scholarly journals β-blockers in hemodialysis: simple questions, complicated answers

2020 ◽  
Author(s):  
Gregory L Hundemer ◽  
Manish M Sood ◽  
Mark Canney
Keyword(s):  
Cardiovascular Events ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Maintenance Hemodialysis ◽  
High Risk Population ◽  
Dialysis Patients ◽  
Term Survival ◽  
All Cause Mortality ◽  
Β Blocker ◽  
Β Blockers

Abstract In this issue of the Clinical Kidney Journal, Wu et al. present the results of a nationwide population-based study using Taiwanese administrative data to compare safety and efficacy outcomes with initiation of bisoprolol versus carvedilol among patients receiving maintenance hemodialysis for >90 days. The primary outcomes were all-cause mortality and major adverse cardiovascular events over 2 years of follow-up. The study found that bisoprolol was associated with a lower risk for both major adverse cardiovascular events and all-cause mortality compared with carvedilol. While the bulk of the existing evidence favors a cardioprotective and survival benefit with β-blockers as a medication class among dialysis patients, there is wide heterogeneity among specific β-blockers in regard to pharmacologic properties and dialyzability. While acknowledging the constraints of observational data, these findings may serve to inform clinicians about the preferred β-blocker agent for dialysis patients to help mitigate cardiovascular risk and improve long-term survival for this high-risk population.

scholarly journals Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 48 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jingjing Jin ◽  
Xiaoyang Guo ◽  
Qiyao Yu
Keyword(s):  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Dialysis Patients ◽  
Statistical Heterogeneity ◽  
All Cause Mortality ◽  
Β Blockers

Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54–0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29–0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31–0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48–0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80–0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57–1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50–1.26). Conclusions: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club “Cappuccino with Claudio Ronco” at  https://www.karger.com/Journal/ArticleNews/496083?sponsor=52

β-blocker dialyzability and the risk of mortality and cardiovascular events in patients undergoing hemodialysis

2020 ◽  
Vol 35 (11) ◽  
pp. 1959-1965 ◽  
Author(s):  
Ping-Hsun Wu ◽  
Yi-Ting Lin ◽  
Mei-Chuan Kuo ◽  
Jia-Sin Liu ◽  
Yi-Chun Tsai ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Hemodialysis Patients ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Mortality Hazard ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Β Blocker ◽  
Mortality Hazard Ratio

Abstract Background β-blocker (BB) dialyzability has been proposed to limit their efficacy among hemodialysis (HD) patients. We attempted to confirm this hypothesis by comparing health outcomes associated with the initiation of dialyzable or nondialyzable BBs in a nationwide cohort of HD patients. Methods We created a prospective cohort study of 15 699 HD patients who initiated dialyzable BBs (atenolol, acebutolol, metoprolol and bisoprolol) and 20 904 hemodialysis patients who initiated nondialyzable BBs (betaxolol, carvedilol and propranolol) between 2004 and 2011 in Taiwan healthcare. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs, a composite of the acute coronary syndrome, ischemic stroke and heart failure) between users of dialyzable versus nondialyzable BBs during a 2-year follow-up. Results New users of dialyzable BBs were younger, more often men, with diabetes mellitus, hypertension and hyperlipidemia compared with users of nondialyzable BBs. Compared with nondialyzable BBs, initiation of dialyzable BBs was associated with lower all-cause mortality {hazard ratio [HR] 0.82 [95% confidence interval (CI) 0.75–0.88]} and lower risk of MACEs [HR 0.89 (95% CI 0.84–0.93)]. Results were confirmed in subgroup analyses, censoring at BB discontinuation or switch, after 1:1 propensity score matching, reclassifying bisoprolol or excluding bisoprolol/carvedilol users. Conclusions This study does not offer support for the hypothesis that the dialyzability of BBs reduces their efficacy in HD patients.

