Risk of Stroke in Patients With Atrial Fibrillation Is Associated With Stroke in Siblings: A Nationwide Study

Background It remains unclear whether heritable factors can contribute to risk stratification for ischemic stroke in patients with atrial fibrillation (AF). We examined whether having a sibling with ischemic stroke was associated with increased risk of ischemic stroke and mortality in patients with AF . Methods and Results In this nationwide study of the Swedish population, patients with AF and their siblings were identified from the Swedish patient registers and the Swedish MGR (Multi‐Generation Register). Ischemic stroke events were retrieved from the Swedish patient registers and CDR (Cause of Death Register). Risk of ischemic stroke was compared between patients with AF with and without a sibling affected by ischemic stroke, AF , or both ischemic stroke and AF . The total study population comprised 113 988 subjects (mean age, 60±12 years) diagnosed with AF between 1989 and 2012. In total, 11 709 of them were diagnosed with a first ischemic stroke and 20 097 died during a mean follow‐up time of 5.5 years for ischemic stroke and 5.9 years for mortality. After adjustment for covariates having a sibling with ischemic stroke, or both ischemic stroke and AF , was associated with increased risk of ischemic stroke (hazard ratio, 1.31; 95% CI, 1.23–1.40 or hazard ratio, 1.36; 95% CI , 1.24–1.49, respectively). Furthermore, ischemic stroke in a sibling was associated with all‐cause mortality (hazard ratio, 1.09; 95% CI , 1.05–1.14). In contrast, the risk of stroke was only marginally increased for patients with AF with a spouse affected by ischemic stroke. Conclusions Having a sibling affected by ischemic stroke confers an increased risk of ischemic stroke and death independently of traditional risk factors in patients with AF.

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Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽

10.1161/hypertensionaha.120.16659 ◽

2021 ◽

Vol 77 (3) ◽

pp. 919-928

Author(s):

So-Ryoung Lee ◽

Chan Soon Park ◽

Eue-Keun Choi ◽

Hyo-Jeong Ahn ◽

Kyung-Do Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Total Study Population ◽

Increased Risk ◽

Burden Scale ◽

History Of ◽

Study Population ◽

Korean National Health Insurance ◽

Stage 1 ◽

The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

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Incidence of Ischemic Stroke in Individuals With and Without Aortic Valve Stenosis

Stroke ◽

10.1161/strokeaha.119.028389 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1364-1371

Author(s):

Charlotte Andreasen ◽

Gunnar H. Gislason ◽

Lars Køber ◽

Jawdat Abdulla ◽

Andreas Martinsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Aortic Valve ◽

Valve Replacement ◽

Aortic Valve Stenosis ◽

Incidence Rates ◽

Hazard Ratio ◽

Relative Risks ◽

Increased Risk ◽

Age And Sex

Background and Purpose— Aortic valve stenosis may lead to atrial and ventricular remodeling, predisposes to atrial fibrillation, and may also be an independent risk factor of ischemic stroke. However, information on stroke rates among persons with aortic valve stenosis are sparse. We aimed to determine the incidence rates and relative risks of ischemic stroke in individuals with diagnosed aortic valve stenosis compared with age- and sex-matched controls. Methods— All patients with incident aortic valve stenosis aged >18 years (n=79 310) and age- and sex-matched controls were identified using the Danish nationwide registries (1997–2017). Incidence rates per 1000 person-years (PY) and multivariable adjusted hazard ratios with 95% CIs were reported. Results— In total, 873 373 individuals (median age 77 years, 51.5% men, 9.1% with aortic valve stenosis) were included. Ischemic stroke occurred in 70 205 (8.0%) individuals during 4 880 862 PY of follow-up. Incidence rates of ischemic stroke were 13.3/1000 PY among the controls compared with 30.4/1000 PY in patients with aortic valve stenosis, corresponding to a hazard ratio of 1.31 (95% CI, 1.28–1.34). In all age-groups, the incidence rates and relative risks were significantly increased in patients with aortic valve stenosis compared with controls, but the relative risk was greater for younger individuals (eg, age group, 18–45 years: hazard ratio, 5.94 [95% CI, 4.10–8.36]). In patients with aortic valve stenosis above 65 years of age, the risk of ischemic stroke was markedly lower after aortic valve replacement (30.3 versus 19.6/1000 PY before and after valve replacement). Among people with atrial fibrillation the incidence rate of ischemic stroke was 1.5 times higher when aortic valve stenosis was present (33.0/1000 PY versus 49.9/1000 PY). Conclusions— People with aortic valve stenosis have a significantly increased risk of ischemic stroke compared with age- and sex-matched controls. Future studies are warranted to explore whether antithrombotic therapy may be beneficial in some individuals.

