PDF(Pubmed)
Abstract：
BACKGROUND: Thyroid dysfunction is common in older people, with females at higher risk. Evidence suggests that thyroid-stimulating hormone (TSH) levels naturally increase with age. However, as uniform serum TSH reference ranges are applied across the adult lifespan, subclinical hypothyroidism (SCH) diagnosis is more likely in older people, with some individuals also being commenced treatment with levothyroxine (LT4). It is unclear whether LT4 treatment in older people with SCH is associated with adverse cardiovascular or bone health outcomes.
METHODS: A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected.
RESULTS: Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible.
CONCLUSIONS: This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years.
BACKGROUND: PROSPERO CRD42022308006.
METHODS: A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected.
RESULTS: Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible.
CONCLUSIONS: This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years.
BACKGROUND: PROSPERO CRD42022308006.
摘要：
背景：甲状腺功能障碍在老年人中很常见，女性风险更高。证据表明，促甲状腺激素（TSH）水平随年龄自然增加。然而,作为统一的血清TSH参考范围适用于整个成人寿命，亚临床甲状腺功能减退症（SCH）诊断更可能发生在老年人中，一些人也开始用左甲状腺素（LT4）治疗。目前尚不清楚老年SCH患者的LT4治疗是否与不良心血管或骨骼健康结局相关。
方法：进行了系统评价和荟萃分析，以综合评估老年人SCH心血管和骨骼健康结局的先前研究，比较LT4治疗与不治疗。PubMed,Embase,科克伦图书馆,MEDLINE,和WebofScience数据库从开始到2023年3月13日进行搜索，并选择了评估50岁以上SCH患者心血管和骨骼健康事件的研究。
结果：找到了六篇招募3853名参与者的文章，从185到1642名参与者，女性的比例从45%到80%不等。数据的匮乏导致仅对65岁以上的人进行分析。此外,一项研究确定了12,212名18岁及以上的参与者；然而，本系统综述仅考虑纳入与65岁及以上患者相关的数据.在这7项研究中，4评估心血管结果，1评估骨骼健康结果，和2评估两者。心血管结局的荟萃分析显示，合并风险比为0.89(95%CI0.71-1.12)，表明接受LT4治疗的SCH老年患者与未接受治疗者相比,心血管风险无显著差异.由于子研究重叠，骨健康结局的荟萃分析是不可能的。
结论：这项系统评价和荟萃分析发现，65岁以上的SCH参与者使用LT4与心血管和骨骼健康结果之间没有显著关联。
背景：PROSPEROCRD42022308006。
方法：进行了系统评价和荟萃分析，以综合评估老年人SCH心血管和骨骼健康结局的先前研究，比较LT4治疗与不治疗。PubMed,Embase,科克伦图书馆,MEDLINE,和WebofScience数据库从开始到2023年3月13日进行搜索，并选择了评估50岁以上SCH患者心血管和骨骼健康事件的研究。
结果：找到了六篇招募3853名参与者的文章，从185到1642名参与者，女性的比例从45%到80%不等。数据的匮乏导致仅对65岁以上的人进行分析。此外,一项研究确定了12,212名18岁及以上的参与者；然而，本系统综述仅考虑纳入与65岁及以上患者相关的数据.在这7项研究中，4评估心血管结果，1评估骨骼健康结果，和2评估两者。心血管结局的荟萃分析显示，合并风险比为0.89(95%CI0.71-1.12)，表明接受LT4治疗的SCH老年患者与未接受治疗者相比,心血管风险无显著差异.由于子研究重叠，骨健康结局的荟萃分析是不可能的。
结论：这项系统评价和荟萃分析发现，65岁以上的SCH参与者使用LT4与心血管和骨骼健康结果之间没有显著关联。
背景：PROSPEROCRD42022308006。
