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Tiller D, Ittermann T, Greiser KH, Meisinger C, Agger C, Hofman A, Thuesen B, Linneberg A, Peeters R, Franco O, Heier M, Kluttig A, Werdan K, Stricker B, Schipf S, Markus M, Dörr M, Völzke H, Haerting J. Association of Serum Thyrotropin with Anthropometric Markers of Obesity in the General Population. Thyroid 2016; 26:1205-14. [PMID: 27393002 DOI: 10.1089/thy.2015.0410] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Except from associations study with body weight, there are few longitudinal data regarding the association between thyroid function and anthropometric measurements such as waist circumference, waist-to-hip ratio, or waist-to height ratio. OBJECTIVE This study aimed to investigate the association of thyrotropin (TSH) at baseline with changes in different anthropometric markers between baseline and follow-up in the general population. METHOD Data were used from four population-based longitudinal cohort studies and one population-based cross-sectional study. A total of 16,902 (8204 males) subjects aged 20-95 years from the general population were studied. Body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio were measured. Multivariable median regression models were calculated adjusting for the following covariates: age, sex, baseline value of the respective anthropometric marker, smoking status, follow-up-time period, and study site. RESULTS In cross-sectional analyses, serum TSH within the reference range was positively associated with waist circumference (β = 0.94 cm [confidence interval (CI) 0.56-1.32]) and waist-to-height-ratio (β = 0.029 [CI 0.017-0.042]). These associations were also present for the full range of TSH. In the longitudinal analyses, serum TSH at baseline was inversely associated with a five-year change of all considered anthropometric measures within the prior defined study-specific reference range, as well as in the full range of serum TSH. CONCLUSION High TSH serum levels were positively associated with current anthropometric markers, even in the study-specific reference ranges. In contrast, high TSH serum levels were associated with decreased anthropometric markers over a time span of approximately five years. Further research is needed to determine possible clinical implications as well as public health consequences of these findings.
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Affiliation(s)
- Daniel Tiller
- 1 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle (Saale), Germany
| | - Till Ittermann
- 2 Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Karin H Greiser
- 1 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle (Saale), Germany
- 3 German Cancer Research Centre , Division of Cancer Epidemiology, Heidelberg, Germany
| | - Christa Meisinger
- 4 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health , München, Germany
| | - Carsten Agger
- 5 Research Centre for Prevention and Health , the Capital Region, Denmark
| | - Albert Hofman
- 6 Department of Epidemiology, Department of Internal Medicine; Erasmus Medical Center , Rotterdam, The Netherlands
| | - Betina Thuesen
- 5 Research Centre for Prevention and Health , the Capital Region, Denmark
| | - Allan Linneberg
- 5 Research Centre for Prevention and Health , the Capital Region, Denmark
- 7 Department of Clinical Experimental Research, Rigshospitalet , Glostrup, Denmark
- 8 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark
| | - Robin Peeters
- 5 Research Centre for Prevention and Health , the Capital Region, Denmark
- 9 Rotterdam Thyroid Center, Department of Internal Medicine; Erasmus Medical Center , Rotterdam, The Netherlands
| | - Oscar Franco
- 6 Department of Epidemiology, Department of Internal Medicine; Erasmus Medical Center , Rotterdam, The Netherlands
| | - Margit Heier
- 4 Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health , München, Germany
| | - Alexander Kluttig
- 1 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle (Saale), Germany
| | - Karl Werdan
- 10 Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Bruno Stricker
- 6 Department of Epidemiology, Department of Internal Medicine; Erasmus Medical Center , Rotterdam, The Netherlands
| | - Sabine Schipf
- 2 Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Marcello Markus
- 2 Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
- 11 Department of Internal Medicine B, University Medicine Greifswald , Greifswald, Germany
- 12 DZHK (German Centre for Cardiovascular Research) , partner site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- 11 Department of Internal Medicine B, University Medicine Greifswald , Greifswald, Germany
- 12 DZHK (German Centre for Cardiovascular Research) , partner site Greifswald, Greifswald, Germany
| | - Henry Völzke
- 2 Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
- 12 DZHK (German Centre for Cardiovascular Research) , partner site Greifswald, Greifswald, Germany
| | - Johannes Haerting
- 1 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle (Saale), Germany
