Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients

Published:February 03, 2015DOI:



      To identify predisposing factors that can result in the onset of takotsubo syndrome, we performed an international, collaborative systematic review focusing on clinical characteristics and comorbidities of patients with takotsubo syndrome.


      We searched and reviewed cited references up to August 2013 to identify relevant studies. Corresponding authors of selected studies were contacted and asked to provide additional quantitative details. Data from each study were extracted by 2 independent reviewers. The cumulative prevalence of presenting features and comorbidities was assessed. Nineteen studies whose authors sent the requested information were included in the systematic review, with a total of 1109 patients (951 women; mean age, 59-76 years). Evaluation of risk factors showed that obesity was present in 17% of patients (range, 2%-48%), hypertension in 54% (range, 27%-83%), dyslipidemia in 32% (range, 7%-59%), diabetes in 17% (range, 4%-34%), and smoking in 22% (range, 6%-49%). Emotional stressors preceded takotsubo syndrome in 39% of patients and physical stressors in 35%. The most common comorbidities were psychological disorders (24%; range, 0-49%), pulmonary diseases (15%; range, 0-22%), and malignancies (10%; range, 4%-29%). Other common associated disorders were neurologic diseases (7%; range, 0-22%), chronic kidney disease (7%; range, 2%-27%), and thyroid diseases (6%; range, 0-37%).


      Patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors and associated comorbidities. Such of associations needs to be evaluated in further studies.


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          The article by Pelliccia et al1 published recently in The American Journal of Medicine is an excellent systematic review on the prevalence of comorbidities associated with Takotsubo cardiomyopathy. Their work is commendable and especially sparked our interest with respect to the prevalence of diabetes mellitus in patients with Takotsubo cardiomyopathy.
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          The report by Pelliccia et al,1 published in June issue, in The American Journal of Medicine, about the prevalence of comorbidities in 1109 patients with Takotsubo syndrome, deriving from 19 studies via an international collaborative effort (COUNTS study), deserves careful reading by all clinicians and investigators working in the field. The authors refer to the clinical characteristics and comorbidities as “predisposing factors” for the emergence of Takotsubo syndrome, although these factors may not be related pathophysiologically to Takotsubo syndrome.
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