Cardiovascular and bone health outcomes in older people with subclinical hypothyroidism treated with levothyroxine: a systematic review and meta-analysis

BACKGROUND

Thyroid dysfunction is common in older people, with females at higher risk. Evidence suggests that thyroid-stimulating hormone (TSH) levels naturally increase with age. However, as uniform serum TSH reference ranges are applied across the adult lifespan, subclinical hypothyroidism (SCH) diagnosis is more likely in older people, with some individuals also being commenced treatment with levothyroxine (LT4). It is unclear whether LT4 treatment in older people with SCH is associated with adverse cardiovascular or bone health outcomes.

METHODS

A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected.

RESULTS

Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible.

CONCLUSIONS

This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022308006.

Assessing the cardiovascular effects of levothyroxine use in an ageing United Kingdom population (ACEL-UK) protocol: a cohort and target trial emulation study

BACKGROUND

Subclinical hypothyroidism is diagnosed when serum thyroid stimulating hormone levels are higher whilst free thyroxine levels remain within their respective reference ranges. These reference ranges are uniformly applied in all adults, despite serum thyroid stimulating hormone levels naturally increasing with age. Research has found that mildly elevated thyroid stimulating hormone levels may be associated with some benefits in ageing patients, including reduced mortality and better cardiorespiratory fitness. Levothyroxine is typically prescribed to patients with hypothyroidism, but no conclusive evidence exists on whether levothyroxine therapy is beneficial or detrimental in older subclinical hypothyroid patients. Despite this, prescriptions for levothyroxine are increasing year-on-year. This study aims to determine if receiving levothyroxine affects the cardiovascular and bone health outcomes of subclinical patients in primary care aged 50 years and over.

METHODS

This project includes a retrospective cohort analysis and a target trial emulation study using electronic patient records collected between 2006 and 2021 and recorded in The Health Improvement Network database. The primary outcome of this study is to compare the cardiovascular outcomes of subclinical hypothyroid patients aged over 50 years treated with levothyroxine compared to those untreated. Secondary outcomes are bone health and all-cause mortality outcomes. Descriptive and inferential statistics will both be employed to analyse the data. Secondary analysis will explore confounding factors, including age, sex, smoking status, body mass index, co-morbidities, and levothyroxine dosage.

DISCUSSION

There needs to be a greater understanding of the potential risks of the current treatment for older patients with subclinical hypothyroidism in a primary care setting. We will investigate the clinical importance of this issue and whether older subclinical hypothyroid patients have poorer outcomes when treated. Clarifying this concern may help address the healthcare resource implications of ageing patients being misclassified as having mild hypothyroidism, as these patients are more likely to repeat their blood tests. This could reduce prescription wastage and improve patient outcomes and quality of life in the ageing population.

TRIAL REGISTRATION

Not applicable.

Psychological Well-Being of Australian Actors and Performing Artists: Life Satisfaction and Negative Affect

BACKGROUND

Anecdotal evidence and media reports suggest that actors and other performing artists experience high levels of depression, anxiety, and stress. However, no empirical study has examined the psychological well-being of this professional group.

OBJECTIVE

The Australian Actors' Wellbeing Study (AWS) was conducted to examine the general wellbeing of Australian actors and performing artists. The present paper, reporting on data from the AWS, focuses on two aspects of respondents' psychological well-being: life satisfaction and the experience of negative affect.

METHODS

An online survey including several questionnaires was distributed to the Equity Foundation membership representing Australian actors. We report results from the Satisfaction with Life Scale (SWLS) and the Depression Anxiety Stress Scales (DASS) and examine their associations with respondents' sociodemographic and occupational background, including their relationship status and any relationship stress, income from performing, and time taken away from performing.

RESULTS

A sample of 782 Australian actors responded to the survey, with 582 participants completing the DASS and 568 the SWLS. Participants reported lower levels of life satisfaction and higher levels of depression, anxiety, and stress than found in the Australian general population. Being in a relationship was associated with better psychological well-being; however, work stress often impacted negatively on relationships. Income had little association with psychological well-being, unless the respondent felt under financial stress. Respondents who took extended periods of time away from performing reported less life satisfaction and more depression than others.

CONCLUSION

Australian actors may be at a high risk for poor psychological health. Further research is necessary to establish causality among the variables we examined and to investigate protective factors that may increase well-being in the context of the performing arts industry.

