Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients

M. S. Tsai, P. Y. Chuang, C. H. Huang, S. R. Shih, W. T. Chang, N. C. Chen, P. H. Yu, H. J. Cheng, C. H. Tang, W. J. Chen

Research output: Contribution to journalArticle

Abstract

Background An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. Methods A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. Results The stroke incidence rates for hyperthyroidism patients with age <45 years and age ≥ 45 years were 0.42 and 3.76 per 1000 person-years, respectively. The patients aged <45 years with MPR <0.2 (adjusted hazard ratio, HR, 2.30; 95% CI, 1.13-4.70; p = 0.02) and 0.2 ≤ MPR <0.4 (adjusted HR, 2.24; 95% CI, 1.06-4.72; p = 0.035) had a significantly increased risk of ischaemic stroke as compared to those with ≥ 0.6. In patients of the age ≥ 45 years, only the patients with MPR <0.2 (adjusted HR, 1.44; 95% CI, 1.03-2.01; p = 0.036) had a significantly higher risk of ischaemic stroke as compared to those with MPR ≥ 0.6. In hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. Conclusion Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance.

Original languageEnglish
Pages (from-to)1473-1485
Number of pages13
JournalInternational Journal of Clinical Practice
Volume69
Issue number12
DOIs
Publication statusPublished - Dec 1 2015

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Antithyroid Agents
Hyperthyroidism
Stroke
Atrial Fibrillation
Compliance
Incidence
National Health Programs
Taiwan
Odds Ratio
Databases

ASJC Scopus subject areas

  • Medicine(all)

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Tsai, M. S., Chuang, P. Y., Huang, C. H., Shih, S. R., Chang, W. T., Chen, N. C., ... Chen, W. J. (2015). Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients. International Journal of Clinical Practice, 69(12), 1473-1485. https://doi.org/10.1111/ijcp.12724

Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients. / Tsai, M. S.; Chuang, P. Y.; Huang, C. H.; Shih, S. R.; Chang, W. T.; Chen, N. C.; Yu, P. H.; Cheng, H. J.; Tang, C. H.; Chen, W. J.

In: International Journal of Clinical Practice, Vol. 69, No. 12, 01.12.2015, p. 1473-1485.

Research output: Contribution to journalArticle

Tsai, MS, Chuang, PY, Huang, CH, Shih, SR, Chang, WT, Chen, NC, Yu, PH, Cheng, HJ, Tang, CH & Chen, WJ 2015, 'Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients', International Journal of Clinical Practice, vol. 69, no. 12, pp. 1473-1485. https://doi.org/10.1111/ijcp.12724
Tsai, M. S. ; Chuang, P. Y. ; Huang, C. H. ; Shih, S. R. ; Chang, W. T. ; Chen, N. C. ; Yu, P. H. ; Cheng, H. J. ; Tang, C. H. ; Chen, W. J. / Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients. In: International Journal of Clinical Practice. 2015 ; Vol. 69, No. 12. pp. 1473-1485.
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abstract = "Background An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. Methods A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. Results The stroke incidence rates for hyperthyroidism patients with age <45 years and age ≥ 45 years were 0.42 and 3.76 per 1000 person-years, respectively. The patients aged <45 years with MPR <0.2 (adjusted hazard ratio, HR, 2.30; 95{\%} CI, 1.13-4.70; p = 0.02) and 0.2 ≤ MPR <0.4 (adjusted HR, 2.24; 95{\%} CI, 1.06-4.72; p = 0.035) had a significantly increased risk of ischaemic stroke as compared to those with ≥ 0.6. In patients of the age ≥ 45 years, only the patients with MPR <0.2 (adjusted HR, 1.44; 95{\%} CI, 1.03-2.01; p = 0.036) had a significantly higher risk of ischaemic stroke as compared to those with MPR ≥ 0.6. In hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. Conclusion Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance.",
author = "Tsai, {M. S.} and Chuang, {P. Y.} and Huang, {C. H.} and Shih, {S. R.} and Chang, {W. T.} and Chen, {N. C.} and Yu, {P. H.} and Cheng, {H. J.} and Tang, {C. H.} and Chen, {W. J.}",
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AU - Tsai, M. S.

AU - Chuang, P. Y.

AU - Huang, C. H.

AU - Shih, S. R.

AU - Chang, W. T.

AU - Chen, N. C.

AU - Yu, P. H.

AU - Cheng, H. J.

AU - Tang, C. H.

AU - Chen, W. J.

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N2 - Background An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. Methods A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. Results The stroke incidence rates for hyperthyroidism patients with age <45 years and age ≥ 45 years were 0.42 and 3.76 per 1000 person-years, respectively. The patients aged <45 years with MPR <0.2 (adjusted hazard ratio, HR, 2.30; 95% CI, 1.13-4.70; p = 0.02) and 0.2 ≤ MPR <0.4 (adjusted HR, 2.24; 95% CI, 1.06-4.72; p = 0.035) had a significantly increased risk of ischaemic stroke as compared to those with ≥ 0.6. In patients of the age ≥ 45 years, only the patients with MPR <0.2 (adjusted HR, 1.44; 95% CI, 1.03-2.01; p = 0.036) had a significantly higher risk of ischaemic stroke as compared to those with MPR ≥ 0.6. In hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. Conclusion Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance.

AB - Background An increased risk for ischaemic stroke has been reported in young hyperthyroidism patients independent of atrial fibrillation (AF). However, whether the use of antithyroid drugs in hyperthyroidism patients can reduce the occurrence of ischaemic stroke remains unclear. Methods A total of 36,510 newly diagnosed hyperthyroidism patients during 2003-2006 were identified from the Taiwan National Health Insurance Research database. Each patient was individually tracked for 5 years from their index date (beginning the antithyroid drugs) to identify those who suffered from new episode of ischaemic stroke. Medication possession ratio (MPR) was used to represent the antithyroid drug compliance. The association between the MPR and the risk of stroke was examined. Results The stroke incidence rates for hyperthyroidism patients with age <45 years and age ≥ 45 years were 0.42 and 3.76 per 1000 person-years, respectively. The patients aged <45 years with MPR <0.2 (adjusted hazard ratio, HR, 2.30; 95% CI, 1.13-4.70; p = 0.02) and 0.2 ≤ MPR <0.4 (adjusted HR, 2.24; 95% CI, 1.06-4.72; p = 0.035) had a significantly increased risk of ischaemic stroke as compared to those with ≥ 0.6. In patients of the age ≥ 45 years, only the patients with MPR <0.2 (adjusted HR, 1.44; 95% CI, 1.03-2.01; p = 0.036) had a significantly higher risk of ischaemic stroke as compared to those with MPR ≥ 0.6. In hyperthyroidism patients without AF, good antithyroid drugs compliance also reduced the incidence of stroke significantly (adjusted HR, range: 1.52-1.61; p = 0.02); but not in hyperthyroidism with AF. Conclusion Hyperthyroidism patients with good antithyroid drug compliance had a lower risk of ischaemic stroke than patients with poor compliance.

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