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Hyperthyroidism and cardiovascular disease: an association study using big data analytics

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Abstract

Background

The cardiovascular (CV) system is profoundly affected by thyroid hormones. Both hypo- and hyperthyroidism can increase the risk of severe CV complications.

Objective

To assess the association of hyperthyroidism with major CV risk factors (CVRFs) and CV diseases (CVDs) using a big data methodology with the Savana Manager platform.

Material and methods

This was an observational and retrospective study. The data were obtained from the electronic medical records of the University Hospital Puerta de Hierro Majadahonda (Spain). Artificial intelligence techniques were used to extract the information from the electronic health records and Savana Manager 3.0 software was used for analysis.

Results

Of a total of 540,939 patients studied (53.62% females; mean age 42.2 ± 8.7 years), 5504 patients (1.02%; 69.9% women) had a diagnosis of hyperthyroidism. Patients with this diagnosis had a significantly (p < 0.0001) higher frequency of CVRFs than that found in non-hyperthyroid subjects. The higher frequency of CVRFs in patients with hyperthyroidism was observed in both women and men and in patients younger and older than 65 years of age. The total frequency of CVDs was also significantly (p < 0.0001) higher in patients diagnosed with hyperthyroidism than that found in patients without this diagnosis. The highest odds ratio values obtained were 6.40 (4.27–9.61) for embolic stroke followed by 5.99 (5.62–6.38) for atrial fibrillation. The frequency of all CVDs evaluated in patients with a diagnosis of hyperthyroidism was significantly higher in both women and men, as well as in those younger and older than 65 years, compared to subjects without this diagnosis. A multivariate regression analysis showed that hyperthyroidism was significantly and independently associated with all the CVDs evaluated except for embolic stroke.

Conclusion

The data from this hospital cohort suggest that there is a significant association between the diagnosis of hyperthyroidism and the main CVRFs and CVDs in our population, regardless of the age and gender of the patients. Our study, in addition to confirming this association, provides useful information for understanding the applicability of artificial intelligence techniques to “real-world data and information”.

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References

  1. I. Klein, K. Ojamaa, Thyroid hormone and the cardiovascular system. N. Engl. J. Med. 344, 501–509 (2001)

    Article  CAS  PubMed  Google Scholar 

  2. S. Fazio, E.A. Palmieri, G. Lombardi, B. Biondi, Effects of thyroid hormone on the cardiovascular system. Recent Prog. Horm. Res. 59, 31–50 (2004)

    Article  CAS  PubMed  Google Scholar 

  3. A. Jabbar, A. Pingitore, S.H. Pearce, A. Zaman, G. Iervasi, S. Razvi, Thyroid hormones and cardiovascular disease. Nat. Rev. Cardiol. 14, 39–55 (2017)

    Article  CAS  PubMed  Google Scholar 

  4. H. Vargas-Uricoechea, A. Bonelo-Perdomo, C.H. Sierra-Torres, Effects of thyroid hormones on the heart. Clin. Investig. Arterioscler. 26, 296–309 (2014)

    PubMed  Google Scholar 

  5. A. Abdel-Moneim, A.M. Gaber, S. Gouda, A. Osama, S.I. Othman, G. Allam, Relationship of thyroid dysfunction with cardiovascular diseases: updated review on heart failure progression. Hormones (Athens) 19, 301–309 (2020)

    Article  PubMed  Google Scholar 

  6. J.G. Hollowell, N.W. Staehling, W.D. Flanders, W.H. Hannon, E.W. Gunter, C.A. Spencer, L.E. Braverman, Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 87, 489–499 (2002)

    Article  CAS  PubMed  Google Scholar 

  7. S. De Leo, S.Y. Lee, L.E. Braverman, Hyperthyroidism. Lancet. 388, 906–918 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  8. P.N. Taylor, D. Albrecht, A. Scholz, G. Gutierrez-Buey, J.H. Lazarus, C.M. Dayan, O.E. Okosieme, Global epidemiology of hyperthyroidism and hypothyroidism. Nat. Rev. Endocrinol. 14, 301–316 (2018)