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Hypertension burden and the risk of new-onset atrial fibrillation: a nationwide population-based study

EP Europace ◽

10.1093/europace/euab116.508 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

SR Lee ◽

CS Park ◽

EK Choi ◽

HJ Ahn ◽

KD Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Population Based ◽

Total Study Population ◽

Funding Sources ◽

Increased Risk ◽

Burden Scale ◽

History Of ◽

Study Population ◽

Stage 1

Abstract Funding Acknowledgements Type of funding sources: None. Background The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. Purpose We aimed to investigate the relationship between hypertension burden and the development of incident AF. Methods and Results: Using the Korean National Health Insurance Service database, we identified 3,726,172 subjects who underwent four consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22,012 patients (0.59% of the total study population, 1.168 per 1,000 person-years). Using the BP values at each health checkup, we determined the burden of hypertension (systolic blood pressure [SBP] ≥130 mmHg or diastolic blood pressure [DBP] ≥80 mmHg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n = 742,806), 19% (n = 704,623), 19% (n = 713,258), 21% (n = 766,204), and 21% (n = 799,281). Compared to normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semi-quantitative analyses with further stratification of stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg) and stage 2 (SBP ≥140 mmHg or DBP ≥90 mmHg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. Conclusions Both a sustained exposure and the degree of increased blood pressure were associated with an increased risk of incident AF. Tailored blood pressure management should be emphasized to reduce the risk of AF. Abstract Figure.

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Impact of smoking cessation after the new diagnosis of atrial fibrillation on the risk of stroke: a nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0396 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.R Lee ◽

E.K Choi ◽

J.H Jung ◽

K.D Han ◽

S Oh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Smoking Cessation ◽

Hazard Ratio ◽

Total Study Population ◽

Increased Risk ◽

Before And After ◽

The Impact ◽

Never Smoker ◽

New Onset

Abstract Background There are limited data about the impact of modifying behavior such as smoking cessation after atrial fibrillation (AF) diagnosis on the clinical outcome. Purpose To evaluate the association between smoking cessation after newly diagnosed AF and the risk of stroke. Methods Among subjects with new-onset AF between 2010 and 2016, those who received a national health checkup exam within 2 years before and after the AF diagnosis were included. Subjects were categorized into 4 groups according to the status of smoking before and after AF diagnosis: (i) never smoker; (ii) new smoker after AF diagnosis; (iii) quit-smoker after AF diagnosis; and (iv) persistent smoker. The primary outcome was incident stroke during follow-up. Results A total of 97,869 patients were included (mean age 61±12, men 62%, and mean CHA2DS2-VASc 2.3±1.5). During a median of 3 years of follow-up, stroke occurred in 3,121 patients (1.0 per 100 person-years). Never smoker, new smoker, quit-smoker, and persistent smoker was 79%, 2%, 7%, and 12% of the total study population, respectively. After multivariable adjustment, new smoker and persistent smoker were associated with an increased risk of stroke compared to never smoker (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.48–2.28 for new smoker; HR 1.66, 95% CI 1.48–1.86 for persistent smoker) (Figure). Quit-smoker who stopped smoking after AF diagnosis also showed a higher risk of stroke than never smoker (HR 1.19, 95% CI 1.03–1.38). The quit-smoker group showed a lower compared to those who continued smoking after AF diagnosis (HR 0.720, 95% CI 0.608–0.851). Conclusion Smoking cessation after AF diagnosis showed a lower risk of stroke compared to patients smoking persistently. Lifestyle change as smoking cessation after diagnosis of AF could modify the risk of stroke in patients with new-onset AF. Hazard ratio of smoking status for AF Funding Acknowledgement Type of funding source: None

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Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Fauchier ◽

A Bisson ◽

A Bodin ◽

J Herbert ◽

T Genet ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Risk Of Death ◽

Increased Risk ◽

History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

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P3762The impact of type and burden of atrial fibrillation on stroke occurrence in patients with atrial fibrillation: from a prospective cohort of atrial fibrillation patients (CODE-AF Registry)

European Heart Journal ◽

10.1093/eurheartj/ehz745.0614 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Cho ◽

