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Published on: February 3, 2023
Long-term cardiovascular and cerebrovascular morbidity in Israeli thyroid cancer survivors
Elena Izkhakov1,2,3, Joseph Meyerovitch2,4,5, Micha Barchana3
1Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Thyroid cancer survivors face higher risks of cardiovascular and cerebrovascular events. While new guidelines may reduce these risks, they remain elevated compared to the general population.
Area of Science:
- Endocrinology
- Cardiology
- Oncology
Background:
- Thyroid cancer (TC) survivors may experience increased cardiovascular and cerebrovascular (CaV&CeV) morbidity.
- The 2009 American Thyroid Association (ATA) guidelines suggested less aggressive treatment for low-risk TC patients.
Purpose of the Study:
- To compare atherosclerotic CaV&CeV outcomes in Israeli TC survivors versus individuals without thyroid disease.
- To evaluate CaV&CeV outcomes before and after the 2009 ATA guidelines implementation.
Main Methods:
- A large Israeli population-based cohort study included 5,677 TC survivors and 23,962 matched controls.
- Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs).
Main Results:
- TC survivors had a 26% increased risk of new atherosclerotic CaV&CeV events (aHR 1.26).
- The 5-year incidence of CaV&CeV events decreased after 2009 (aHR 0.49), but remained higher than in controls (aHR 1.5).
Conclusions:
- TC survivors exhibit significantly higher atherosclerotic CaV&CeV morbidity than the general population.
- The 2009 ATA guidelines showed a trend toward reduced CaV&CeV events, though risks persist.
Objective:
Thyroid cancer (TC) survivors may be at risk of subsequent cardiovascular and cerebrovascular (CaV&CeV) morbidity. The 2009 American Thyroid Association (ATA) guidelines recommended less aggressive treatment for low-risk TC patients. The aim of this study was to assess the atherosclerotic CaV&CeV outcome of Israeli TC survivors compared to individuals with no thyroid disease, and the atherosclerotic CaV&CeV outcome before (2000-2008) and after (2009-2011) implementation of the 2009 ATA guidelines.
Methods:
All members of the largest Israeli healthcare organization who were diagnosed with TC from 1/2000 to 12/2014 (study group) and age- and sex-matched members with no thyroid disease (controls) were included. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models.
Results:
The mean follow-up was 7.6 ± 4.2 and 7.8 ± 4.1 years for the study (n = 5,677, 79% women) and control (n = 23,962) groups, respectively. The former had an increased risk of new atherosclerotic CaV&CeV events (adjusted HR 1.26, 95% CI 1.15-1.39). The 5-year incidence of CaV&CeV was lower (adjusted HR 0.49, 95% CI 0.38-0.62) from 2009 to 2011 compared to 2000 to 2008, but remained higher in the study group than in the control group (adjusted HR 1.5, 95% CI 1.14-1.69).
Conclusions:
This large Israeli population-based cohort study showed greater atherosclerotic CaV&CeV morbidity in TC survivors compared to individuals with no thyroid diseases. There was a trend toward a decreased 5-year incidence of atherosclerotic CaV&CeV events among TC survivors following the implementation of the 2009 ATA guidelines, but it remained higher compared to the general population.
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