Risk of coronary heart disease and ischemic stroke in thyroid cancer patients taking levothyroxine.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 105-105 ◽  
Author(s):  
Dong Wook Shin ◽  
Beomseok Suh ◽  
Jae Moon Yoon ◽  
Youngmin Park
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Thyroid Cancer ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cancer Patients ◽  
Cox Proportional Hazards ◽  
Health Insurance Data ◽  
Tsh Suppression

105 Background: Many thyroid cancer patients are exposed to long-term TSH suppression, in many cases as lifetime treatment, and are consequently subjected to risk for cardiovascular disease. We investigated incidence of CHD and ischemic stroke among thyroid cancer patients and explored possible pathophysiological mechanisms involved. Methods: A total of 182,419 subjects who received thyroidectomy for thyroid cancer during 2004-2012 were selected from the Korean National Health Insurance data, which covers approximately 97% of the entire Korean population. Propensity score matching was used to select non-cancer controls. Cox proportional hazards regression analysis was used to determine relative risk of coronary heart disease (CHD), and ischemic stroke. Mean follow-up was 4.32 years. Results: Thyroid cancer patients had elevated risk for CHD and ischemic stroke with HR 1.15 (95% CI 1.10-1.22), and 1.15 (1.09-1.22), respectively. This risk was marked in those who received total thyroidectomy and in those who took higher dosage of levothyroxine (HR 1.47, 95% CI 1.34-1.60 for CHD and HR 1.56, 95% CI 1.42-1.72 for ischemic stroke among those who took ≥ 170mcg/d). Atrial fibrillation risk was dose-dependently associated with levothyroxine dosage; however, once patients developed atrial fibrillation, ischemic stroke risk was not significantly greater in those who took higher dosage. Conclusions: The risk for CHD and ischemic stroke was higher in thyroid cancer patients who received thyroidectomy, and the dosage of levothyroxine administered appears to play a major role. More caution is suggested for the choice of thyroidectomy and TSH suppression therapy, as well as proper management for cardiovascular disease prevention.

scholarly journals Increased cardiovascular risk in thyroid cancer patients taking levothyroxine: a nationwide cohort study in Korea

2019 ◽  
Vol 180 (1) ◽  
pp. 11-20 ◽  
Author(s):  
Beomseok Suh ◽  
Dong Wook Shin ◽  
Youngmin Park ◽  
Hyunsun Lim ◽  
Jae Moon Yun ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Cohort Study ◽  
Thyroid Cancer ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cancer Patients ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Tsh Suppression

Objective Many thyroid cancer patients are exposed to long-term thyroid-stimulating hormone (TSH) suppression, often as lifetime treatment, and are consequently at risk for cardiovascular disease. We investigated the incidence of coronary heart disease (CHD) and ischemic stroke among thyroid cancer patients compared with matched control subjects. Design Retrospective cohort study. Methods A total of 182 419 subjects who received thyroidectomy for thyroid cancer during 2004–2012 were selected from the Korean National Health Insurance data, which cover approximately 97% of the entire Korean population. Propensity score matching was used to select non-cancer controls. Cox proportional hazards regression analysis was used to determine relative risk of coronary heart disease and ischemic stroke. Mean follow-up was 4.32 years. Results Thyroid cancer patients had elevated risk for CHD and ischemic stroke with hazard ratio (HR) of 1.15 (95% confidence interval (CI): 1.10–1.22) and 1.15 (1.09–1.22), respectively. This risk was increased in those who took a higher dosage of levothyroxine (HR: 1.47, 95% CI: 1.34–1.60 for CHD and HR: 1.56, 95% CI: 1.42–1.72 for ischemic stroke among those who took ≥170 μg/day levothyroxine). Although risk of atrial fibrillation was dose-dependently associated with levothyroxine dosage, it represents only a small proportion of ischemic stroke incidence (4.4%, 128/2914). Conclusions The risk for CHD and ischemic stroke was higher in thyroid cancer patients who received thyroidectomy, and the dosage of levothyroxine administered appears to play a major role. Greater caution is suggested for the screening and treatment of thyroid cancer and subsequent TSH suppression therapy, as well as proper management for cardiovascular disease prevention.

scholarly journals The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: Data from the Heart and Soul Study

2011 ◽  
Vol 162 (3) ◽  
pp. 555-561 ◽  
Author(s):  
Christine C. Welles ◽  
Mary A. Whooley ◽  
Beeya Na ◽  
Peter Ganz ◽  
Nelson B. Schiller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Chads2 Score

scholarly journals Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study

2021 ◽  
Author(s):  
Andrea J. Glenn ◽  
Kenneth Lo ◽  
David J. A. Jenkins ◽  
Beatrice A. Boucher ◽  
Anthony J. Hanley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Postmenopausal Women ◽  
Prospective Cohort ◽  
Health Initiative ◽  
Dietary Portfolio ◽  
Diet Score

Background The plant‐based Dietary Portfolio combines established cholesterol‐lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low‐density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78–0.95), and heart failure (HR, 0.83; 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87–1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87–1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.

