{'fraction_non_alphanumeric': 0.038206826286296486, 'fraction_numerical': 0.020886398369842078, 'mean_word_length': 5.397394136807818, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Should we screen for hypothyroidism in patients with cardiovascular disease?

This editorial refers to ‘Clinical outcomes of patients with hypothyroidism undergoing primary percutaneous coronary intervention’[†][1], by A. Lerman et al ., on page 2055. 

In contrast to overt dysfunction, the screening and treatment of subclinical hypothyroidism has been controversial for >20 years.1 Subclinical hypothyroidism is defined as a thyroid-stimulating hormone (TSH) level above the upper limit of the reference ranges with normal free thyroxine (T4) concentrations.2 The prevalence of subclinical hypothyroidism increases with ageing, reaching up to 10% in the elderly.3 The evidence on the cardiovascular risks of subclinical hypothyroidism has been recently investigated in several individual participant data (IPD) analyses of prospective cohorts.4–6 The Thyroid Studies Collaboration pooled IPD of 50 953 patients with euthyroidism and 3348 with subclinical hypothyroidism from seven countries and 10 cohorts, and found a significant increase in coronary heart disease (CHD) mortality, especially in those with high levels of TSH ≥10.0 mIU/L ( Figure 1 ).4 The same observations were found for CHD events, including non-fatal and fatal myocardial infarction (MI) events and heart failure (HF) events ( Figure 1 ).4,6 These associations persisted after adjustment for traditional cardiovascular risk factors and after excluding those with thyroid medications or previous cardiovascular disease. IPD analysis is the most robust method to summarize data across observational studies, as it allows the analysis of reduced heterogeneity and the analysis of subgroups without ecological bias. 



Figure 1 
Hazard ratios (HRs) for coronary heart disease mortality (black) and heart failure event (red) according to thyroid-stimulating hormone (TSH) levels.4–6 Age- and sex-adjusted HRs and their 95% confidence intervals (CIs) are represented by squares. …

 [1]: #fn-2