    Article  PubMed  Google Scholar 

  9. M. Hussein, E. Toraih, A.S.C. Reisner, P. Miller, R. Corsetti, E. Kandil, Prevalence and mortality of cardiovascular events in patients with hyperthyroidism: a nationwide cohort study in the United States. Gland Surg. 10, 2608–2621 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  10. W.M. Wiersinga, K.G. Poppe, G. Effraimidis, Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol. 11, 282–298 (2023)

    Article  CAS  PubMed  Google Scholar 

  11. J.L. Izquierdo, C. Almonacid, C. Campos, D. Morena, M. Benavent, D. González-de-Olano, J.M. Rodríguez,, Systemic corticosteroids in patients with bronchial asthma: a real-life study. J. Investig. Allergol. Clin. Immunol. (2021). https://doi.org/10.18176/jiaci.0765.

  12. J.L. Izquierdo, C. Almonacid, Y. González, C. Del Rio-Bermudez, J. Ancochea, R. Cárdenas, S. Lumbreras, J.B. Soriano, The impact of COVID-19 on patients with asthma. Eur. Respir. J. 57, 2003142 (2021). https://doi.org/10.1183/13993003.03142-2020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. D. Morena, J. Fernández, C. Campos, M. Castillo, G. López, M. Benavent, J.L. Izquierdo, Clinical profile of patients with idiopathic pulmonary fibrosis in real life. J. Clin. Med. 12, 1669 (2023). https://doi.org/10.3390/jcm12041669

    Article  PubMed  PubMed Central  Google Scholar 

  14. I. Hernandez Medrano, C. Belda, A. Urena, I. Salcedo, L.T. Espinosa-Anke, H. Saggion, Savana: Reusing electronic health records with artificial intelligence. Int. J. Interact. Multimed. Artif. Intell. 4, 8–12 (2017)

    Google Scholar 

  15. L. Canales, S. Menke, S. Marchesseau, A. D’Agostino, C. del Rio-Bermudez, M. Taberna, J. Tello, Assessing the performance of clinical natural language processing systems: development of an evaluation methodology. JMIR Med. Inform. 9, e20492 (2021)

  16. R.A. Baeza-Yates, B. Ribeiro-Neto, Modern Information Retrieval (Addison-Wesley Longman Publishing Co, Inc., Boston, 1999)

  17. J.S. Neves, R. Fontes-Carvalho, M. Borges-Canha, A.R. Leite, M. von Hafe, C. Vale, S. Martins, J.T. Guimarães, D. Carvalho, A. Leite-Moreira, A. Azevedo, Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study. Front. Endocrinol. (Lausanne). 13, 1067801 (2022)

    Article  PubMed  PubMed Central  Google Scholar 

  18. P. Iglesias, J.J. Díez, Hyperthyroidism and cardiovascular risk factors: a nationwide study. Endocrinol. Diabetes Nutr. (Engl Ed.) 70, 255–261 (2023).

  19. I. Saito, K. Ito, T. Saruta, The effect of age on blood pressure in hyperthyroidism. J. Am. Geriatr. Soc. 33, 19–22 (1985)

    Article  CAS  PubMed  Google Scholar 

  20. F. Osman, J.A. Franklyn, R.L. Holder, M.C. Sheppard, M.D. Gammage, Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. J. Am. Coll. Cardiol. 49, 71–81 (2007)

    Article  CAS  PubMed  Google Scholar 

  21. S. Metso, A. Auvinen, J. Salmi, H. Huhtala, P. Jaatinen, Increased long-term cardiovascular morbidity among patients treated with radioactive iodine for hyperthyroidism. Clin. Endocrinol. (Oxf). 68, 450–457 (2008)

    Article  PubMed  Google Scholar 

  22. E. Ryödi, J. Salmi, P. Jaatinen, H. Huhtala, R. Saaristo, M. Välimäki, A. Auvinen, S. Metso, Cardiovascular morbidity and mortality in surgically treated hyperthyroidism – a nation-wide cohort study with a long-term follow-up. Clin. Endocrinol. (Oxf). 80, 743–750 (2014)

    Article  PubMed  Google Scholar 

  23. E. Ryödi, S. Metso, H. Huhtala, M. Välimäki, A. Auvinen, P. Jaatinen, Cardiovascular morbidity and mortality after treatment of hyperthyroidism with either radioactive iodine or thyroidectomy. Thyroid 28, 1111–1120 (2018)

