Rationale: Thyroid hormones have been linked with various proatherogenic and antiatherogenic processes. However, the relationship of thyroid function with manifestations of atherosclerosis remains unclear.

Objective: To investigate the association of thyroid function with atherosclerosis throughout its spectrum; that is, subclinical atherosclerosis, incident atherosclerotic cardiovascular (ASCV) events, and ASCV mortality.

Methods and Results: This population-based study was embedded within the Rotterdam Study. The risk of atherosclerosis was evaluated by measuring (1) presence of subclinical atherosclerosis, assessed by coronary artery calcification score >100 AU; (2) ASCV events, defined as fatal and nonfatal myocardial infarction, other coronary heart disease mortality, or stroke; (3) ASCV mortality, defined as death because of coronary heart disease and cerebrovascular or other atherosclerotic diseases. Associations of thyroid-stimulating hormone and free thyroxine with the outcomes were assessed through logistic regression and Cox proportional hazard models, adjusted for potential confounders, including cardiovascular risk factors. A total of 9420 community-dwelling participants (mean age±SD, 64.8±9.7 years) were included. During a median follow-up of 8.8 years (interquartile range, 4.5–11.8 years), 934 incident ASCV events and 612 ASCV deaths occurred. Free thyroxine levels were positively associated with high coronary artery calcification score (odds ratio, 2.28; 95% confidence interval, 1.30–4.02) and incident ASCV events (hazard ratio, 1.87; confidence interval, 1.34–2.59). The risk of ASCV mortality increased in a linear manner with higher free thyroxine levels (hazard ratio, 2.41; confidence interval, 1.68–3.47 per 1 ng/dL) and lower thyroid-stimulating hormone levels (hazard ratio, 0.92; confidence interval, 0.84–1.00 per 1 logTSH). Results remained similar or became stronger among euthyroid participants.

Conclusions: Free thyroxine levels in middle-aged and elderly subjects were positively associated with atherosclerosis throughout the whole disease spectrum, independent of cardiovascular risk factors.

理由：甲状腺激素与各种促动脉粥样硬化和抗动脉粥样硬化过程有关。然而，甲状腺功能与动脉粥样硬化表现之间的关系仍不清楚。

目的：研究甲状腺功能与整个动脉粥样硬化的关系；也就是亚临床动脉粥样硬化，动脉粥样硬化性心血管事件（ASCV）和ASCV死亡率。

方法和结果：这项基于人群的研究被嵌入在鹿特丹研究中。动脉粥样硬化的风险通过测量（1）亚临床动脉粥样硬化的存在进行评估，通过冠状动脉钙化评分> 100 AU评估；（2）ASCV事件，定义为致命和非致命性心肌梗塞，其他冠心病死亡率或中风；（3）ASCV死亡率，定义为因冠心病和脑血管疾病或其他动脉粥样硬化性疾病而死亡。通过logistic回归和Cox比例风险模型评估了促甲状腺激素和游离甲状腺素与结局的相关性，并针对包括心血管疾病危险因素在内的潜在混杂因素进行了调整。总共纳入了9420名社区居民参与者（平均年龄±SD，64.8±9.7岁）。在中位随访8次中。8年（四分位间距，4.5-11.8年），发生了934起ASCV事件和612起ASCV死亡。游离甲状腺素水平与冠状动脉钙化评分高（比值比为2.28； 95％置信区间为1.30-4.02）和ASCV事件呈正相关（危险比为1.87；置信区间为1.34-2.59）。游离甲状腺素水平较高（危险比为2.41；置信区间为每1 ng / dL 1.68–3.47）和甲状腺刺激激素水平较低（危险比为0.92；置信区间为0.84）时，ASCV死亡的风险呈线性增加。 –1.00每1 logTSH）。甲状腺功能正常者的结果仍然相似或变得更强。28; 95％置信区间1.30-4.02）和ASCV事件（危险比1.87；置信区间1.34-2.59）。游离甲状腺素水平较高（危险比为2.41；置信区间为每1 ng / dL 1.68–3.47）和甲状腺刺激激素水平较低（危险比为0.92；置信区间为0.84）时，ASCV死亡的风险呈线性增加。 –1.00每1 logTSH）。甲状腺功能正常者的结果仍然相似或变得更强。28; 95％置信区间1.30-4.02）和ASCV事件（危险比1.87；置信区间1.34-2.59）。游离甲状腺素水平较高（危险比为2.41；置信区间为每1 ng / dL 1.68–3.47）和甲状腺刺激激素水平较低（危险比为0.92；置信区间为0.84）时，ASCV死亡的风险呈线性增加。 –1.00每1 logTSH）。甲状腺功能正常者的结果仍然相似或变得更强。

结论：在整个疾病谱中，中老年受试者的游离甲状腺素水平与动脉粥样硬化呈正相关，而与心血管疾病的危险因素无关。