Assessing the Cardiovascular Effects of Levothyroxine Use in an Ageing United Kingdom Population (ACEL-UK): Cohort Study
Main finding · CV eventsResult — go to the resultHazard ratio 0.91 95% CI 0.87–0.97Authors' conclusion
Our data suggest that LT4 therapy in older individuals with SCH is associated with a trade-off between the potentially beneficial effect on CV risk and the deleterious relationship with bone health and mortality risk. These risks need to be considered, mitigated, and discussed when LT4 therapy is being deliberated in older patients with SCH.
Study context
- Population
- Adults older than 50 years with subclinical hypothyroidism (SCH), UK Primary Care (Health Improvement Network); median age 67 years, 68.5% female, median TSH 4.6 mU/L
- Participants
- 53,899 participants
- Exposure
- Levothyroxine (LT4) prescribed vs not prescribed
- LT4n = 19,952
- No LT4n = 33,947reference
- Outcome
- Cardiovascular (CV) events:
- Angina
- MI
- Peripheral vascular disease
- Stent procedures
- Stroke
- Follow-up
- Median 10 years (IQR: 5.5-10.0 years)
Methodological detailstime-varying adjusted hazard ratios (HRs)
- Time-varying adjusted HRs
Main finding
CV events
Hazard ratio
0.91
95% CI 0.87–0.97
P < 0.001
LT4vs No LT4
HR 0.91 (95% CI 0.87–0.97); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Bone events (fragility fractures or osteoporosis) | 1.21 (1.14–1.28) | P < 0.001 | |
| All-cause mortality | 1.17 (1.13–1.22) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Original publication
Assessing the Cardiovascular Effects of Levothyroxine Use in an Ageing United Kingdom Population (ACEL-UK): Cohort Study. J Clin Endocrinol Metab. Published 3 April 2025. doi:10.
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