Impact of dialysis modality on major adverse cardiovascular events and all-cause mortality: a national population-based study

2020 ◽  
Author(s):  
Ping-Jen Hu ◽  
Yu-Wei Chen ◽  
Tzu-Ting Chen ◽  
Li-Chin Sung ◽  
Mei-Yi Wu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Study Design ◽  
Cardiovascular Events ◽  
Objective Assessment ◽  
Major Adverse Cardiovascular Events ◽  
Time Varying ◽  
Dialysis Patients ◽  
Score Study ◽  
Design For All ◽  
All Cause Mortality

Abstract Background Only few studies with inconsistent results comparing the relative risk of cardiac mortality between peritoneal dialysis (PD) and hemodialysis (HD). Switches between renal replacement therapy (RRT) modalities render objective assessment of survival benefits a greater challenge. Methods Data were retrieved from Taiwan’s National Health Insurance Database from 1 January 2006 to 31 December 2015. We included 13 662 and 41 047 long-term dialysis patients in a propensity score matching study design and a time-varying study design, respectively, to compare major adverse cardiovascular events (MACEs) between patients receiving PD and HD. We also included 109 256 dialysis patients to compare the all-cause mortality among different RRT modalities. Results For MACE, the hazard ratio (HR) for PD patients compared to HD patients was 0.95 [95% confidence interval (CI) 0.89–1.02] in the propensity score study design and 1.06 (95% CI 1.01–1.12) in the time-varying study design. For all-cause mortality, the HR for PD patients compared to HD patients was 1.09 (95% CI 1.05–1.13) in the propensity score study design and 1.13 (95% CI 1.09–1.17) in the time-varying study design. The HR for death was higher at a level of statistical significance for females (1.21, 95% CI 1.15–1.28), patients ≥65 years old (1.30, 95% CI 1.24–1.36) and diabetes mellitus (DM; 1.28, 95% CI 1.22–1.34). Conclusions The HR for MACE is significantly higher among PD patients in time-varying design analysis. In addition, all-cause mortality was higher in PD patients compared to patients with HD, especially in those who were aged ≥65 years, female or DM.

P1018LIPID PROFILES AND RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN CKD AND DIABETES: A NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yeonhee Lee ◽  
Sehoon Park ◽  
Soojin Lee ◽  
Min Woo Kang ◽  
SangHyun Park ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
Population Based ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Major Adverse Cardiovascular Events ◽  
Linear Association ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
The Impact

Abstract Background and Aims The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. Method We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Results Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n=10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend). A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. Conclusion The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes.

C-X-C Motif Chemokine Ligand 16 Is a Potent Predictor of Outcomes in Dialysis Patients

2021 ◽  
pp. 1-10
Author(s):  
Wenjin Liu ◽  
Lulu Wang ◽  
Xiurong Li ◽  
Chaoqing Gao ◽  
Jianmei Zhou ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Cardiovascular Events ◽  
Inflammatory Marker ◽  
Adverse Outcomes ◽  
Categorical Variables ◽  
Major Adverse Cardiovascular Events ◽  
Dialysis Patients ◽  
Potent Predictor ◽  
All Cause Mortality ◽  
Chemokine Ligand

<b><i>Introduction:</i></b> C-X-C motif chemokine ligand 16 (CXCL16) is an inflammatory marker that has been found to be predictive of outcomes in patients with cardiovascular disease. Our previous work has also demonstrated its relation to cardiac injury in dialysis patients. However, it is yet unclear whether there is an association between CXCL16 and adverse outcomes in dialysis patients. We aimed to evaluate its prognostic value along with several traditional inflammatory markers in the current study. <b><i>Methods:</i></b> This is a multicenter longitudinal study of prevalent dialysis patients. Circulating inflammatory markers including CXCL16, C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 (IL-6) were measured using a multiplex assay. The primary outcomes were all-cause mortality and a composite of major adverse cardiovascular events (MACEs). The associations between biomarkers and outcomes were analyzed using Cox proportional hazards regression models. <b><i>Results:</i></b> Of the 366 participants with available plasma samples, the average age was 52.5 (±12.1) years, and there were 160 (43.7%) female participants. For all-cause mortality, logarithmically transformed CXCL16, IL-6, and CRP were independent predictors after adjustment for covariates. When the 3 markers were included in the same model, CXCL16 was the only one remaining its significance. For MACEs, logarithmically transformed CXCL16 and IL-6 were significant predictors when analyzed separately and CXCL16 was an independent predictor even after adjustment for IL-6. When the biomarkers were analyzed as categorical variables, only CXCL16 was associated with both outcomes. Adding CXCL16 to established risk factors improved risk prediction as revealed by Net Reclassification Index (NRI). <b><i>Conclusion:</i></b> Using a multimarker approach, we determined that CXCL16 is a potent predictor of all-cause mortality and cardiovascular events in dialysis patients. Our data suggest CXCL16 may improve risk stratification and could be a potential interventional target.

