Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

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Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease. / Toulis, Konstantinos A; Viola, David; Gkoutos, George; Keerthy, Deepiksana; Boelaert, Kristien; Nirantharakumar, Krishnarajah.

In: Clinical Endocrinology, Vol. 91, No. 2, 01.08.2019, p. 323-330.

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@article{d3fc245e758744f69fb8dfdb8b72df5c,
title = "Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease",
abstract = "CONTEXT: The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long-term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases.DESIGN: Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population-based, open cohort study using The Health Improvement Network.PATIENTS: A total of 3009 patients treated for DTC with no pre-existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years.RESULTS: A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95{\%} CI: 0.80-1.36) or heart failure (HF) (aHR: 1.27, 95{\%} CI: 0.89-1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95{\%} CI: 1.36-2.15 and aHR: 1.34, 95{\%} CI: 1.05-1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95{\%} CI: 1.33-2.60).CONCLUSIONS: The increased risk of AF in patients who have undergone treatment for DTC but without pre-existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.",
keywords = "atrial fibrillation, cardiovascular events, s, differentiated thyroid carcinoma, thyroid cancer",
author = "Toulis, {Konstantinos A} and David Viola and George Gkoutos and Deepiksana Keerthy and Kristien Boelaert and Krishnarajah Nirantharakumar",
note = "{\circledC} 2019 John Wiley & Sons Ltd.",
year = "2019",
month = "8",
day = "1",
doi = "10.1111/cen.13990",
language = "English",
volume = "91",
pages = "323--330",
journal = "Clinical Endocrinology",
issn = "0300-0664",
publisher = "Wiley",
number = "2",

}

RIS

TY - JOUR

T1 - Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

AU - Toulis, Konstantinos A

AU - Viola, David

AU - Gkoutos, George

AU - Keerthy, Deepiksana

AU - Boelaert, Kristien

AU - Nirantharakumar, Krishnarajah

N1 - © 2019 John Wiley & Sons Ltd.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - CONTEXT: The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long-term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases.DESIGN: Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population-based, open cohort study using The Health Improvement Network.PATIENTS: A total of 3009 patients treated for DTC with no pre-existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years.RESULTS: A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80-1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89-1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36-2.15 and aHR: 1.34, 95% CI: 1.05-1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33-2.60).CONCLUSIONS: The increased risk of AF in patients who have undergone treatment for DTC but without pre-existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.

AB - CONTEXT: The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long-term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases.DESIGN: Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population-based, open cohort study using The Health Improvement Network.PATIENTS: A total of 3009 patients treated for DTC with no pre-existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years.RESULTS: A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80-1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89-1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36-2.15 and aHR: 1.34, 95% CI: 1.05-1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33-2.60).CONCLUSIONS: The increased risk of AF in patients who have undergone treatment for DTC but without pre-existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.

KW - atrial fibrillation

KW - cardiovascular events

KW - s, differentiated thyroid carcinoma

KW - thyroid cancer

U2 - 10.1111/cen.13990

DO - 10.1111/cen.13990

M3 - Article

C2 - 30993728

VL - 91

SP - 323

EP - 330

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 2

ER -