Correlation between hyperthyroidism and risk of stroke: a meta-analysis based on prospective cohort studies

doi:10.3877/cma.j.issn.2095-9605.2016.04.010

Abstract

Abstract:

Objective

To investigate the correlation between hyperthyroidism (HT) and stroke.

Methods

The search terms included "hyperthyroidism" "stroke" and "cerebral infarction" in both Chinese and English, and "thyroid dysfunction" "thyroid disorder" "thyroid disease" "thyrotoxicosis" "cerebrovascular disease" and "cerebrovascular accident" in English. PubMed, Embase, Google Scholar, CNKI, CBM and Wanfang were searched, and the related magazines were also hand-searched. These studies were selected and related data were extracted by two authors according to the inclusion and exclusion criteria, and a third author would make a decision when the former two authors couldn't reach an agreement. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies, and the Stata 12.0 software was used for meta-analysis.

Results

Eleven prospective cohort studies were included. The NOS scores indicated that all the studies were high-quality studies. The meta-analysis showed that the risk of stroke in the HT group is 1.30 times as high as that in the euthyroidism (ET) group (P<0.05). Subgroup analyses showed that among Asian populations, the risk of stroke in the HT group is 1.39 times as high as that in the ET group (P<0.05); the risk of stoke in the clinical HT group is 1.32 times as high as that in the ET group (P<0.05 ); and the risk of stroke in the HT group without atrial fibrillation is 1.33 times as high as that in the ET group (P<0.05). In addition, the subgroup analysis of studies which had adjusted most of confounding factors showed that the risk of stroke in the HT group was 1.35 times as high as that in the ET group (P<0.05). Begg and Egger tests both showed that there were no published biases, and the RR value was 1.26 after conducting a trim and fill analysis. Sensitivity analysis indicated that the results were stable.

Conclusion

HT might be a risk factor of stroke, but due to the limitations of this meta-analysis, further relevant research is warranted for validation.

Key words: Hyperthyroidism, Stroke, Atrial fibrillation, Meta-analysis

Canzhui Li, Zhaohui Li, Qiang Zhou, Zhiwei Luo. Correlation between hyperthyroidism and risk of stroke: a meta-analysis based on prospective cohort studies[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2016, 02(04): 230-236.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2016.04.010