T Kim ◽

J Uhm ◽

M Cha ◽

J Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Stroke Risk ◽

Hazard Ratio ◽

Interquartile Range ◽

Clinical Variable ◽

P Value ◽

Clinical Variables ◽

Increased Risk

Abstract Background and purpose Although several studies reported that stroke risk in patients with paroxysmal atrial fibrillation (AF) is similar to those with persistent or permanent AF, there is still controversy on the relationship of AF type and stroke occurrence. We investigated the effect of AF type on AF burden and stroke risk in patients with non-valvular AF. Methods Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), we identified 8,883 patients ≥18 years of age with non-valvular AF and eligible follow-up visits. We compared AF burden and stroke risk among patients with 3 types of AF: paroxysmal (n=5,808) or persistent (n=2,806) or permanent (n=269). Results The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 36.0% were female. Patients with persistent and permanent AF were older and had higher CHA2DS2-VASc scores and anticoagulation rate than those with paroxysmal AF. Compared with permanent AF (5.2±16.4%), the arrhythmic burden of AF on 24hrs Holter monitoring was significantly lower in paroxysmal AF (2.1±7.2%, p<0.001) and persistent AF (2.0±7.5%, p<0.001). During median follow-up period of 1.38 years (interquartile range: 0.96–1.67), total 82 (0.92%) patients experienced ischemic stroke with incidence rates of 0.51, 1.04 and 1.69 events per 100 person-years for paroxysmal, persistent and permanent AF, respectively. Compared with paroxysmal AF, the risk of ischemic stroke was increased in persistent AF with clinical variable adjusted hazard ratio (aHR) of 1.94 (95% confidence intervals [CI], 1.23–3.07; P=0.005) and permanent AF with aHR of 2.64 (95% CI, 1.09–6.41; P=0.03). AF type and HR of stroke occurrence Paroxysmal (n=5,808) Persistent (n=2,806) Permanent (n=269) Stoke events 39 37 6 Person years (PYs) 7673 3544 356 /100 PYs 0.51 1.04 1.69 HR (95% CI), p-value HR (95% CI), p-value HR (95% CI), p-value Unadjusted HR 1 (Reference) 2.05 (1.27–3.31), 0.003 3.32 (1.15–7.90), 0.02 Clinical variables adjusted HR 1 (Reference) 1.94 (1.23–3.07), 0.005 2.64 (1.09–6.41), 0.03 PYs: Person years; HR: Hazard ratio. Conclusion Persistent and permanent AF was associated with the increased risk of stroke than paroxysmal AF, after adjustment of clinical variables including age, sex, comorbidities and anticoagulation rate. These results suggest that AF type and burden might be related with the risk of ischemic stroke and should be considered in the stroke prevention of AF.

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Metabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation

Stroke ◽

10.1161/strokeaha.119.025376 ◽

2019 ◽

Vol 50 (11) ◽

pp. 3045-3050 ◽

Cited By ~ 2

Author(s):

Joseph J. Decker ◽

Faye L. Norby ◽

Mary R. Rooney ◽

Elsayed Z. Soliman ◽

Pamela L. Lutsey ◽

...

Keyword(s):

Atrial Fibrillation ◽

Metabolic Syndrome ◽

Ischemic Stroke ◽

Stroke Risk ◽

Proportional Hazards ◽

International Diabetes Federation ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Increased Risk ◽

Low Hdl

Background and Purpose— Metabolic syndrome (MetS), a prothrombotic state, is associated with an increased risk of atrial fibrillation (AF) and stroke. The CHA 2 DS 2 -VASc score does not account for the MetS components of prehypertension, prediabetes mellitus, abdominal obesity, elevated triglycerides, and low HDL (high-density lipoprotein). Data are limited on the association of MetS with stroke in AF, independent of CHA 2 DS 2 -VASc variables. Our aim was to identify MetS components associated with ischemic stroke in participants with AF in the ARIC study (Atherosclerosis Risk in Communities). Methods— We included 1172 participants with incident AF within 5 years of measurement of MetS components. MetS was defined by ATP criteria and International Diabetes Federation criteria. Incident ischemic stroke was physician adjudicated. Multivariable Cox proportional hazards regression was used to assess the association of MetS components with stroke. Results— After a median follow-up of 14.8 years, there were 113 ischemic stroke cases. Of the individual MetS components, low HDL was borderline associated with increased stroke risk (hazard ratio, 1.48 [95% CI, 0.99–2.21]) after adjustment for CHA 2 DS 2 -VASc variables while the remaining MetS variables were not associated with stroke risk. The presence of ≥3 components of MetS was not significantly associated with ischemic stroke after adjustment for CHA 2 DS 2 -VASc variables (hazard ratio, 1.38 [95% CI, 0.91–2.11]). The risk of stroke increased by 13% for each additional component of MetS; however, this association was borderline significant (hazard ratio, 1.13 [95% CI, 0.99–1.28]). Conclusions— The presence of MetS was not significantly associated with ischemic stroke after adjustment for CHA 2 DS 2 -VASc variables. Consideration of MetS is unlikely to improve stroke prediction in AF.

