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Prevalence of Comorbidities in Patients with Takotsubo Syndrome

      To the Editor:
      The report by Pelliccia et al,
      • Pelliccia F.
      • Parodi G.
      • Greco C.
      • et al.
      Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
      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. One wonders whether the traditionally made distinction between emotional and physical stressors, with a prevalence of 39% and 34%, in this study,
      • Pelliccia F.
      • Parodi G.
      • Greco C.
      • et al.
      Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
      is appropriate because physical stress may have an enormous psychologic overlay. The prevalence of cardiovascular risk factors in this study was thought to be higher than what is expected in the general population and similar to that of patients with acute myocardial infarction, although the prevalence for hypertension and diabetes mellitus in individuals in the age range of 60 to 75 years (ie, similar to the range of mean ages of 59 to 76 years of the included series) in the general population globally is quite high. The 19 included patient case series comprised 10 to 190 patients, and the reported prevalence of hypertension was 54%, with a range of 27% to 83%, and of diabetes mellitus was 17%, with a range of 4% to 34%; such a large range of variation in the number of patients, as well as the prevalence of hypertension and diabetes mellitus per included series,
      • Pelliccia F.
      • Parodi G.
      • Greco C.
      • et al.
      Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
      prevents pathophysiologic linking of the risk factors to Takotsubo syndrome. It has been reported recently that the prevalence of diabetes mellitus is low in patients with Takotsubo syndrome, a finding that may have pathophysiologic connotations for Takotsubo syndrome.
      • Madias J.E.
      Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations.
      Do the authors of this report
      • Pelliccia F.
      • Parodi G.
      • Greco C.
      • et al.
      Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
      have any additional details about the 158 patients from the 18 of 19 reported series, such as the type of diabetes mellitus, duration of the disease, and presence of diabetic neuropathy?

      References

        • Pelliccia F.
        • Parodi G.
        • Greco C.
        • et al.
        Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
        Am J Med. 2015; 128: 654.e11-654.e19
        • Madias J.E.
        Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations.
        Eur Heart J Acute Cardiovasc Care. February 11, 2015; ([Epub ahead of print])

      Linked Article

      • Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients
        The American Journal of MedicineVol. 128Issue 6
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          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.
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      • The Reply
        The American Journal of MedicineVol. 128Issue 8
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          We thank Madias for his interest in our study1 that was recently published in The American Journal Medicine and for giving us the opportunity to better address the diabetes mellitus prevalence in patients with Takotsubo syndrome. The COmorbidity freqUency iN Takotsubo Syndrome (COUNTS) study highlights that comorbidities are highly prevalent in patients with Takotsubo syndrome. In regard to cardiovascular risk factors (in particular, hypertension, hypercholesterolemia, and smoking), there is now a general consensus that the not negligible prevalence presented overall by patients with Takotsubo syndrome may account for potential premorbid endothelial dysfunction that may represent a predisposing factor for the syndrome.
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