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2016/V02/I04/230

Figures/Tables 8

References 29

[1]	Vanderpump MP. The epidemiology of thyroid disease[J]. Br Med Bull, 2011(99):39-51.
[2]	Petersen P, Hansen JM. Stroke in thyrotoxicosis with atrial fibrillation[J]. Stroke, 1988, 19(1):15-18.
[3]	Squizzato A, Gerdes VE, Brandjes DP, et al. Thyroid diseases and cerebrovascular disease[J]. Stroke, 2005, 36(10):2302-2310.
[4]	Wang YJ, Zhang SM, Zhang L, et al. Chinese guidelines for the secondary prevention of ischemic stroke and transient ischemic attack 2010[J]. CNS Neurosci Ther, 2012, 18(2):93-101.
[5]	Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)[J]. Chest, 2008, 133(6 Suppl):546S-592S.
[6]	Wann LS, Curtis AB, January CT, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines[J]. Circulation, 2011, 123(1):104-123.
[7]	Chaker L, Baumgartner C, Ikram MA, et al. Subclinical thyroid dysfunction and the risk of stroke: a systematic review and meta-analysis[J]. Eur J Epidemiol, 2014, 29(11):791-800.
[8]	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group[J]. JAMA, 2000, 283(15):2008-2012.
[9]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605.
[10]	Parle JV, Maisonneuve P, Sheppard MC, et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study[J]. Lancet, 2001, 358(9285):861-865.
[11]	Qureshi AI, Suri FK, Nasar A, et al. Free thyroxine index and risk of stroke: results from the National Health and Nutrition Examination Survey Follow-up Study[J]. Med Sci Monit, 2006, 12(12):CR501-CR506.
[12]	Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults[J]. JAMA, 2006, 295(9):1033-1041.
[13]	Siu CW, Pong V, Zhang X, et al. Risk of ischemic stroke after new-onset atrial fibrillation in patients with hyperthyroidism[J]. Heart Rhythm, 2009, 6(2):169-173.
[14]	Sheu JJ, Kang JH, Lin HC, et al. Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study[J]. Stroke, 2010, 41(5):961-966.
[15]	Schultz M, Kistorp C, Raymond I, et al. Cardiovascular events in thyroid disease: a population based, prospective study[J]. Horm Metab Res, 2011, 43(9):653-659.
[16]	Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study[J]. Eur Heart J, 2012, 33(12):1500-1510.
[17]	Chen Q, Yan Y, Zhang L, et al. Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation[J]. Cardiology, 2014, 127(3):176-182.
[18]	Yang MH, Yang FY, Lee DD. Thyroid disease as a risk factor for cerebrovascular disease[J]. J Stroke Cerebrovasc Dis, 2015, 24(5):912-920.
[19]	Bruere H, Fauchier L, Bernard BA, et al. History of thyroid disorders in relation to clinical outcomes in atrial fibrillation[J]. Am J Med, 2015, 128(1):30-37.
[20]	Martin SS, Daya N, Lutsey PL, et al. Thyroid dysfunction, cardiovascular risk factors, and incident cardiovascular events: the atherosclerosis risk in communities (ARIC) study[J]. Circulation, 2015, 132(suppl 3):A13100.
[21]	Wang KC, Phi JH, Lee JY, et al. Indirect revascularization surgery for moyamoya disease in children and its special considerations[J]. Korean J Pediatr, 2012, 55(11):408-413.
[22]	Völzke H, Robinson DM, Schminke U, et al. Thyroid function and carotid wall thickness[J]. J Clin Endocrinol Metab, 2004, 89(5):2145-2149.
[23]	Erem C, Ersoz HO, Karti SS, et al. Blood coagulation and fibrinolysis in patients with hyperthyroidism[J]. J Endocrinol Invest, 2002, 25(4):345-350.
[24]	Colleran KM, Ratliff DM, Burge MR. Potential association of thyrotoxicosis with vitamin B and folate deficiencies, resulting in risk for hyperhomocysteinemia and subsequent thromboembolic events[J]. Endocr Pract, 2003, 9(4):290-295.
[25]	Heeringa J, Hoogendoorn EH, van der Deure WM, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study[J]. Arch Intern Med, 2008, 168(20):2219-2224.
[26]	Zhang X, Chen Z, Shi Z, et al. Correlation between thyroid autoantibodies and intracranial arterial stenosis in stroke patients with hyperthyroidism[J]. J Neurol Sci, 2012, 318(1-2):82-84.
[27]	Metso S, Jaatinen P, Huhtala H, et al. Increased cardiovascular and cancer mortality after radioiodine treatment for hyperthyroidism[J]. J Clin Endocrinol Metab, 2007, 92(6):2190-2196.
[28]	Franklyn JA, Maisonneuve P, Sheppard M, et al. Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study[J]. Lancet, 1999, 353(9170):2111-2115.
[29]	Tsai MS, Chuang PY, Huang CH, et al. Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients[J]. Int J Clin Pract, 2015, 69(12):1473-1485.

纳入研究	发表年份（年）	地区	样本量（例）	平均年龄（岁）	随访时间（年）	暴露组（例）		非暴露组（例）	是否合并房颤	结局指标	校正的混杂因素
纳入研究	发表年份（年）	地区	样本量（例）	平均年龄（岁）	随访时间（年）	临床HT	SHT	非暴露组（例）	是否合并房颤	结局指标	校正的混杂因素
Parle等^[10]	2001	英国	1 191	67.9	8.3±1.8	–	70	1 026	否	致死性卒中	性别、年龄
Qureshi等^[11]	2006	美国	5 269	48±14	20	34	–	4 776	否	卒中	性别、年龄、种族、吸烟、糖尿病、收缩压、血脂、体质指数
Cappola等^[12]	2006	美国	3 233	72.7±5.6	12.5	–	47	2 639	否	卒中/TIA	性别、年龄、种族、吸烟、糖尿病、高血压病、低密度脂蛋白水平
Siu等^[13]	2009	中国香港	480	64.7±3.3	1	320	–	160	是	缺血性卒中	性别、年龄
Sheu等^[14]	2010	中国台湾	28 584	32.1±7.4	5	3 176	–	25 408	否	缺血性卒中	性别、年龄、房颤、收入、居住地区、高血压病、糖尿病、体质指数
Schultz等^[15]	2011	丹麦	605	67.9	5	–	25	549	否	卒中	性别、年龄、吸烟、高血压病、糖尿病
Friberg等^[16]	2012	瑞典	90 490	76.2	1.5	–^a	–	–	是	缺血性卒中	性别、年龄
Chen等^[17]	2014	中国	269	57.8±2.5	3	162	–	107	是	缺血性卒中	性别、年龄、高血压病、糖尿病、慢性心力衰竭
Yang等^[18]	2014	中国台湾	68 462	41.2±14.7	2	8 698	–	26 621	否	卒中	性别、年龄、糖尿病、高血压病、肾功能不全
Bruere等^[19]	2015	法国	8 692	71±14	2.6	141	–	8 281	是	卒中/系统性栓塞	性别、年龄
Martin等^[20]	2015	美国	11 359	57±6	20	204	374	9 984	否	卒中	性别、年龄、吸烟、酗酒、糖尿病、血压、房颤、血脂、体质指数