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THE RELATIONSHIP BETWEEN INFLAMMATORY DIETARY PATTERN AND INCIDENCE OF PERIODONTITIS

British Journal Of Nutrition ◽

10.1017/s0007114520005231 ◽

2021 ◽

pp. 1-36

Author(s):

Ahmed A. Alhassani ◽

Frank B. Hu ◽

Bernard A. Rosner ◽

Fred K. Tabung ◽

Walter C. Willett ◽

...

Keyword(s):

Confidence Interval ◽

Periodontal Disease ◽

Secondary Analysis ◽

Hazard Ratio ◽

Reduced Rank Regression ◽

Rank Regression ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Study Population

ABSTRACT The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food based, reduced rank regression (RRR) derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34,940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years, and dietary data through validated semi-quantitative food frequency questionnaires every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) to the lowest quintile was 0.99 (95% confidence interval: 0.89 -1.10, p-value for trend = 0.97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile to the lowest was 1.39 (95% confidence interval: 0.98 -1.96, p-value for trend = 0.03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated EDIP was significantly associated with increased risk of periodontitis only among nonsmokers who were obese. Hence, this association must be interpreted with caution.

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Abstract 79: Troponin T, NT-proBNP, and Incidence of Stroke: The Atherosclerosis Risk in Communities (ARIC) Study

Stroke ◽

10.1161/str.44.suppl_1.a79 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Aaron R Folsom ◽

Vijay Nambi ◽

Elizabeth J Bell ◽

Oludamilola W Oluleye ◽

Rebecca F Gottesman ◽

...

Keyword(s):

Ischemic Stroke ◽

General Population ◽

Troponin T ◽

High Sensitivity ◽

Hazard Ratio ◽

Cardioembolic Stroke ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study

Increased levels of plasma troponins and natriuretic peptides in the general population are associated with increased future risk of cardiovascular disease, but only limited information exists on these biomarkers and stroke occurrence. In a prospective epidemiological study, the Atherosclerosis Risk in Communities (ARIC) Study, we tested the hypothesis that high-sensitivity troponin T (TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) are associated positively with incidence of stroke. We measured plasma high-sensitivity TnT and NT-proBNP in 10,902 men or women initially free of stroke and followed them for a mean of 11.3 years for stroke occurrence (n=507). Analyses were performed using proportional hazards modeling. Both biomarkers were associated positively with total stroke, nonlacunar ischemic, and especially, cardioembolic stroke, but not with lacunar or hemorrhagic stroke. After adjustment for other stroke risk factors, the hazard ratio (95% CI) per one SD greater increment of natural log-transformed TnT was 1.23 (1.13, 1.35) for total stroke, 1.27 (1.15, 1.40) for total ischemic stroke, and 1.36 (1.14, 1.62) for cardioembolic stroke. Likewise, the hazard ratio per one SD greater natural log-transformed NT-proBNP, was 1.37 (1.26, 1.49) for total stroke, 1.39 (1.27, 1.53) for total ischemic stroke, and 1.95 (1.67, 2.28) for cardioembolic stroke. The hazard ratios for jointly high values of TnT (≥0.013 ug/L) and NT-proBNP (≥155.2 pg/mL), versus neither biomarker high, were 2.70 (1.92, 3.79) for total stroke and 6.26 (3.40, 11.5) for cardioembolic stroke, and somewhat stronger for NT-proBNP than TnT. Strikingly, approximately 58% of cardioembolic strokes occurred in the highest quintile of pre-stroke NT-proBNP (versus 3% occurring in the lowest quintile), and 32% of cardioembolic strokes occurred in participants who had both NT-proBNP in the highest quintile and were known by ARIC to have atrial fibrillation sometime before their cardioembolic stroke occurrence. In conclusion, in the general population, elevated plasma TnT and NT-proBNP concentrations are associated with increased risk of cardioembolic and other nonlacunar ischemic strokes.

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Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-16-0576 ◽

2017 ◽

Vol 176 (1) ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Olaf M Dekkers ◽

Erzsébet Horváth-Puhó ◽

Suzanne C Cannegieter ◽

Jan P Vandenbroucke ◽

Henrik Toft Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Arterial Embolism ◽

Registration System ◽

Increased Risk ◽

All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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