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All-cause mortality and death by aortic dissection in women with Turner syndrome : A national clinical cohort study

Thunström, Sofia ; Thunström, Erik ; Naessén, Sabine ; Berntorp, Kerstin LU ; Laczna Kitlinski, Margareta ; Ekman, Bertil ; Wahlberg, Jeanette ; Bergström, Ingrid ; Isaksson, Magnus and Basic, Carmen , et al. (2025) In American Heart Journal 281. p.1-9
Abstract

Background: Turner syndrome (TS) is a complex genetic disorder with raised mortality. Our objective was to investigate mortality and causes of death in TS. Methods: A matched retrospective observational study of women with TS recruited from the Turner centers in Sweden were conducted. A total of 472 women with TS, ≥16 years old with a cytogenetically verified diagnosis and 2357 controls, matched for birthyear and sex, were examined and followed since 1995 for up to 26 years. Survival analyses were performed with Cox proportional hazard models. Kaplan-Meier curves were generated. Cumulative incidence rates were evaluated by competing risks analysis, using cumulative incidence function. Results: During a mean follow-up of 17 years, 35... (More)

Background: Turner syndrome (TS) is a complex genetic disorder with raised mortality. Our objective was to investigate mortality and causes of death in TS. Methods: A matched retrospective observational study of women with TS recruited from the Turner centers in Sweden were conducted. A total of 472 women with TS, ≥16 years old with a cytogenetically verified diagnosis and 2357 controls, matched for birthyear and sex, were examined and followed since 1995 for up to 26 years. Survival analyses were performed with Cox proportional hazard models. Kaplan-Meier curves were generated. Cumulative incidence rates were evaluated by competing risks analysis, using cumulative incidence function. Results: During a mean follow-up of 17 years, 35 (7.4%) women with TS and 70 (3.0%) controls died. All-cause mortality was elevated in TS, hazard ratio (HR) 2.90 (95% CI 1.92-4.37), mainly due to circulatory diseases and notably aortic dissection, with HR of 9.11 (95% CI 4.54-18.25) and 21.79 (95% CI 4.62-102.82), respectively. Aortic dissection was the single largest cause of death in TS, accounting for 23% (8/35) of total deaths. Death by cancer or external causes were not raised in TS. In individuals below 45 years of age death, aortic dissections were greatly increased compared to controls, HR 55.59 (95% CI 2.33-1325.69). From the ages 46 to 80 years a notably higher risk of dying by heart diseases, aortic dissection excluded, was shown in TS compared to controls HR, 7.7 (2.65-22.36). The median survival time was 8 years shorter in TS compared to controls. Conclusions: The increased mortality in TS was mainly driven by aortic dissections in the young and by heart diseases in the older. Healthcare professionals should prioritize detection and monitoring, with emphasis on cardiovascular diseases.

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publication status
published
subject
in
American Heart Journal
volume
281
pages
9 pages
publisher
Mosby-Elsevier
external identifiers
  • pmid:39603484
  • scopus:85211980969
ISSN
0002-8703
DOI
10.1016/j.ahj.2024.11.007
language
English
LU publication?
yes
id
7a5a183e-20c1-43d6-8984-8d3f43e8661a
date added to LUP
2025-02-28 12:59:03
date last changed
2025-07-19 01:00:20
@article{7a5a183e-20c1-43d6-8984-8d3f43e8661a,
  abstract     = {{<p>Background: Turner syndrome (TS) is a complex genetic disorder with raised mortality. Our objective was to investigate mortality and causes of death in TS. Methods: A matched retrospective observational study of women with TS recruited from the Turner centers in Sweden were conducted. A total of 472 women with TS, ≥16 years old with a cytogenetically verified diagnosis and 2357 controls, matched for birthyear and sex, were examined and followed since 1995 for up to 26 years. Survival analyses were performed with Cox proportional hazard models. Kaplan-Meier curves were generated. Cumulative incidence rates were evaluated by competing risks analysis, using cumulative incidence function. Results: During a mean follow-up of 17 years, 35 (7.4%) women with TS and 70 (3.0%) controls died. All-cause mortality was elevated in TS, hazard ratio (HR) 2.90 (95% CI 1.92-4.37), mainly due to circulatory diseases and notably aortic dissection, with HR of 9.11 (95% CI 4.54-18.25) and 21.79 (95% CI 4.62-102.82), respectively. Aortic dissection was the single largest cause of death in TS, accounting for 23% (8/35) of total deaths. Death by cancer or external causes were not raised in TS. In individuals below 45 years of age death, aortic dissections were greatly increased compared to controls, HR 55.59 (95% CI 2.33-1325.69). From the ages 46 to 80 years a notably higher risk of dying by heart diseases, aortic dissection excluded, was shown in TS compared to controls HR, 7.7 (2.65-22.36). The median survival time was 8 years shorter in TS compared to controls. Conclusions: The increased mortality in TS was mainly driven by aortic dissections in the young and by heart diseases in the older. Healthcare professionals should prioritize detection and monitoring, with emphasis on cardiovascular diseases.</p>}},
  author       = {{Thunström, Sofia and Thunström, Erik and Naessén, Sabine and Berntorp, Kerstin and Laczna Kitlinski, Margareta and Ekman, Bertil and Wahlberg, Jeanette and Bergström, Ingrid and Isaksson, Magnus and Basic, Carmen and Svanvik, Teresia and Bryman, Inger and Landin-Wilhelmsen, Kerstin}},
  issn         = {{0002-8703}},
  language     = {{eng}},
  pages        = {{1--9}},
  publisher    = {{Mosby-Elsevier}},
  series       = {{American Heart Journal}},
  title        = {{All-cause mortality and death by aortic dissection in women with Turner syndrome : A national clinical cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.ahj.2024.11.007}},
  doi          = {{10.1016/j.ahj.2024.11.007}},
  volume       = {{281}},
  year         = {{2025}},
}