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

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.

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.105 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 105-105 ◽

Cited By ~ 1

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.

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Association of Rosacea With Cardiovascular Disease: A Retrospective Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.020671 ◽

2021 ◽

Author(s):

Daein Choi ◽

Sungjun Choi ◽

Seulggie Choi ◽

Sang Min Park ◽

Hyun‐Sun Yoon

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Hazard Ratios ◽

Increased Risk

Background There is emerging evidence that rosacea, a chronic cutaneous inflammatory disease, is associated with various systemic diseases. However, its association with cardiovascular disease (CVD) remains controversial. We aimed to investigate whether patients with rosacea are at increased risk of developing CVD. Methods and Results This retrospective cohort study from the Korean National Health Insurance Service‐Health Screening Cohort included patients with newly diagnosed rosacea (n=2681) and age‐, sex‐, and index year–matched reference populations without rosacea (n=26 810) between 2003 and 2014. The primary outcome was subsequent CVD including coronary heart disease and stroke. Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios for subsequent CVD adjusted for major risk factors of CVD. Compared with the reference population (13 410 women; mean [SD] age, 57.7 [9.2] years), patients with rosacea (1341 women; mean [SD] age, 57.7 [9.2] years) displayed an increased risk for CVD (adjusted hazard ratios, 1.20; 95% CI, 1.03–1.40) and coronary heart disease (adjusted hazard ratios, 1.29; 95% CI, 1.05–1.60). The risk for stroke was not significantly elevated (adjusted hazard ratios, 1.12; 95% CI, 0.91–1.37). Conclusions This study suggests that patients with rosacea are more likely to develop subsequent CVD. Proper education for patients with rosacea to manage other modifiable risk factors of CVD along with rosacea is needed.

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

Journal of the American Heart Association ◽

10.1161/jaha.119.015405 ◽

2020 ◽

Vol 9 (13) ◽

Cited By ~ 1

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.

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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 ◽

10.1161/str.44.suppl_1.awp192 ◽

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.

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