甲状腺癌与心血管疾病风险的关联：一项全国性观察研究。
Association between thyroid cancer and cardiovascular disease risk: a nationwide observation study.
机构信息
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Mackay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City, 10449, Taiwan.
出版信息
Sci Rep. 2022 Nov 2;12(1):18438. doi: 10.1038/s41598-022-22462-z.
Treatment with levothyroxine and radioiodine contribute alternative cardiovascular function in adults with thyroid cancer. The risks of long-term cardiovascular conditions among thyroid cancer patients is unknown. This study aimed to compare the incidence of coronary heart disease (CHD), ischemic stroke (IS), and atrial fibrillation (AF) among adults with thyroid cancer with that of the general population, especially when stratified by age (< 65 and ≥ 65 years old). This observational cohort study enrolled patients between January 1, 2011 and December 31, 2016 with a follow-up until December 31, 2018. This study analyzed the data of Taiwanese thyroid cancer patients registered on the National Taiwan Cancer Registry Database, with CHD and IS. SIR models were used to evaluate the association between thyroid cancer and CHD, IS, AF, and cardiovascular disease outcome, stratified by age and sex. SIR analyses were also conducted for both sexes, age groups (< 65, ≥ 65 years), and different follow-up years. After excluding 128 individuals (< 20 years or ≥ 85 years old) and with missing index data, 4274 eligible thyroid cancer patients without CHD history, 4343 patients without IS history, and 4247 patients without AF history were included for analysis. During the median follow-up of 3.5 (1.2) years among thyroid cancer patients, the observed number of new CHD events was 70; IS, 30; and AF, 20, respectively. The SIR was significantly higher for CHD (SIR, 1.57; 95% confidence interval [CI] 1.2-1.93) among thyroid cancer patients compared with the age- and sex-specific standardized population. However, the association between thyroid cancer and the risks of IS (SIR, 0.74; 95% CI 0.47-1), cardiovascular disease (SIR, 0.88; 95% CI 0.7-1.05), and atrial fibrillation (SIR, 0.74; 95% CI 0.42-1.06) were insignificant. Moreover, stratification by age < 65 or age ≥ 65 years old and by sex for CHD suggested that the diagnosis of thyroid cancer in the young may attenuate the CHD risk (SIR, 2.08; 95% CI 1.5-2.66), and the CVD risk was constant among both men (SIR, 1.63; 95% CI 1.03-2.24) and women (SIR, 1.53; 95% CI 1.06-1.99). The patients had persistent higher CHD risk for 5 years after cancer diagnosis. Thyroid cancer survivors have a substantial CHD risk, even at long-term follow-up, especially in those patients < 65 years old. Further research on the association between thyroid cancer and CHD risk is warranted.
左甲状腺素和放射性碘治疗可改善甲状腺癌患者的心血管功能。然而，甲状腺癌患者长期患心血管疾病的风险尚不清楚。本研究旨在比较甲状腺癌患者与一般人群冠心病（CHD）、缺血性脑卒中（IS）和心房颤动（AF）的发病率，特别是按年龄（<65 岁和≥65 岁）分层时的发病率。本观察性队列研究纳入了 2011 年 1 月 1 日至 2016 年 12 月 31 日期间在国家癌症登记数据库登记的甲状腺癌患者，并随访至 2018 年 12 月 31 日。本研究分析了台湾甲状腺癌患者的数据，这些患者来自于国家癌症登记数据库，伴有 CHD 和 IS。采用 SIR 模型评估了甲状腺癌与 CHD、IS、AF 和心血管疾病结局之间的关联，关联分析按年龄和性别分层。还对男女两性、年龄组（<65 岁、≥65 岁）和不同随访年限进行了 SIR 分析。排除了 128 名年龄<20 岁或≥85 岁和索引数据缺失的个体后，纳入了 4274 名无 CHD 病史、4343 名无 IS 病史和 4247 名无 AF 病史的合格甲状腺癌患者进行分析。在甲状腺癌患者的中位随访 3.5（1.2）年期间，观察到新发 CHD 事件 70 例，IS 事件 30 例，AF 事件 20 例。与年龄和性别特异性标准化人群相比，甲状腺癌患者 CHD 的 SIR 显著升高（SIR，1.57；95%置信区间 [CI]，1.2-1.93）。然而，甲状腺癌与 IS（SIR，0.74；95%CI，0.47-1）、心血管疾病（SIR，0.88；95%CI，0.7-1.05）和心房颤动（SIR，0.74；95%CI，0.42-1.06）风险之间的关联并不显著。此外，按年龄<65 岁或年龄≥65 岁和性别分层的 CHD 表明，甲状腺癌的诊断在年轻人中可能会降低 CHD 风险（SIR，2.08；95%CI，1.5-2.66），而男性（SIR，1.63；95%CI，1.03-2.24）和女性（SIR，1.53；95%CI，1.06-1.99）中的 CVD 风险保持不变。癌症诊断后，患者的 CHD 风险持续存在长达 5 年。甲状腺癌幸存者存在重大的 CHD 风险，即使在长期随访中也是如此，尤其是年龄<65 岁的患者。需要进一步研究甲状腺癌与 CHD 风险之间的关系。
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