Abstract P173: Hyperthyroidism Increases the Risk of Takotsubo Cardiomyopathy Among Hospitalized US Patients

Abstract

Background: The association between hyperthyroidism and Takotsubo Cardiomyopathy (TTCM) has only been reported in isolated case reports and a recent single center study with inconclusive results. It is known that elevated thyroid hormone causes an increased sympathetic modulation of heart rate. It has also been shown that TTCM occurs in the setting of acute stressful illnesses involving excess catecholamine release. What is unclear is whether hyperthyroid states can predispose to TTCM. This is the first nationwide study of this association. Methods: We used ICD-9 CM codes to extract data from the Nationwide Inpatient Sample database from 2007-2011. Patients with TTCM and coexisting hyperthyroidism were compared with TTCM patients without coexisting hyperthyroidism. We excluded persons below the age of 18 as well as patients diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of coexisting hyperthyroidism on the occurrence of TTCM. Results: A total of 33,639,230 patients were included, where 123,923 patients had hyperthyroidism while 32,400,000 did not have hyperthyroidism. There were 101 (0.08%) TTCM patients with coexisting hyperthyroidism compared to 13,893 (0.04%) without (p<0.0001). In adjusted models, patients with hyperthyroidism had a higher risk of TTCM in the index hospital admission (aOR=1.43, 95% CI=1.18-1.74), independent of potential demographic, comorbid and lifestyle confounders. Hispanics with hyperthyroidism had the highest risk of TTCM (OR=1.41, 95% CI=1.39-1.44). Conclusion: In this large, nationwide study, hyperthyroidism was associated with increased risk of TTCM. This association was strongest among hispanics. Further research is needed to understand the mechanisms behind this association.