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Meisinger C, Ittermann T, Tiller D, Agger C, Nauck M, Schipf S, Wallaschofski H, Jørgensen T, Linneberg A, Thiery J, Kluttig A, Greiser KH, Werdan K, Burkhardt K, Völzke H. Sex-specific associations between thyrotropin and serum lipid profiles. Thyroid 2014; 24:424-32. [PMID: 24102572 DOI: 10.1089/thy.2013.0259] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Population-based studies investigating the sex-specific association between thyrotropin (TSH) levels and serum lipid concentrations are scarce. We examined the association between TSH and total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides in men and women from the general population. Furthermore, the association with TSH outside and within the reference range and lipid levels was studied. METHODS Individual data of 13,571 men and women without lipid medication of four population-based studies conducted in Western European adults were pooled for cross-sectional analyses. The association between TSH levels and lipid concentrations were analyzed by calculating sex-specific multivariable median regression models. RESULTS In the pooled population, serum TSH levels were significantly positively associated with triglyceride values in men and with total cholesterol, LDL cholesterol, and triglyceride values in women. In the pooled male population, low serum TSH levels (<3.0 mIU/L) were significantly associated with lower total cholesterol, while high serum TSH levels (≥ 3.0 mIU/L) were associated with higher triglyceride values. In the pooled female population, low serum TSH levels were significantly associated with lower total cholesterol, LDL cholesterol, and HDL cholesterol. High TSH levels were associated with higher total cholesterol and LDL cholesterol in the pooled female population. In both sexes, serum TSH levels within the reference range (0.3-3.0 mIU/L) were significantly positively associated with triglyceride concentrations. CONCLUSIONS Increasing levels of TSH were associated with a less favorable lipid profile in both men and women from the general population. In both sexes, TSH levels within the reference range were significantly positively associated with triglyceride concentrations.
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Affiliation(s)
- Christa Meisinger
- 1 Institute of Epidemiology II , Helmholtz Zentrum Munich, German Research Center for Environmental Health, Neuherberg, Germany
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Nakano A, Johnsen SP, Frederiksen BL, Svendsen ML, Agger C, Schjødt I, Egstrup K. Trends in quality of care among patients with incident heart failure in Denmark 2003-2010: a nationwide cohort study. BMC Health Serv Res 2013; 13:391. [PMID: 24093516 PMCID: PMC3851278 DOI: 10.1186/1472-6963-13-391] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing. Methods We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24504) and examined changes in use of recommended processes of care and 1-year mortality. Results The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96). Conclusions Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.
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Affiliation(s)
- Anne Nakano
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Ittermann T, Tiller D, Meisinger C, Agger C, Nauck M, Rettig R, Hofman A, Jørgensen T, Linneberg A, Witteman JCM, Franco OH, Greiser KH, Werdan K, Döring A, Kluttig A, Stricker BHC, Völzke H. High serum thyrotropin levels are associated with current but not with incident hypertension. Thyroid 2013; 23:955-63. [PMID: 23427935 PMCID: PMC3752519 DOI: 10.1089/thy.2012.0626] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent data from a population-based study in children and adolescents suggest that serum thyrotropin (TSH) levels are associated with arterial blood pressure and hypertension. These results are in agreement with some but not all population-based studies in adults. Discrepancies in results might be explained by drug intake, different iodine supplies, and sizes of populations investigated. In addition, it is not clear whether an association between TSH and hypertension exists longitudinally or only cross-sectionally. Thus, our aim was to investigate cross-sectional and longitudinal associations between thyroid function and arterial blood pressure in a large consortium of cohort studies in adults. METHODS Data from five population-based studies were pooled resulting in 17,023 individuals being available for cross-sectional and 10,048 individuals for longitudinal analyses. Associations of baseline TSH with baseline blood pressure or hypertension were analyzed by multivariable median or logistic regression models. Multivariable median or Poisson regression models were used to investigate associations of baseline TSH with five-year change in arterial blood pressure or incident hypertension. RESULTS There was a cross-sectional positive association of TSH with arterial blood pressure (p<0.001) and hypertension (odds ratio [OR]=1.76 [confidence interval (CI) 1.24-2.50], p=0.002). Likewise, hypothyroidism was associated with systolic (β=1.1 [CI 0.1-2.1], p=0.040) and diastolic blood pressure (β=1.4 [CI 0.7-2.0], p<0.001). TSH, however, was not consistently associated with a five-year change in blood pressure or incident hypertension. CONCLUSIONS High serum TSH levels were associated with current hypertension and blood pressure but not with a five-year change in blood pressure and incident hypertension. This argues for only a short-term effect of thyroid hormone levels on arterial blood pressure or a spurious association that needs further evaluation in population-based studies.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University of Greifswald, Germany.
