Increased risk of cardiovascular diseases among patients with carpal tunnel syndrome in a multicenter global retrospective cohort study

Abstract Carpal tunnel syndrome (CTS) is linked to cardiovascular outcomes such as cardiac amyloidosis, but prior studies with limited scope leave uncertainty about its role as an marker of other major cardiovascular diseases such as stroke and myocardial infarction. The aim of this study is to evaluate cardiovascular risks in CTS using large-scale global electronic health records. We conducted a retrospective cohort study using TriNetX Global Collaborative Network from a cohort of 619,538 patients with CTS and 8,630,919 CTS-free controls. To minimize confounding, a 1:1 propensity-score matching strategy was employed, creating two well-balanced cohorts of 615,201 patients each. We assessed the risk for a comprehensive range of acute and chronic cardiovascular events and compared the risk in CTS patients with active comparator cohorts of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Following propensity matching, patients with CTS had a significantly increased risk for ischemic stroke (HR = 1.39, 95% CI, 1.35–1.44) and haemorrhagic stroke (HR = 1.34, 95% CI, 1.26–1.43) compared to controls. This excess risk extended to other cardiovascular outcomes, including acute myocardial infarction (HR = 1.58, 95% CI, 1.53–1.64), heart failure (HR = 1.51, 95% CI, 1.47–1.55), and cerebrovascular disorders (HR 1.62, 95% CI, 1.57–1.67). The strongest association was observed for cardiac amyloidosis (HR = 2.41, 95% CI, 2.07–2.80). These elevated risks were consistent across subgroups stratified by age, sex, and race. Notably, the risk of stroke in the CTS cohort was higher than in both the RA and AS cohorts. The findings remained robust in multiple sensitivity analyses. CTS is associated with increased risk of diverse cardiovascular diseases, with risks exceeding those of established inflammatory conditions such as RA and AS.