Abstract 14: Cardiac Biomarkers are Associated With Findings on Brain MRI in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Andreea M Rawlings ◽  
Christie M Ballantyne ◽  
Rebecca F Gottesman ◽  
Ron C Hoogeveen ◽  
Timothy M Hughes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin T ◽  
Brain Mri ◽  
Standard Deviation Increase ◽  
Cortical Volume ◽  
Galectin 3

Background: Cerebrovascular disease is often the consequence of cardiac disease. Our aim was to examine associations of biomarkers of cardiovascular disease, high sensitivity troponin T (hs-cTnT), NT-proBNP, and galectin-3, with cerebrovascular signs: lacunar infarcts, lobar and subcortical microhemorrhages, cortical infarcts, and white matter hyperintensity (WMH) volume. We also examined total cortical and Alzheimer’s Disease (AD) signature region volumes. Methods: We conducted a cross-sectional analysis of 1748 ARIC participants from the 2011-2013 exam who had biomarker measurements, completed a brain MRI, and did not have a clinical history of stroke. We used linear regression to model brain volumes, modeled as Z scores, and logistic regression for all other outcomes; biomarkers were log transformed. We repeated analyses excluding persons with coronary heart disease, atrial fibrillation, and heart failure. Results: The mean age of participants was 76, 62% were female, and 21% were Black. All biomarkers were associated with total cortical volume. Each standard deviation increase in log hs-cTnT was associated with lower total cortical volume (adjusted beta = -0.08, 95% CI: -0.12, -0.05); results for the other biomarkers were similar (Figure). All biomarkers were associated with lobar microhemorrhages. Hs-cTnT and NT-proBNP were associated with WMH volume, but galectin-3 was not. No biomarker was associated with subcortical microhemorrhages or cortical infarcts. Results were similar in persons without coronary heart disease, atrial fibrillation, or heart failure (conditions associated with cerebral thromboembolism). Conclusions: In persons free of clinical cardiovascular disease, biomarkers of cardiac stretch, strain, and fibrosis were associated cerebral small vessel disease and reduced cortical volume, but not in a specific pattern suggestive of AD pathogenesis. This suggests subclinical vascular insults affect brain structure through mixed pathogenic processes.

scholarly journals Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 439-448 ◽  
Author(s):  
Catherine M Bulka ◽  
Martha L Daviglus ◽  
Victoria W Persky ◽  
Ramon A Durazo-Arvizu ◽  
James P Lash ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cerebrovascular Disease ◽  
Organic Solvents ◽  
Occupational Exposures ◽  
Latino Workers ◽  
Prevalence Ratios

ObjectiveCardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.MethodsCross-sectional data from 7404 employed individuals, aged 18–74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.ResultsHispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.ConclusionsOur results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.

scholarly journals Atrial fibrillation risk factors in patients with ischemic stroke

2021 ◽  
Vol 17 (1) ◽  
pp. 19-24
Author(s):  
Paweł Wańkowicz ◽  
Przemysław Nowacki ◽  
Monika Gołąb-Janowska
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Nonvalvular Atrial Fibrillation ◽  
Multivariable Logistic Regression Model ◽  
Lipid Metabolism Disorders

IntroductionAtrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS.Material and methodsThis is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation.ResultsIn this study we found – based on a univariable and multivariable logistic regression model – that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01).ConclusionsOur study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.

scholarly journals Levels and Change in Galectin‐3 and Association With Cardiovascular Events: The ARIC Study

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
David Aguilar ◽  
Caroline Sun ◽  
Ron C. Hoogeveen ◽  
Vijay Nambi ◽  
Elizabeth Selvin ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Prognostic Information ◽  
Incident Coronary Heart Disease ◽  
Increased Risk ◽  
Galectin 3

