Key result
Concomitant hyperthyroidism in patients with atrial fibrillation was an independent risk factor for ischaemic stroke (aHR 1.133; 95% CI 1.080-1.189), particularly within the first year of diagnosis.
Why the study?
Hyperthyroidism is associated with AF, which is a major risk factor for stroke, but the yearly incidence of stroke and bleeding in AF patients with versus without concomitant hyperthyroidism required investigation.
Does concomitant hyperthyroidism increase the risk of ischaemic stroke and bleeding in patients with atrial fibrillation?
Cohort (n=2,421,087)
Yes
Does concomitant hyperthyroidism increase the risk of ischaemic stroke and bleeding in patients with atrial fibrillation?
Hazard Ratio: 1.133 (95% CI 1.08–1.189)
Absolute Event Rate: 2.6% vs 2.3%
Hyperthyroidism independently increases the risk of ischemic stroke in patients with atrial fibrillation, particularly within the first year of diagnosis.
May increase early ischaemic stroke risk in hyperthyroid AF; leaves open whether thyroid treatment modifies outcomes.
Background: Hyperthyroidism is associated with atrial fibrillation (AF), and the latter is a major risk factor for stroke. Aim: We aimed to investigate the yearly incidence of stroke and bleeding in AF patients with and without concomitant hyperthyroidism from the French National Hospital Discharge Database. Methods: Admissions with AF between January 2010 and December 2019 were retrospectively identified and retrieved from the French national database. Incidence rates of ischaemic stroke and bleeding were compared in AF patients with and without concomitant hyperthyroidism. The associations of risk factors with ischaemic stroke were assessed by Cox regression. Results: Overall 2,421,087 AF patients, among whom 32,400 had concomitant hyperthyroidism were included in the study. During the follow-up (mean: 2.0 years, standard deviation SD: 2.2 years), the yearly incidence of ischaemic stroke was noted to be 2.6 (95% confidence interval CI: 2.5−2.8) in AF patients with concomitant hyperthyroidism, and 2.3 (95%CI: 2.3−2.4) in non-thyroid AF patients. Hyperthyroidism was noted as an independent risk factor for ischaemic stroke (adjusted hazard ratio aHR: 1.133, 95%CI: 1.080−1.189) overall, particularly within the first year of hyperthyroidism diagnosis (aHR 1.203, 95%CI 1.120−1.291), however, the association became non-significant in subsequent years (aHR 1.047, 95%CI 0.980−1.118). Major bleeding incidence was lower in the hyperthyroid AF group in comparison to the non-thyroid AF group (incidence ratio: 5.1 vs. 5.4%/year, p < 0.001). The predictive value of CHA2DS2VASc and HAS-BLED scores for ischaemic stroke and bleeding events, respectively, did not differ significantly between AF patients with or without concomitant hyperthyroidism. Conclusions: Hyperthyroidism seems to be an independent risk factor of ischaemic stroke in AF patients, particularly within the first year of hyperthyroidism diagnosis.
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Zhang et al. (2022) conducted a cohort in Atrial Fibrillation (n=2,421,087). Concomitant hyperthyroidism vs. Without concomitant hyperthyroidism was evaluated on Ischaemic stroke (aHR 1.133, 95% CI 1.080-1.189). Concomitant hyperthyroidism in patients with atrial fibrillation was an independent risk factor for ischaemic stroke (aHR 1.133; 95% CI 1.080-1.189), particularly within the first year of diagnosis.
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