scholarly journals Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease

2020 ◽  
Vol 79 (9) ◽  
pp. 1182-1188 ◽  
Author(s):  
Brian Bridal Løgstrup ◽  
Kevin Kris Warnakula Olesen ◽  
Dzenan Masic ◽  
Christine Gyldenkerne ◽  
Pernille Gro Thrane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Treatment Strategies ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
All Cause Mortality ◽  
Artery Disease ◽  
The Impact

IntroductionRheumatoid arthritis (RA) is a risk factor for cardiovascular disease. The clinical consequences of coincident RA and coronary artery disease (CAD) are unknown.ObjectiveWe aimed to estimate the impact of RA on the risk of adverse cardiovascular events in patients with and without CAD.MethodsA population-based cohort of patients registered in the Western Denmark Heart Registry, who underwent coronary angiography (CAG) between 2003 and 2016, was stratified according to the presence of RA and CAD. Endpoints were myocardial infarction (MI), major adverse cardiovascular events (MACE; MI, ischaemic stroke and cardiac death) and all-cause mortality.ResultsA total of 125 331 patients were included (RA: n=1732). Median follow-up was 5.2 years. Using patients with neither RA nor CAD as reference (cumulative MI incidence 2.7%), the 10-year risk of MI was increased for patients with RA alone (3.8%; adjusted incidence rate ratio (IRRadj) 1.63, 95% CI 1.04 to 2.54), for patients with CAD alone (9.9%; IRRadj 3.35, 95% CI 3.10 to 3.62), and highest for patients with both RA and CAD (12.2%; IRRadj 4.53, 95% CI 3.66 to 5.59). Similar associations were observed for MACE an all-cause mortality.ConclusionsIn patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MACE and all-cause mortality regardless of the presence of CAD. However, patients with RA and CAD carry the largest risk, while the additive risk of RA in patients without CAD is minor. Among patients with RA, risk stratification by presence or absence of documented CAD may allow for screening and personalised treatment strategies

scholarly journals P0948ASSOCIATION OF PHASE ANGLE WITH NUTRITION, MORTALITY, MAJOR ADVERSE CARDIOVASCULAR EVENTS AND SARCOPENIA IN MAINTENANCE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eunjin Bae ◽  
Tae Won Lee ◽  
Ha Nee Jang ◽  
Hyun Seop Cho ◽  
Hyun-Jung Kim ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Phase Angle ◽  
Cardiovascular Events ◽  
Hemodialysis Patients ◽  
Major Adverse Cardiovascular Events ◽  
Maintenance Hemodialysis ◽  
Lower Phase ◽  
All Cause Mortality ◽  
History Of ◽  
Maintenance Hemodialysis Patients

