Helene Bruere1, Laurent Fauchier2, Anne Bernard Brunet1, Bertrand Pierre1, Edouard Simeon1, Dominique Babuty1, Nicolas Clementy1. 1. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France. 2. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France. Electronic address: lfau@med.univ-tours.fr.
Abstract
BACKGROUND: Atrial fibrillation is the most common cardiac complication of hyperthyroidism. The association between history of hyperthyroidism and stroke remains unclear. We sought to determine whether history of thyroid dysfunction is a thromboembolic risk factor in patients with atrial fibrillation. METHODS: Patients with atrial fibrillation seen in an academic institution between 2000 and 2010 were identified and followed-up. Clinical events (stroke/systemic embolism, bleeding, all-cause death) were recorded and related to thyroid status and disorders. Associations were examined in time-dependent models with adjustment for relevant confounders. RESULTS: Among 8962 patients, 141 patients had a history of hyperthyroidism, 540 had a history of hypothyroidism, and 8271 had no thyroid dysfunction. Mean follow-up was 929 ± 1082 days. A total of 715 strokes/systemic embolism were recorded, with no significant difference in the rates of these events in patients with a history of thyroid dysfunction vs those without thyroid problems in either univariate or multivariable analysis (hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.41-1.76 for hyperthyroidism; HR 0.98; 95% CI, 0.73-1.34 for hypothyroidism). There were 791 bleeding events; history of hypothyroidism was independently related to a higher rate of bleeding events (HR 1.35; 95% CI, 1.02-1.79). No significant difference among the 3 groups was observed for the incidence of death. CONCLUSIONS: History of hyperthyroidism was not an independent risk factor for stroke/systemic embolism in atrial fibrillation, whereas hypothyroidism was associated with a higher risk of bleeding events. These data suggest no additional benefit from the inclusion of thyroid dysfunction in thromboembolic prediction models in atrial fibrillation.
BACKGROUND:Atrial fibrillation is the most common cardiac complication of hyperthyroidism. The association between history of hyperthyroidism and stroke remains unclear. We sought to determine whether history of thyroid dysfunction is a thromboembolic risk factor in patients with atrial fibrillation. METHODS:Patients with atrial fibrillation seen in an academic institution between 2000 and 2010 were identified and followed-up. Clinical events (stroke/systemic embolism, bleeding, all-cause death) were recorded and related to thyroid status and disorders. Associations were examined in time-dependent models with adjustment for relevant confounders. RESULTS: Among 8962 patients, 141 patients had a history of hyperthyroidism, 540 had a history of hypothyroidism, and 8271 had no thyroid dysfunction. Mean follow-up was 929 ± 1082 days. A total of 715 strokes/systemic embolism were recorded, with no significant difference in the rates of these events in patients with a history of thyroid dysfunction vs those without thyroid problems in either univariate or multivariable analysis (hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.41-1.76 for hyperthyroidism; HR 0.98; 95% CI, 0.73-1.34 for hypothyroidism). There were 791 bleeding events; history of hypothyroidism was independently related to a higher rate of bleeding events (HR 1.35; 95% CI, 1.02-1.79). No significant difference among the 3 groups was observed for the incidence of death. CONCLUSIONS: History of hyperthyroidism was not an independent risk factor for stroke/systemic embolism in atrial fibrillation, whereas hypothyroidism was associated with a higher risk of bleeding events. These data suggest no additional benefit from the inclusion of thyroid dysfunction in thromboembolic prediction models in atrial fibrillation.
Authors: Bulent Gorenek; Antonio Pelliccia; Emelia J Benjamin; Giuseppe Boriani; Harry J Crijns; Richard I Fogel; Isabelle C Van Gelder; Martin Halle; Gulmira Kudaiberdieva; Deirdre A Lane; Torben Bjerregaard Larsen; Gregory Y H Lip; Maja-Lisa Løchen; Francisco Marin; Josef Niebauer; Prashanthan Sanders; Lale Tokgozoglu; Marc A Vos; David R Van Wagoner; Laurent Fauchier; Irina Savelieva; Andreas Goette; Stefan Agewall; Chern-En Chiang; Márcio Figueiredo; Martin Stiles; Timm Dickfeld; Kristen Patton; Massimo Piepoli; Ugo Corra; Pedro Manuel Marques-Vidal; Pompilio Faggiano; Jean-Paul Schmid; Ana Abreu Journal: Eur J Prev Cardiol Date: 2016-11-04 Impact factor: 7.804
Authors: Bulent Gorenek; Antonio Pelliccia; Emelia J Benjamin; Giuseppe Boriani; Harry J Crijns; Richard I Fogel; Isabelle C Van Gelder; Martin Halle; Gulmira Kudaiberdieva; Deirdre A Lane; Torben Bjerregaard Larsen; Gregory Y H Lip; Maja-Lisa Løchen; Francisco Marín; Josef Niebauer; Prashanthan Sanders; Lale Tokgozoglu; Marc A Vos; David R Van Wagoner; Laurent Fauchier; Irina Savelieva; Andreas Goette; Stefan Agewall; Chern-En Chiang; Márcio Figueiredo; Martin Stiles; Timm Dickfeld; Kristen Patton; Massimo Piepoli; Ugo Corra; Pedro Manuel Marques-Vidal; Pompilio Faggiano; Jean-Paul Schmid; Ana Abreu Journal: Europace Date: 2017-02-01 Impact factor: 5.214