Qiang Judy K, Alwithenani Raad, Uleryk Elizabeth, Ezzat Shereen, Lipscombe Lorraine L, Sawka Anna M
Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Thyroid. 2023 Feb;33(2):192-202. doi: 10.1089/thy.2022.0209. Epub 2022 Oct 20.
Long-term cardiovascular (CV) risk is a concern for differentiated thyroid cancer (DTC) survivors. We performed a systematic review and meta-analysis evaluating the risks of CV mortality and morbidity in DTC survivors compared with the general population. Respective meta-analyses were conducted for data that were adjusted for relevant confounders and crude data. We searched five electronic databases from inception to October 2021, supplemented with a hand search. Two reviewers independently screened citations, reviewed full text articles, extracted data, and critically appraised the studies, with discrepancies resolved by a third reviewer. The primary outcome was CV mortality. Secondary outcomes included atrial fibrillation, ischemic heart disease, stroke, and heart failure. We estimated the relative risk (RR) and confidence intervals [CI] of outcomes using random-effects models (adjusted for age and gender), compared with the general population. We reviewed 3409 unique citations, 65 full text articles, and included 7 studies. CV mortality risk was significantly increased in DTC survivors in one study adjusted for confounders-adjusted RR (aRR) 3.35 ([CI 1.66-6.67]; 524 DTC, 1572 controls). The risk of CV morbidity in DTC survivors, adjusted for risk factors, was estimated as follows: atrial fibrillation-aRR 1.66 [CI 1.22-2.27] (3 studies, 4428 DTC, = 75%), ischemic heart disease-aRR 0.97 [CI 0.84-1.13] (2 studies, 3910 DTC, = 0%), stroke-aRR 1.14 [CI 0.84-1.55] (2 studies, 3910 DTC, = 69%), and heart failure-aRR 0.98 [CI 0.60-1.59] (2 studies, 3910 DTC, = 79%). In meta-analyses of unadjusted data, the risks of CV mortality were not significantly increased but the CV morbidity risks were similar to adjusted data. There is limited evidence suggesting that DTC survivors may be at an increased risk of CV death and atrial fibrillation (after adjustment for confounders). We did not observe a significantly increased risk of ischemic heart disease, stroke, or heart failure. Most analyses were subject to significant heterogeneity and further research, with careful attention to CV risk factors, is needed to clarify CV risk in DTC survivors. PROSPERO CRD42021244743.
长期心血管（CV）风险是分化型甲状腺癌（DTC）幸存者所关注的问题。我们进行了一项系统评价和荟萃分析，评估DTC幸存者与普通人群相比发生CV死亡和发病的风险。对调整了相关混杂因素的数据和原始数据分别进行了荟萃分析。我们检索了从数据库建立至2021年10月的五个电子数据库，并辅以手工检索。两名审阅者独立筛选文献、审阅全文、提取数据并严格评估研究，分歧由第三名审阅者解决。主要结局是CV死亡。次要结局包括心房颤动、缺血性心脏病、中风和心力衰竭。我们使用随机效应模型（根据年龄和性别进行调整）估计与普通人群相比结局的相对风险（RR）和置信区间[CI]。我们审阅了3409篇独特文献、65篇全文，并纳入了7项研究。在一项对混杂因素进行调整的研究中，DTC幸存者的CV死亡风险显著增加——调整后的RR（aRR）为3.35（[CI 1.66 - 6.67]；524例DTC患者，1572例对照）。调整风险因素后，DTC幸存者发生CV发病的风险估计如下：心房颤动——aRR 1.66 [CI 1.22 - 2.27]（3项研究，4428例DTC患者，参与率 = 75%），缺血性心脏病——aRR 0.97 [CI 0.84 - 1.13]（2项研究，3910例DTC患者，参与率 = 0%），中风——aRR 1.14 [CI 0.84 - 1.55]（2项研究，3910例DTC患者，参与率 = 69%），心力衰竭——aRR 0.98 [CI 0.60 - 1.59]（2项研究，3910例DTC患者，参与率 = 79%）。在未调整数据的荟萃分析中，CV死亡风险没有显著增加，但CV发病风险与调整后的数据相似。有有限的证据表明DTC幸存者可能有更高的CV死亡和心房颤动风险（在对混杂因素进行调整后）。我们没有观察到缺血性心脏病、中风或心力衰竭风险显著增加。大多数分析存在显著异质性，需要进一步研究，并密切关注CV风险因素，以阐明DTC幸存者的CV风险。PROSPERO CRD42021244743。