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Abstract
OBJECTIVE To assess the risk of venous thrombosis in current users of different types of hormonal contraception, focusing on regimen, oestrogen dose, type of progestogen, and route of administration. DESIGN National cohort study. SETTING Denmark, 1995-2005. PARTICIPANTS Danish women aged 15-49 with no history of cardiovascular or malignant disease. MAIN OUTCOME MEASURES Adjusted rate ratios for all first time deep venous thrombosis, portal thrombosis, thrombosis of caval vein, thrombosis of renal vein, unspecified deep vein thrombosis, and pulmonary embolism during the study period. RESULTS 10.4 million woman years were recorded, 3.3 million woman years in receipt of oral contraceptives. In total, 4213 venous thrombotic events were observed, 2045 in current users of oral contraceptives. The overall absolute risk of venous thrombosis per 10 000 woman years in non-users of oral contraceptives was 3.01 and in current users was 6.29. Compared with non-users of combined oral contraceptives the rate ratio of venous thrombembolism in current users decreased with duration of use (<1 year 4.17, 95% confidence interval 3.73 to 4.66, 1-4 years 2.98, 2.73 to 3.26, and >4 years 2.76, 2.53 to 3.02; P<0.001) and with decreasing dose of oestrogen. Compared with oral contraceptives containing levonorgestrel and with the same dose of oestrogen and length of use, the rate ratio for oral contraceptives with norethisterone was 0.98 (0.71 to 1.37), with norgestimate 1.19 (0.96 to 1.47), with desogestrel 1.82 (1.49 to 2.22), with gestodene 1.86 (1.59 to 2.18), with drospirenone 1.64 (1.27 to 2.10), and with cyproterone 1.88 (1.47 to 2.42). Compared with non-users of oral contraceptives, the rate ratio for venous thromboembolism in users of progestogen only oral contraceptives with levonorgestrel or norethisterone was 0.59 (0.33 to 1.03) or with 75 mug desogestrel was 1.12 (0.36 to 3.49), and for hormone releasing intrauterine devices was 0.90 (0.64 to 1.26). CONCLUSION The risk of venous thrombosis in current users of combined oral contraceptives decreases with duration of use and decreasing oestrogen dose. For the same dose of oestrogen and the same length of use, oral contraceptives with desogestrel, gestodene, or drospirenone were associated with a significantly higher risk of venous thrombosis than oral contraceptives with levonorgestrel. Progestogen only pills and hormone releasing intrauterine devices were not associated with any increased risk of venous thrombosis.
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Affiliation(s)
- Øjvind Lidegaard
- Gynaecological Clinic, Rigshospitalet, Copenhagen University, DK-2100 Copenhagen, Denmark.
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Abstract
BACKGROUND Recently, the Danish National Register of Medicinal Product Statistics (NRM) was opened for research purposes, and therefore, on an individual basis, can merge with other national registers. The aim of this study was to analyse the use of hormones based on the individual data of the entire Danish female population, with the focus on a detailed evaluation of specific hormone regimens and factors associated with systemic hormone replacement therapy (HRT). METHODS All Danish female citizens, aged 15-70 years during the study period 1995-2004, were identified in the Civil Registration System, and their redeemed prescriptions for hormones and medication for diabetes, hypertension, hypercholesterolemia and heart conditions were retrieved from the NRM. Information on habitation, education, employment and gynaecological surgery was obtained from other national registers. RESULTS After 2002, the use of HRT was reduced by 65%. In 2002, HRT was most prevalent in women aged 55-59 years, when an average of 200 defined daily doses per 1,000 women per day was recorded. In 2002, approximately 39% of women aged 50-57 years were ever exposed to HRT. The mean duration of HRT was 5 years in an 8-year time window. During the study period, there was a significant decline in the use of systemic hormones, initially due to a decrease in cyclic combined therapy, but after 2002 continuous combined therapy decreased rapidly. HRT was positively associated with middle-term education, employment status, and living in urban areas. Women treated for diabetes used hormones less frequently than women without diabetes. Women using antiarrhythmics or antihypertensives used hormones more often than women not using this medication. HRT was positively associated with gynaecological surgery. CONCLUSION One in five women, aged 50-59 years, redeemed daily HRT. Use of HRT declined from 1995 to 2002, but more than halved after 2002. HRT is associated to redemption of other medications of significance for health.
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Affiliation(s)
- Ellen Løkkegaard
- Department of Obstetrics & Gynaecology, Rigshospitalet, Copenhagen, Denmark
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