Thyroid dysfunction has long been known to affect certain cardiovascular conditions. Measuring thyroid function to discover occult hyperthyroidism is recommended to evaluate causal factors for new-onset atrial fibrillation.¹ Similarly, thyroid function testing is advocated to exclude hypothyroidism as a secondary cause of dyslipidemia before initiating lipid-lowering therapy.² However, the effect of thyroid hormone on atherothrombosis, the major cause of cardiovascular morbidity and mortality, remains controversial, with various studies showing no effect on cardiovascular risk,^3,4 increased risk associated with low thyroid function,^5,6 and greater risk associated with high thyroid function,^7–9 in some cases within the reference range. Thus, whether variations in thyroid function both without and within the normal reference range can impact atherosclerotic cardiovascular disease (ASCVD) risk is unresolved.

Article, see p 1392

In this issue of Circulation Research, Bano et al¹⁰ examine the relationship of 3 metrics of thyroid function to 3 measures of atherosclerosis, spanning its spectrum from preclinical disease (defined by coronary artery calcification), to clinical ASCVD events, to ASCVD-related mortality. To examine this association, they turned to the well-known prospective population-based Rotterdam Cohort Study—an ongoing investigation of the determinants of chronic disease occurrence and progression in middle-aged and older adults. The Rotterdam Study enrolled its first cohort in 1989 and added a second cohort in 2000 and a third in 2006, with clinical follow-up for health outcomes every 3 to 5 years.

The present study included 9420 subjects, including those seen at the third visit for cohort 1 and the first visits for cohorts 2 and 3, who had complete baseline thyroid function measurements for thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies, and who also had complete information on ASCVD. Over a mean follow-up of 8.8 …

长期以来，甲状腺功能障碍会影响某些心血管疾病。建议测量甲状腺功能以发现隐匿性甲状腺功能亢进，以评估新发房颤的病因。¹同样，提倡进行甲状腺功能检查以在开始降脂治疗之前将甲状腺功能低下症作为血脂异常的次要原因排除在外。²然而，在动脉粥样硬化甲状腺激素的作用，心血管发病率和死亡率的主要原因仍然是有争议的，与各种研究显示对心血管风险，没有效果^3，4增加的风险低甲状腺功能，相关联的^5，6与甲状腺功能高相关的更高风险，在某些情况下在参考范围内为^{7 – 9}。因此，尚不清楚在正常参考范围内或不在正常参考范围内的甲状腺功能变化是否会影响动脉粥样硬化性心血管疾病（ASCVD）的风险。

文章，请参阅第1392页

在本期《循环研究》中，Bano等人[ ^10]研究了3种甲状腺功能指标与3种动脉粥样硬化测量指标之间的关系，其范围从临床前疾病（由冠状动脉钙化定义）到临床ASCVD事件，再到与ASCVD相关的死亡率。为了检验这种关联，他们转向了著名的基于前瞻性人群的鹿特丹队列研究。该研究是对中老年人的慢性疾病发生和发展的决定因素进行的一项持续调查。鹿特丹研究小组于1989年招募了第一批研究对象，并于2000年增加了第二批研究对象，并于2006年增加了第三批研究对象，并每3至5年对健康结果进行临床随访。

本研究包括9420名受试者，包括在队列1的第三次访视，队列2和3的首次访视中所见的受试者，这些受试者对甲状腺刺激激素（TSH），游离甲状腺素（FT4）和甲状腺过氧化物酶抗体，以及关于ASCVD的完整信息。平均随访8.8…