    Article  PubMed  Google Scholar 

  24. E.N. Liberopoulos, M.S. Elisaf, Dyslipidemia in patients with thyroid disorders. Hormones (Athens) 1, 218–223 (2002)

    Article  PubMed  Google Scholar 

  25. M. Hage, M.S. Zantout, S.T. Azar, Thyroid disorders and diabetes mellitus. J. Thyroid Res. 2011, 439463 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  26. B. Biondi, G.J. Kahaly, R.P. Robertson, Thyroid dysfunction and diabetes mellitus: two closely associated disorders. Endocr. Rev. 40, 789–824 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  27. P. Perros, R.J. McCrimmon, G. Shaw, B.M. Frier, Frequency of thyroid dysfunction in diabetic patients: value of annual screening. Diabet. Med. 12, 622–627 (1995)

    Article  CAS  PubMed  Google Scholar 

  28. J.J. Díez, P. Sánchez, P. Iglesias, Prevalence of thyroid dysfunction in patients with type 2 diabetes. Exp. Clin. Endocrinol. Diabetes 119, 201–207 (2011)

    Article  PubMed  Google Scholar 

  29. M. Nishi, Diabetes mellitus and thyroid diseases. Diabetol. Int. 9, 108–112 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  30. K.E. Peters, S.A.P. Chubb, D.G. Bruce, W.A. Davis, T.M.E. Davis, Prevalence and incidence of thyroid dysfunction in type 1 diabetes, type 2 diabetes and latent autoimmune diabetes of adults: The Fremantle Diabetes Study Phase II. Clin. Endocrinol. (Oxf). 92, 373–382 (2020)

    Article  CAS  PubMed  Google Scholar 

  31. J.J. Díez, P. Iglesias, Subclinical hyperthyroidism in patients with type 2 diabetes. Endocrine. 42, 157–163 (2012)

    Article  PubMed  Google Scholar 

  32. J.J. Díez, P. Iglesias, Prevalence of diabetes in people with thyroid dysfunction. Med. Clin. (Barc). 160, 333–340 (2023).

  33. P. Vestergaard, L. Rejnmark, J. Weeke, H.C. Hoeck, H.K. Nielsen, J. Rungby, P. Laurberg, L. Mosekilde, Smoking as a risk factor for Graves’ disease, toxic nodular goiter, and autoimmune hypothyroidism. Thyroid 12, 69–75 (2002)

    Article  PubMed  Google Scholar 

  34. W.M. Wiersinga, Smoking and thyroid. Clin. Endocrinol. (Oxf). 79, 145–151 (2013)

    Article  CAS  PubMed  Google Scholar 

  35. S. Park, W.G. Kim, M.J. Jeon, M. Kim, H. Oh, M. Han, T.Y. Kim, Y.K. Shong, W.B. Kim, Serum thyroid-stimulating hormone levels and smoking status: data from the Korean National Health and Nutrition Examination Survey VI. Clin. Endocrinol. (Oxf). 88, 969–976 (2018)

    Article  CAS  PubMed  Google Scholar 

  36. L. Frost, P. Vestergaard, L. Mosekilde, Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch. Intern. Med. 164, 1675–1678 (2004)

    Article  PubMed  Google Scholar 

  37. H. Bruere, L. Fauchier, A. Bernard Brunet, B. Pierre, E. Simeon, D. Babuty, N. Clementy, History of thyroid disorders in relation to clinical outcomes in atrial fibrillation. Am. J. Med. 128, 30–37 (2015)

    Article  PubMed  Google Scholar 

  38. B. Gorenek, G. Boriani, G. Dan, L. Fauchier, G. Fenelon, H. Huang, G. Kudaiberdieva, G.Y.H. Lip, R. Mahajan, T. Potpara, J.D. Ramirez, M.A. Vos, F. Marin; ESC Scientific Document Group, European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS). Europace 20, 895–896 (2018)

