Triiodothyronine levels in relation to mortality from breast cancer and all causes: a population-based prospective cohort study

ObjectiveThe potential association between thyroid hormones and breast cancer has been investigated in a large number of studies without conclusive results. This study investigated triiodothyronine (T3) levels in relation to breast cancer mortality in a population with no breast cancer patients at baseline. An additional aim was to study T3levels in relation to mortality from other cancers and all-cause mortality.Design and methodsThis was a population-based prospective cohort study including 2185 women in whom T3levels were measured as part of a preventive health project, i.e. before diagnosis in women who later developed breast cancer. Mean follow-up was 24.1 years and record-linkage to The Swedish Cause-of-Death registry identified 471 women who died: 26 out of breast cancer and 182 from other cancers. Mortality was assessed using a Cox's analysis, yielding hazard ratios (HRs), with 95% confidence intervals. Analyses of T3as a continuous variable were repeated for pre- and peri/postmenopausal women separately.ResultsT3levels were positively associated with the risk of breast cancer-specific death in the age-adjusted analysis: HR for T3as a continuous variable was 2.80 (1.26–6.25). However, the crude analysis did not reach statistical significance. Breast cancer mortality was even higher in postmenopausal women: 3.73 (1.69–8.22), but stratified analyses included few events. There were no statistically significant associations between T3levels and deaths from other cancers, age-adjusted HR: 1.09 (0.72–1.65) or all-cause mortality (1.25:0.97–1.60).ConclusionsThis study, the first of its kind on prospectively measured T3levels, indicates that T3levels are positively associated with breast cancer-specific mortality and that this is not related to a general effect on all-cause mortality.

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Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study

BMJ ◽

10.1136/bmj.c693 ◽

2010 ◽

Vol 340 (feb08 1) ◽

pp. c693-c693 ◽

Cited By ~ 257

Author(s):

C. M Kelly ◽

D. N Juurlink ◽

T. Gomes ◽

M. Duong-Hua ◽

K. I Pritchard ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Cancer Mortality ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Breast Cancer Mortality ◽

Population Based ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin

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P0154BLOOD PRESSURE CONTROL IN ELDERLY PATIENTS WITH HEART FAILURE AND MORTALITY RISK: A POPULATION-BASED PROSPECTIVE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0154 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Antonios Douros ◽

Alice Schneider ◽

Dörte Huscher ◽

Natalie Ebert ◽

Nina Mielke ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

High Risk ◽

Elderly Patients ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antihypertensive Drugs ◽

Population Based ◽

Vulnerable Population ◽

All Cause Mortality

Abstract Background and Aims Current guidelines on the management of heart failure (HF) recommend control of blood pressure (BP) in elderly patients. However, the exact treatment goals in this vulnerable population are unclear. Thus, our population-based prospective cohort study aimed to assess whether BP values <140/90 mmHg are associated with a decreased risk of cardiovascular (CV) death and all-cause mortality in HF patients ≥70 years. Method The study included participants of the Berlin Initiative Study (BIS), all ≥70 years, who were treated with antihypertensive drugs and had a diagnosis of HF (ICD-10 codes: I11.0, I13.0, I13.2, I50.x) at baseline. The study period was from 2009 to 2017. Demographics, lifestyle factors, medications, and comorbidities were assessed in face-to-face interviews and from linked administrative healthcare data. Outcomes were adjudicated using death certificates and hospital discharge notes. Cox proportional hazards models yielded crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of CV death and all-cause mortality associated with normalized BP (systolic BP <140 mmHg and diastolic BP <90 mmHg) compared with non-normalized BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) in patients with HF. In sensitivity analyses we restricted to high-risk HF patients (≥80 years or with previous CV events). We also repeated the analyses in patients without HF to assess a potential effect modification. Results Among 1623 BIS participants treated with antihypertensive drugs at baseline, 544 (33.5%) had a diagnosis of HF. Of those, 255 (46.9%) showed normalized BP and 289 (53.1%) had non-normalized values. Mean age (standard deviation [SD]) was 82.8 (6.8) years (45.4% female). Selected patient characteristics are shown in the Table. Median (interquartile range) duration of follow-up was 6.7 (4.1-7.3) years. Compared with non-normalized BP, normalized BP was associated with a numerically increased risk of CV death (HR, 1.40; 95% CI, 0.90-2.17) and all-cause mortality (HR, 1.28; 95% CI, 0.96-1.71) in patients with HF. The associations were more pronounced or reached statistical significance when restricting to HF patients ≥80 years (CV death: HR, 1.54; 95% CI, 0.94-2.53 / all-cause mortality: HR, 1.56; 95% CI, 1.11-2.18) or HF patients with previous CV events (CV death: HR, 1.65; 95% CI, 0.83-3.29 / all-cause mortality: HR, 1.33; 95% CI, 0.85-2.07) (Figure). The effect estimates in patients without HF were comparable to those with HF (CV death: HR, 1.18; 95% CI, 0.78-1.78; p for interaction, 0.695 / all-cause mortality: HR, 1.20; 95% CI, 0.93-1.54; p for interaction, 0.604). Conclusion Our study suggests that normalized BP does not decrease the risk of CV death or all-cause mortality in elderly patients with HF and it could even increase the risk especially in high-risk subgroups. Thus, individualized benefit-risk assessment is required for the pharmacotherapy of HF in this vulnerable population.

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