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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Risk of Adverse Cardiovascular Outcomes in Differentiated Thyroid Cancer Survivors: A Systematic Review and
Judy K Qiang1,2, Raad Alwithenani1,3, Elizabeth Uleryk4
1Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Differentiated thyroid cancer survivors may face increased risks of cardiovascular death and atrial fibrillation. Further research is needed to confirm these findings and understand long-term cardiovascular risks.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Long-term cardiovascular (CV) risk is a significant concern for differentiated thyroid cancer (DTC) survivors.
- Understanding the specific CV risks in this population is crucial for improved patient management and outcomes.
Approach:
- A systematic review and meta-analysis was conducted to evaluate CV mortality and morbidity risks in DTC survivors compared to the general population.
- Data from electronic databases were screened, extracted, and critically appraised by independent reviewers.
- Random-effects models were used to estimate relative risks (RR) and confidence intervals (CI) for various CV outcomes, with adjustments for confounders.
Key Points:
- Limited evidence suggests DTC survivors may have an increased risk of CV death (aRR 3.35) and atrial fibrillation (aRR 1.66) after adjusting for confounders.
- No significantly increased risk was observed for ischemic heart disease, stroke, or heart failure.
- Significant heterogeneity was noted in most analyses, highlighting the need for further investigation.
Conclusions:
- Differentiated thyroid cancer survivors may be at a higher risk for cardiovascular mortality and atrial fibrillation.
- Current evidence is limited, and further research focusing on CV risk factors is essential to clarify the long-term CV risk profile in DTC survivors.
Abstract:
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, I2 = 75%), ischemic heart disease-aRR 0.97 [CI 0.84-1.13] (2 studies, 3910 DTC, I2 = 0%), stroke-aRR 1.14 [CI 0.84-1.55] (2 studies, 3910 DTC, I2 = 69%), and heart failure-aRR 0.98 [CI 0.60-1.59] (2 studies, 3910 DTC, I2 = 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.
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