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甲状腺功能亢进症患者的急性心血管事件和全因死亡率:一项基于人群的队列研究。

Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study.

机构信息

Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark.

Department of Clinical Endocrinology and Metabolism.

出版信息

Eur J Endocrinol. 2017 Jan;176(1):1-9. doi: 10.1530/EJE-16-0576. Epub 2016 Oct 3.

Abstract

OBJECTIVE

Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality.

DESIGN

It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated.

RESULTS

The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40-4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33-1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58-8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30-8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold.

CONCLUSIONS

We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

摘要

目的

多项研究表明,甲状腺功能亢进症患者发生心血管疾病(CVD)的风险增加,但大多数研究规模太小,无法确定甲状腺功能亢进症对个体心血管终点的影响。我们的主要目的是评估甲状腺功能亢进症、急性心血管事件和死亡率之间的关联。

设计

这是一项全国性的基于人群的队列研究。数据来自丹麦民事登记系统和丹麦国家患者登记处,涵盖了所有丹麦医院。我们比较了两组人群的全因死亡率以及静脉血栓栓塞(VTE)、急性心肌梗死(AMI)、缺血性和非缺血性卒中、动脉栓塞、心房颤动(AF)和经皮冠状动脉介入治疗(PCI)的发生率。使用 95%置信区间(95%CI)估计了危险比(HR)。

结果

该研究纳入了 85856 例甲状腺功能亢进症患者和 847057 例匹配的基于人群的对照组。平均随访时间为 9.2 年。甲状腺功能亢进症诊断后 3 个月内的死亡率 HR 最高:4.62,95%CI:4.40-4.85,并且在长期随访(>3 年)期间仍保持升高(HR:1.35,95%CI:1.33-1.37)。所有检查的心血管事件风险均增加,甲状腺功能亢进症诊断后 3 个月的风险最高。诊断后 3 个月的风险最高的是心房颤动(HR:7.32,95%CI:6.58-8.14)和动脉栓塞(HR:6.08,95%CI:4.30-8.61),但 VTE、AMI、缺血性和非缺血性卒中和 PCI 的风险也增加了 2-3 倍。

结论

我们发现甲状腺功能亢进症患者的全因死亡率和急性心血管事件风险增加。

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