纳入研究	发表年份（年）	地区	样本量（例）	平均年龄（岁）	随访时间（年）	暴露组（例）		非暴露组（例）	是否合并房颤	结局指标	校正的混杂因素
纳入研究	发表年份（年）	地区	样本量（例）	平均年龄（岁）	随访时间（年）	临床HT	SHT	非暴露组（例）	是否合并房颤	结局指标	校正的混杂因素
Parle等^[10]	2001	英国	1 191	67.9	8.3±1.8	–	70	1 026	否	致死性卒中	性别、年龄
Qureshi等^[11]	2006	美国	5 269	48±14	20	34	–	4 776	否	卒中	性别、年龄、种族、吸烟、糖尿病、收缩压、血脂、体质指数
Cappola等^[12]	2006	美国	3 233	72.7±5.6	12.5	–	47	2 639	否	卒中/TIA	性别、年龄、种族、吸烟、糖尿病、高血压病、低密度脂蛋白水平
Siu等^[13]	2009	中国香港	480	64.7±3.3	1	320	–	160	是	缺血性卒中	性别、年龄
Sheu等^[14]	2010	中国台湾	28 584	32.1±7.4	5	3 176	–	25 408	否	缺血性卒中	性别、年龄、房颤、收入、居住地区、高血压病、糖尿病、体质指数
Schultz等^[15]	2011	丹麦	605	67.9	5	–	25	549	否	卒中	性别、年龄、吸烟、高血压病、糖尿病
Friberg等^[16]	2012	瑞典	90 490	76.2	1.5	–^a	–	–	是	缺血性卒中	性别、年龄
Chen等^[17]	2014	中国	269	57.8±2.5	3	162	–	107	是	缺血性卒中	性别、年龄、高血压病、糖尿病、慢性心力衰竭
Yang等^[18]	2014	中国台湾	68 462	41.2±14.7	2	8 698	–	26 621	否	卒中	性别、年龄、糖尿病、高血压病、肾功能不全
Bruere等^[19]	2015	法国	8 692	71±14	2.6	141	–	8 281	是	卒中/系统性栓塞	性别、年龄
Martin等^[20]	2015	美国	11 359	57±6	20	204	374	9 984	否	卒中	性别、年龄、吸烟、酗酒、糖尿病、血压、房颤、血脂、体质指数

纳入研究	研究对象				可比性	结局			总得分
纳入研究	暴露队列代表性	非暴露队列选择	暴露确定	研究前是否发生结局事件	是否控制了重要的混杂因素	结局事件评估	随访是否充分	随访的完整性	总得分
Parle等	1	1	1	1	1	1	1	0	7
Qureshi等	1	1	1	1	2	1	1	1	9
Cappola等	1	1	1	0	2	1	1	0	7
Siu等	1	1	1	1	1	1	0	1	7
Sheu等	1	1	1	1	2	1	1	0	8
Schultz等	1	1	1	0	2	1	1	1	8
Friberg等	1	1	1	0	1	1	0	1	6
Chen等	1	1	1	0	2	1	1	1	8
Yang等	1	1	1	1	2	1	0	1	8
Bruere等	1	1	1	1	1	1	1	0	7
Martin等	1	1	1	0	2	1	1	0	7

纳入研究	研究对象				可比性	结局			总得分
纳入研究	暴露队列代表性	非暴露队列选择	暴露确定	研究前是否发生结局事件	是否控制了重要的混杂因素	结局事件评估	随访是否充分	随访的完整性	总得分
Parle等	1	1	1	1	1	1	1	0	7
Qureshi等	1	1	1	1	2	1	1	1	9
Cappola等	1	1	1	0	2	1	1	0	7
Siu等	1	1	1	1	1	1	0	1	7
Sheu等	1	1	1	1	2	1	1	0	8
Schultz等	1	1	1	0	2	1	1	1	8
Friberg等	1	1	1	0	1	1	0	1	6
Chen等	1	1	1	0	2	1	1	1	8
Yang等	1	1	1	1	2	1	0	1	8
Bruere等	1	1	1	1	1	1	1	0	7
Martin等	1	1	1	0	2	1	1	0	7

Please choose a citation manager

Content to export