Background Circulating galectin‐3 levels provide prognostic information in patients with established heart failure (HF), but the associations between galectin‐3 levels and other incident cardiovascular events in asymptomatic individuals at midlife and when remeasured ≈15 years later are largely uncharacterized. Methods and Results Using multivariable Cox proportional hazards models, we identified associations between plasma galectin‐3 levels (hazard ratio [HR] per 1 SD increase in natural log galectin‐3) and incident coronary heart disease, ischemic stroke, HF hospitalization, and total mortality in ARIC (Atherosclerosis Risk in Communities) participants free of cardiovascular disease at ARIC visit 4 (1996–1998; n=9247) and at ARIC visit 5 (2011–2013; n=4829). Higher galectin‐3 level at visit 4 (median age 62) was independently associated with incident coronary heart disease (adjusted HR, 1.30; 95% CI, 1.06–1.60), ischemic stroke (HR, 1.42; 95% CI, 1.01–2.00), HF (HR, 1.44; 95% CI, 1.17–1.76), and mortality (HR, 1.56; 95% CI, 1.35–1.80). At visit 5 (median age, 74), higher galectin‐3 level was associated with incident HF (HR, 1.93; 95% CI, 1.15–3.24) and total mortality (HR, 1.70; 95% CI, 1.15–2.52), but not coronary heart disease or stoke. Individuals with the greatest increase in galectin‐3 levels from visit 4 to visit 5 were also at increased risk of incident HF and total mortality. Conclusions In a large, biracial community‐based cohort, galectin‐3 measured at midlife and older age was associated with increased risk of cardiovascular events. An increase in galectin‐3 levels over this period was also associated with increased risk.

Abstract WP192: Secular Trends in the Incidence, Mortality and Survival Rates of Cardiovascular Disease in a General Japanese Population: the Hisayama Study, 1961-2009

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jun Hata ◽  
Toshiharu Ninomiya ◽  
Yasufumi Doi ◽  
Yoichiro Hirakawa ◽  
Masayo Fukuhara ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Survival Rates ◽  
The Past ◽  
Past Half Century ◽  
Incidence And Mortality ◽  
Clear Change ◽  
Past Half

Background: Changes in lifestyle and advances in medical technology during the past half century have been likely to affect the incidence and mortality of cardiovascular diseases and the prevalence of their risk factors in Japan. Methods: We established 5 cohorts consisting of residents of the town of Hisayama, Fukuoka, Japan, aged 40 years or older without a history of cardiovascular disease in 1961, 1974, 1983, 1993, and 2002. Each cohort was followed up for 7 years. Results: The age-adjusted incidence and mortality rates of ischemic stroke decreased significantly in men and women over the past half century. These decreasing trends were the greatest in the earlier period (from the 1960s to the 1970s) and slowed down in the recent period (from the 1980s to the 2000s). The incidence and mortality of intracerebral hemorrhage decreased significantly in men but not in women. The incidence and mortality of coronary heart disease decreased in women, but did not show a clear change in men. Five-year survival rates of stroke and acute myocardial infarction increased significantly with time. While the prevalence of hypertension did not show a drastic secular change, the proportion of individuals with antihypertensive treatment increased consistently, and mean systolic and diastolic blood pressures among hypertensive participants significantly decreased over the study period. On the other hand, the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply. Conclusions: The incidence and mortality rates of ischemic stroke in both sexes, intracerebral hemorrhage in men, and coronary heart disease in women decreased significantly, probably owing to better management of hypertension. However, the decreasing trends in ischemic stroke slowed down recently and there was no clear change for coronary heart disease in men, probably because the benefits of hypertension control were negated by increasing prevalence of metabolic risk factors. In addition to strict control of hypertension, urgent management of metabolic disorders is needed for further prevention of cardiovascular disease in Japan.

PREVENTION AND RISK FACTORS FOR BRAIN INFARCTION(LITERATURE REVIEW)

2020 ◽  
Vol 2 (1) ◽  
pp. 14-16
Author(s):  
Malika Kamalova ◽  
◽  
Nodir Khaidarov ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Brain Infarction ◽  
Blood Cholesterol ◽  
High Blood Cholesterol

Stroke is the leading cause of death and disability in the world.Statistics from Uzbekistan show that over 60,000 new strokes occur each year. At the same time, more than 160 new cases occur daily in the country. In Tashkent alone, 25-30 cases of stroke occur every day. In Tashkent alone, 25-30 strokes are observed daily [1].The main risk factors for atherothromboembolic ischemic stroke are, high blood pressure, high blood cholesterol, smoking and diabetes; and the main risk factors for cardiogenic ischemic stroke are atrial fibrillation and coronary heart disease.

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