Abstract Background and Aims Nutrition has been consistently important in end stage renal disease patients. However, it is difficult to obtain adequate nutritional status while avoiding fluid overload, hyperphosphatemia and hyperkalemia in hemodialysis patients. In addition, there is no golden standard for diagnosing protein energy wasting (PEW) in maintenance hemodialysis patients. We studied the clinical significance of phase angle using bioelectrical impedance analysis (BIA), one of the PEW diagnostic tools, to predict various clinical outcomes in maintenance hemodialysis patients. Method We retrospectively enrolled patients who received hemodialysis for more than 3 months from 2016 to March 2019, excluding patients had active cancer, or died within 30 days, had no BIA data. We evaluated the factors related phase angle and the role of phase angle as predictors of all-cause mortality and major adverse cardiovascular events (MACE), sarcopenia. Results Of 191 patients, 63.4% were men, mean age was 64.2 ± 12.4 years, mean body mass index (BMI) was 23.8 ± 6.9 kg/m2, and the most common underlying disease were hypertension and diabetes mellitus. Lower phase angle group (phase angle ≤4°) patients had older age, higher portion of women, malnourished, and history of coronary artery disease (CAD) than higher phase angle group (phase angle &gt;4°) patients. Phase was significantly related with nutritional parameters. During a median follow up of 16.7 months, 14.1% (n=27) patients experienced a MACE, 11.0% (n=21) patients died. In multivariate Cox analyses, lower phase angle, higher CRP level and history of CAD were significantly related with all-cause mortality even after adjustment for covariates. However, phase angle was not significantly associated with MACE and sarcopenia. Conclusion In maintenance hemodialysis patients, phase angle was significantly related to mortality as well as nutritional status, but MACE and sarcopenia were not. Clinicians should be careful to find and treat correctable factors with low phase angle and high CRP level in maintenance hemodialysis patients.

scholarly journals Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

2021 ◽  
Author(s):  
Ping-Hsun Wu ◽  
Yi-Ting Lin ◽  
Jia-Sin Liu ◽  
Yi-Chun Tsai ◽  
Mei-Chuan Kuo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Cox Model ◽  
Major Adverse Cardiovascular Events ◽  
Maintenance Hemodialysis ◽  
Risk Of Death ◽  
Relative Safety ◽  
Dialysis Vintage ◽  
All Cause Mortality

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

scholarly journals EFFECTIVENESS OF TICAGRELOR COMPARED TO CLOPIDOGREL IN REDUCING THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY HEART DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTION

2017 ◽  
Vol 9 (9) ◽  
pp. 178 ◽  
Author(s):  
Hendra Wana Nur’amin ◽  
Iwan Dwiprahasto ◽  
Erna Kristin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Repeat Revascularization ◽  
Percutaneous Coronary

Objective: Antiplatelet therapy is recommended in patients with coronary heart disease (CHD) who had the percutaneous coronary intervention (PCI) procedure to reduce major adverse cardiovascular events (MACE). There has been a lack of population-based studies that showed the superior effectiveness of ticagrelor over clopidogrel and similar studies have not been conducted in Indonesia yet. The aim of the study was to investigate the effectiveness of ticagrelor compared to clopidogrel in reducing the risk of MACE in patients with CHD after PCI.Methods: A retrospective cohort study with 1-year follow-up was conducted. 361 patients consisted of 111 patients with ticagrelor exposure and 250 patients with clopidogrel exposure. The primary outcome was MACE, defined as a composite of repeat revascularization, myocardial infarction, or all-cause death. The association between antiplatelet exposure and the MACE was analyzed with Cox proportional hazard regression, adjusted for sex, age, comorbid, PCI procedures and concomitant therapy.Results: MACE occurred in 22.7% of the subjects. Clopidogrel had a significantly higher risk of MACE compared with ticagrelor (28.8%, vs 9.0%, hazard ratio (HR): 1.96 (95% CI 1.01 to 3.81, p=0.047). There were no significant differences in risk of repeat revascularization (20.40% vs 5.40%, HR: 2.32, 95% CI 0.99 to 5.42, p = 0.05), myocardial infarction (11.60% vs 3.60%, HR: 2.08, 95% CI, 0.73 to 5.93, p = 0.17), and death (1.60% vs 1.80%, HR: 0.77, 95% CI, 0.14 to 4.25, p = 0.77).Conclusion: Clopidogrel had a higher risk of MACE compared to clopidogrel in patients with CHD after PCI, but there were no significant differences in the risk of repeat revascularization, myocardial infarction, and all-cause death. 

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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