Alcohol Use by Australian Actors and Performing Artists: A Preliminary Examination from the Australian Actors' Wellbeing Study

BACKGROUND

Anecdotal and media reports suggest that actors and performing artists are vulnerable to high levels of alcohol use. However, little empirical research is available to document the extent and correlates of alcohol use amongst these artists, particularly in an Australian context.

OBJECTIVE

This study investigated alcohol use in a sample of Australian actors and other performing artists and its associations with sociodemographic background, psychological wellbeing, and work stress.

METHODS

An online survey was distributed to the Equity Foundation membership representing Australian actors and performing artists. The survey included questions on sociodemographic and occupational background and psychological wellbeing (DASS-21), as well as the AUDIT questionnaire to assess self-reported alcohol consumption. A sample of 620 performing artists responded to the survey, a large majority of whom were actors.

RESULTS

Australian actors and performing artists appear to consume alcohol at levels that are higher than those found in the general Australian population. About 40% of men and 31% of women were classified as drinking alcohol at potentially harmful or hazardous levels. Alcohol use was not strongly associated with age, education, or income, but it had a relationship with poorer psychological wellbeing. About 50% of respondents reported that their alcohol drinking was related to work stress as a performer. This perception was more pronounced amongst those performers who reported drinking at harmful levels.

CONCLUSIONS

Australian actors and performing artists appear to be an at-risk population for harmful or hazardous alcohol use.

Eating Disorder Symptoms in Australian Actors and Performing Artists

AIMS

Anecdotal evidence suggests that actors and other performing artists are under great pressure to conform to idealized appearances and body types. The pursuit of such appearances may trigger eating disorder symptoms, such as unhealthy attitudes towards body weight and shape. Thus far, there has been no dedicated empirical study of the prevalence of such problems in Australian actors and performing artists specifically. Therefore, this study sought to examine eating disorder symptomatology in Australian actors and performing artists.

METHODS

An online survey was distributed to the Equity Foundation membership representing Australian actors and performing artists, of whom 573 individuals completed the survey. This survey gauged demographic information and eating disorder symptoms using the psychometrically validated Eating Disorder Diagnostic Scale (EDDS).

RESULTS

A large proportion of actors reported unhealthy attitudes such as 'feeling fat' even though they are of normal weight or underweight; reported an extreme fear of gaining weight; and evaluated their self-worth based on their body weight and shape, particularly women. Results also showed that 2.5% of women in the study met the diagnostic criteria for anorexia nervosa and 13% met diagnostic criteria for bulimia nervosa based on their scores on the EDDS.

DISCUSSION

Performers may be a particularly at-risk population for the development and/or maintenance for a range of eating disorders.

Calusterone therapy for advanced breast cancer

Calusterone was given at a dose of 200 mg daily to 45 postmenopausal patients with advanced metastatic breast cancer. Of the 40 evaluable patients, 11 were unable to tolerate the drug because of severe toxicity. Objective regression of soft tissue disease and relief of bone pain were seen in four patients (9.1%) for an average duration of 15.2 weeks. Thirteen patients showed an arrest of disease progression. In 12 patients the lesions continued to progress in spite of therapy. Toxic effects consisting of nausea, vomiting, fluid retention, SGOT elevation, and androgenic side effects were seen in 33 patients (75%), necessitating discontinuation of the drug in 11 (25%).

Intermittent cyclophosphamide treatment of autoimmune thombocytopenia

Cyclophosphamide was given intermittently rather than daily to 14 patients with autoimmune thrombocytopenic purpura. Eight patients responded and six did not. In those who responded the rise in platelet count was rapid, and in all patients the lack of toxicity was striking. Intermittent cyclophosphamide seems effective in some cases of autoimmune thrombocytopenia and is safe, at least in the short term. Controlled trials would be required to prove that intermittent is better than daily administration.

Intermittent cyclophosphamide in pemphigus vulgaris and bullous pemphigoid

Cyclophosphamide, given in widely spaced doses, was used in the treatment of a patient with pemphigus vulgaris and a patient with bullous pemphigoid. To our knowledge, this form of therapy has not previously been reported in these two diseases. The distinct advantages of the larger intermittent dose method of cyclophosphamide therapy over the more conventional daily dose regimen are discussed.