 2965.
5.	Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation, 2011, 123(15): 1587.
6.	He W, Chu Y. Atrial fibrillation as a prognostic indicator of myocardial infarction and cardiovascular death: a systematic review and meta-analysis. Sci Rep, 2017, 7(1): 3360.
7.	Youssef I, Kamran H, Yacoub M, et al. Obstructive sleep apnea as a risk factor for atrial fibrillation: a meta-analysis. J Sleep Disord Ther, 2018, 7(1): 282.
8.	Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ, 2016, 532: h7013.
9.	Wanahita N, Messerli FH, Bangalore S, et al. Atrial fibrillation and obesity--results of a meta-analysis. Am Heart J, 2008, 155(2): 310-315.
10.	Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil, 2010, 17(6): 706-712.
11.	Reddy V, Taha W, Kundumadam S, et al. Atrial fibrillation and hyperthyroidism: a literature review. Indian Heart J, 2017, 69(4): 545-550.
12.	Heeringa J, Hoogendoorn EH, van der Deure WM, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med, 2008, 168(20): 2219-2224.
13.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14.	Komatsu R, Karimi N, Zimmerman NM, et al. Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis. J Anesth, 2018, 32(5): 663-672.
15.	Jaimes MC, Torrado LAA, Reyes NFS, et al. Hypothyroidism is a risk factor for atrial fibrillation after coronary artery bypass graft. Braz J Cardiovasc Surg, 2017, 32(6): 475-480.
16.	Worku B, Tortolani AJ, Gulkarov I, et al. Preoperative hypothyroidism is a risk factor for postoperative atrial fibrillation in cardiac surgical patients. J Card Surg, 2015, 30(4): 307-312.
17.	Kim EJ, Lyass A, Wang N, et al. Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study). Am Heart J, 2014, 167(1): 123-126.
18.	Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
19.	Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol, 2018, 14(5): 301-316.
20.	Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid, 2007, 17(12): 1211-1223.
21.	Walsh JP, Bremner AP, Feddema P, et al. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab, 2010, 95(3): 1095-1104.
22.	Jensen MT, Marott JL, Allin KH, et al. Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers: the Copenhagen City Heart Study. Eur J Prev Cardiol, 2012, 19(1): 102-108.
23.	Ladenson PW, Kristensen JD, Ridgway EC, et al. Use of the thyroid hormone analogue eprotirome in statin-treated dyslipidemia. N Engl J Med, 2010, 362(10): 906-916.
24.	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. Circulation, 2019, 140(2): e125-e151.
25.	陈明辉. 甲状腺功能减退对稳定性心绞痛患者发生房颤的影响. 哈尔滨医药, 2015, (3): 177-178, 179.

1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
2. Lip GYH, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest, 2012, 142(6): 1489-1498.
3. Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
4. Guttmann OP, Rahman S, O'Mahony C, et al. Systematic review of atrial fibrillation and stroke in patients with hypertrophic cardiomyopathy. Europ Heart J, 2013, 34(1): 2965.
5. Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation, 2011, 123(15): 1587.
6. He W, Chu Y. Atrial fibrillation as a prognostic indicator of myocardial infarction and cardiovascular death: a systematic review and meta-analysis. Sci Rep, 2017, 7(1): 3360.
7. Youssef I, Kamran H, Yacoub M, et al. Obstructive sleep apnea as a risk factor for atrial fibrillation: a meta-analysis. J Sleep Disord Ther, 2018, 7(1): 282.
8. Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ, 2016, 532: h7013.
9. Wanahita N, Messerli FH, Bangalore S, et al. Atrial fibrillation and obesity--results of a meta-analysis. Am Heart J, 2008, 155(2): 310-315.
10. Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil, 2010, 17(6): 706-712.
11. Reddy V, Taha W, Kundumadam S, et al. Atrial fibrillation and hyperthyroidism: a literature review. Indian Heart J, 2017, 69(4): 545-550.
12. Heeringa J, Hoogendoorn EH, van der Deure WM, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med, 2008, 168(20): 2219-2224.
13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14. Komatsu R, Karimi N, Zimmerman NM, et al. Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis. J Anesth, 2018, 32(5): 663-672.
15. Jaimes MC, Torrado LAA, Reyes NFS, et al. Hypothyroidism is a risk factor for atrial fibrillation after coronary artery bypass graft. Braz J Cardiovasc Surg, 2017, 32(6): 475-480.
16. Worku B, Tortolani AJ, Gulkarov I, et al. Preoperative hypothyroidism is a risk factor for postoperative atrial fibrillation in cardiac surgical patients. J Card Surg, 2015, 30(4): 307-312.
17. Kim EJ, Lyass A, Wang N, et al. Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study). Am Heart J, 2014, 167(1): 123-126.
18. Selmer C, Olesen JB, Hansen ML, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ, 2012, 345: e7895.
19. Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol, 2018, 14(5): 301-316.
20. Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid, 2007, 17(12): 1211-1223.
21. Walsh JP, Bremner AP, Feddema P, et al. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab, 2010, 95(3): 1095-1104.
22. Jensen MT, Marott JL, Allin KH, et al. Resting heart rate is associated with cardiovascular and all-cause mortality after adjusting for inflammatory markers: the Copenhagen City Heart Study. Eur J Prev Cardiol, 2012, 19(1): 102-108.
23. Ladenson PW, Kristensen JD, Ridgway EC, et al. Use of the thyroid hormone analogue eprotirome in statin-treated dyslipidemia. N Engl J Med, 2010, 362(10): 906-916.
24. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. Circulation, 2019, 140(2): e125-e151.
25. 陈明辉. 甲状腺功能减退对稳定性心绞痛患者发生房颤的影响. 哈尔滨医药, 2015, (3): 177-178, 179.

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