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Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study

27 Pages Posted: 13 Mar 2019

See all articles by Elena Izkhakov

Elena Izkhakov

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension; University of Haifa - School of Public Health; Tel Aviv University - Sackler School of Medicine

Lital Keinan-Boker

Tel Aviv University - Sackler School of Medicine

Micha Barchana

University of Haifa - School of Public Health

Yacov Shacham

Tel Aviv University - Sackler School of Medicine

Narin n Carmel Neiderman

Tel Aviv University - Sackler School of Medicine

Iris Yaish

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension

Dan Marian Fliss

Tel Aviv University - Sackler School of Medicine

Naftali Stern

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension; Tel Aviv University - Sackler School of Medicine

Joseph Meyerovitch

Tel Aviv University - Sackler School of Medicine

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Abstract

Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed long-term all-cause mortality and its association with cardiovascular risk factors in Israeli TC survivors compared to the general population.      

Methods: The computerized database of Clalit Health Services, the largest healthcare fund in Israel, was used to identify individuals who were diagnosed with TC during 2001-2014 (exposed group) and age- and sex-matched individuals from the same healthcare system without thyroid disease or a cancer history (non-exposed group). Cox regression hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality were calculated by exposure status.  

Findings: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10·2%) exposed patients and 1,235 individuals out of 23,962 (5·2%) non-exposed patients died. The TC survivors had an increased risk of all-cause mortality (HR=1·89, 95% CI 1·71-2·10), after adjusting for cardiovascular risk factors already present at the beginning of the follow-up. This increased risk was most pronounced in the 55- to 64-year old age group (HR=1·49, 95% CI 1·33-1·67). At the end of the follow-up, the TC survivors who died had a higher prevalence of hypertension (14·6% vs. 10·3%, P=0·002), more dyslipidemia (11·4% vs. 7·2%, P<0·001), and more cardiovascular disease (33·6% vs. 22·3%, P=0·05) compared to those who died in the non-TC group. In addition, there was no association between the presence of a second primary malignancy in the former group and the presence of a primary malignancy in the latter group.      

Interpretation: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among Israeli TC survivors compared to matched non-TC individuals. Follow-up, primary and secondary prevention of cardiovascular risk factors in TC survivors are mandatory.   

Funding Statement: The authors declare: "none."

Declaration of Interests: The authors declare: "none."

Ethics Approval Statement: The Medical Ethics Committee of the CHS provided approval to conduct this study. Signed informed consent from the participants was waived since the study was based on existing databases.

Keywords: thyroid cancer, mortality, hazard ratios, risk factors, survivors

Suggested Citation

Izkhakov, Elena and Keinan-Boker, Lital and Barchana, Micha and Shacham, Yacov and Neiderman, Narin n Carmel and Yaish, Iris and Fliss, Dan Marian and Stern, Naftali and Meyerovitch, Joseph, Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study (March 11, 2019). Available at SSRN: https://ssrn.com/abstract=3350548

Elena Izkhakov (Contact Author)

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension ( email )

6 Weizmann Street
Tel Aviv, 6423906
United States

University of Haifa - School of Public Health ( email )

Israel

Tel Aviv University - Sackler School of Medicine ( email )

Tel Aviv University
Ramat Aviv, 69978
Israel

Lital Keinan-Boker

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

Micha Barchana

University of Haifa - School of Public Health

Israel

Yacov Shacham

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

Narin n Carmel Neiderman

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

Iris Yaish

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension

6 Weizmann Street
Tel Aviv, 6423906
United States

Dan Marian Fliss

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

Naftali Stern

Tel Aviv Sourasky Medical Center - Institute of Endocrinology, Metabolism and Hypertension

6 Weizmann Street
Tel Aviv, 6423906
United States

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

Joseph Meyerovitch

Tel Aviv University - Sackler School of Medicine

Tel Aviv University
Ramat Aviv, 69978
Israel

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