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Increased Cardiovas...
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Giesecke, PeterKarolinska Institutet
(författare)
Increased Cardiovascular Mortality and Morbidity in Patients Treated for Toxic Nodular Goiter Compared to Graves' Disease and Nontoxic Goiter
- Artikel/kapitelEngelska2017
Förlag, utgivningsår, omfång ...
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Mary Ann Liebert,2017
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printrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:oru-60900
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-60900URI
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https://doi.org/10.1089/thy.2017.0029DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:136195306URI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
Anmärkningar
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Funding agencies:Cardiology Clinic of Danderyds Hospital (Stockholm, Sweden) Swedish Endocrine Society Carl Bennet AB
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BACKGROUND: Previous research has suggested an increased risk of death and cardiovascular disease in patients treated for hyperthyroidism. However, studies on this subject are heterogeneous, often based on old data, or have not considered the impact that treatment for hyperthyroidism might have on cardiovascular risk. It is also unclear whether long-term prognosis differs between Graves' disease and toxic nodular goiter. The aim of this study was to use a very large cohort built on recent data to assess whether improvements in cardiovascular care might have changed the prognosis over time. The study also investigated the impact of different etiologies of hyperthyroidism.METHODS: This was an observational register study for the period 1976-2012, with subjects followed for a median period of 18.4 years. Study patients were Stockholm residents treated for Graves' disease or toxic nodular goiter with either radioactive iodine or surgery (N = 12,239). This group was compared to Stockholm residents treated for nontoxic goiter (N = 3685), with adjustments made for age, sex, comorbidities, and time of treatment. Comparisons were also made to the general population of Stockholm. Outcomes were assessed in terms of all-cause and cardiovascular mortality as well as cardiovascular morbidity.RESULTS: The hazard ratios (HR) for all-cause mortality and for cardiovascular mortality were 1.27 [confidence interval (CI) 1.20-1.35] and 1.29 [CI 1.17-1.42], respectively, for hyperthyroid patients compared to those with nontoxic goiter. For cardiovascular morbidity, the HR was 1.12 [CI 1.06-1.18]. Patients aged ≥45 years who were treated for toxic nodular goiter were generally at greater risk than others, and those included from the year 1990 and onwards were at greater risk than those included earlier. Increased all-cause mortality, as well as cardiovascular mortality and morbidity, were also seen in comparisons with the general population.CONCLUSIONS: This is the first large study to indicate that the long-term risk of death and cardiovascular disease in hyperthyroid subjects is due to the hyperthyroidism itself and not an effect of confounding introduced by its treatment. Much of the excess risk is confined to individuals treated for toxic nodular goiter. Despite advances in cardiovascular care during recent decades, hyperthyroidism is still a diagnosis associated with increased cardiovascular morbidity and mortality.
Ämnesord och genrebeteckningar
Biuppslag (personer, institutioner, konferenser, titlar ...)
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Rosenqvist, MårtenKarolinska Institutet
(författare)
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Frykman, VivekaKarolinska Institutet
(författare)
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Friberg, LeifKarolinska Institutet
(författare)
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Wallin, Göran,1952-Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden(Swepub:oru)gwn
(författare)
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Höijer, JonasKarolinska Institutet
(författare)
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Lönn, StefanResearch and Development, Region Halland, Halmstad, Sweden
(författare)
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Törring, OveKarolinska Institutet
(författare)
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Karolinska InstitutetInstitutionen för medicinska vetenskaper
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Thyroid: Mary Ann Liebert27:7, s. 878-8851050-72561557-9077
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