    Article  PubMed  Google Scholar 

  39. H.J. Kim, T. Kang, M.J. Kang, H.S. Ahn, S.Y. Sohn, Incidence and mortality of myocardial infarction and stroke in patients with hyperthyroidism: a nationwide cohort study in Korea. Thyroid 30, 955–965 (2020)

    Article  CAS  PubMed  Google Scholar 

  40. X. Jiang, H. Xing, J. Wu, R. Du, H. Liu, J. Chen, J. Wang, C. Wang, Y. Wu, Prognostic value of thyroid hormones in acute ischemic stroke – a meta analysis. Sci. Rep. 7, 16256 (2017)

  41. L. Fani, O. Roa Dueñas, D. Bos, M.W. Vernooij, C.C.W. Klaver, M.K. Ikram, R.P. Peeters, M.A. Ikram, L. Chaker, Thyroid status and brain circulation: The Rotterdam Study. J. Clin. Endocrinol. Metab. 107, e1293–e1302 (2022)

    Article  PubMed  Google Scholar 

  42. S. Danzi, I. Klein, Thyroid disease and the cardiovascular system. Endocrinol. Metab. Clin. North Am. 43, 517–528 (2014)

    Article  PubMed  Google Scholar 

  43. C.H. Shih, S.L. Chen, C.C. Yen, Y.H. Huang, C.D. Chen, Y.S. Lee, K.H. Lin, Thyroid hormone receptor-dependent transcriptional regulation of fibrinogen and coagulation proteins. Endocrinology. 145, 2804–2814 (2004)

    Article  CAS  PubMed  Google Scholar 

  44. J. Horacek, J. Maly, I. Svilias, L. Smolej, J. Cepkova, J. Vizda, P. Sadilek, I. Fatorova, P. Zak, Prothrombotic changes due to an increase in thyroid hormone levels. Eur. J. Endocrinol. 172, 537–542 (2015)

    Article  CAS  PubMed  Google Scholar 

  45. L.P.B. Elbers, E. Fliers, S.C. Cannegieter, The influence of thyroid function on the coagulation system and its clinical consequences. J. Thromb. Haemost. 16, 634–645 (2018)

    Article  CAS  PubMed  Google Scholar 

  46. J.C. Liu, H.Y. Huang, Y.T. Hsu, Hyperthyroidism and thrombophilia in cerebral arterial and venous thrombosis: a case report and critical review. Neurologist 19, 53–55 (2015)

    Article  CAS  PubMed  Google Scholar 

  47. M. Yokoyama, R. Yamashita, M. Furuya, M. Yamazaki, K. Koyama, F. Tanaka, A case of cerebral venous thrombosis and deep venous thrombosis due to hyperthyroidism with increased factor VIII activity. J. Stroke Cerebrovasc. Dis. 28, 104364 (2019)

    Article  PubMed  Google Scholar 

  48. A. Kato, Y. Matsuo, A. Miyagaki, K. Endo, E. Hiraoka, Portal and mesenteric vein thrombosis associated with hyperthyroidism. Am. J. Case Rep. 22, e929565 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  49. T.Y. Kim, S.H. Ihm, J.W. Roh, S. Lim, C.S. Park, H.Y. Kim, Massive pulmonary thromboembolism combined with transient thyrotoxicosis in an 18 year old girl. Clin. Hypertens 26, 17 (2020).

  50. F. Brandt, M. Thvilum, D. Almind, K. Christensen, A. Green, L. Hegedüs, T.H. Brix, Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One 8, e66711 (2013)

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology and Nutrition, University Hospital Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain

    Pedro Iglesias & Juan J. Díez

  2. Departament of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Pedro Iglesias & Juan J. Díez

  3. MedSavana S.L., Madrid, Spain

    María Benavent, Guillermo López, Javier Arias & Iago Romero

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  1. Pedro Iglesias
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  2. María Benavent
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  3. Guillermo López
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  6. Juan J. Díez
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Correspondence to Pedro Iglesias.

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Iglesias, P., Benavent, M., López, G. et al. Hyperthyroidism and cardiovascular disease: an association study using big data analytics. Endocrine 83, 405–413 (2024). https://doi.org/10.1007/s12020-023-03482-9

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  • DOI: https://doi.org/10.1007/s12020-023-03482-9

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