Publications (13)56.55 Total impact
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Article: Systemic sclerosis and risk of ischaemic stroke: a nationwide cohort study.
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ABSTRACT: Objective. To investigate whether SSc increases the risk of ischaemic stroke in a large, nationwide cohort study. Methods. From the Registry of Catastrophic Illness in Taiwan, we obtained data for 1280 patients with a diagnosis of SSc from 1997 to 2006. We also obtained data for 10 age-, gender-, comorbidity- and enrolment date-matched controls per SSc patient from the Longitudinal Health Insurance 2000. All study subjects were followed up from the date of enrolment until they developed ischaemic stroke, death or to the end of 2006, whichever was earlier. We used Cox's regression model with adjustment for age, gender and comorbid disorders to assess the independent factors in determining the risk of developing ischaemic stroke. Results. We identified 1238 SSc patients and 12 380 controls. Among these patients, 765 (86 SSc patients and 679 controls) had developed ischaemic stroke during the median 4.7 years (0.1-10.0 years) of follow-up. Patients with SSc had a significantly higher incidence of ischaemic stroke when compared with controls (16.5/1000 vs 11.5/1000 person-year). After multivariate analysis, SSc was associated with a 43% increase in ischaemic stroke risk (95% CI 12%, 83%; P = 0.004). Additionally, the medication usually being prescribed among SSc patients did not alter the risk of further ischaemic stroke. Conclusion. We conclude that SSc is independently associated with higher risk of ischaemic stroke development.Rheumatology (Oxford, England) 01/2013; 52(1):161-5. · 4.24 Impact Factor -
Article: Usefulness of plasma matrix metalloproteinase-9 level in predicting future coronary revascularization in patients after acute myocardial infarction.
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ABSTRACT: OBJECTIVES: This study aims to determine whether plasma levels of matrix metalloproteinases (MMPs) and inflammatory markers can predict the long-term prognosis of coronary revascularization in patients after acute myocardial infarction (AMI). BACKGROUND: MMPs have been implicated in the development of atherosclerosis and plaque rupture in acute coronary syndrome. METHODS: Ninety-six consecutive patients (63±11 years) diagnosed with myocardial infarction were enrolled. All patients were followed up for 43±12 months. Plasma levels of MMP-2 and MMP-9 were determined from blood samples collected immediately after hospitalization. Coronary revascularization was defined as having received a percutaneous coronary intervention or a coronary artery bypass graft surgery. RESULTS: A total of 29 patients (30%) had undergone coronary revascularization during the follow-up period, including 27 percutaneous coronary intervention and two coronary artery bypass graft surgery. The baseline characteristics were similar between groups with or without revascularization. Patients with coronary revascularization had significantly higher MMP-9 levels (P=0.048), but not MMP-2 levels. In addition, a positive correlation was found between circulating MMP-9 level and total cholesterol (r=0.250, P=0.016) and low-density lipoprotein-cholesterol (r=0.284, P=0.009). All patients were divided into a high-MMP-9 group (highest tertile≥1.10 ng/ml) and a low-MMP-9 group (<1.10 ng/ml). The incidence of coronary revascularization was significantly increased in the high-MMP-9 group (P=0.034). In a multivariate Cox regression analysis that included MMP-9 and classical risk factors, the MMP-9 level was an independent predictor of coronary revascularization in patients after AMI (hazard ratio, 2.72; 95% confidence interval, 1.24-5.98; P=0.026). CONCLUSION: Increased plasma levels of MMP-9 but not MMP-2 or inflammatory markers predict future coronary revascularization, and a significant association was observed with MMP-9 and low-density lipoprotein-cholesterol. These findings suggest a pivotal role of MMP-9 in atherothrombosis in AMI patients.Coronary artery disease 11/2012; · 1.56 Impact Factor -
Article: Angiotensin-Receptor Blockers and Risk of Alzheimer's Disease in Hypertension Population.
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ABSTRACT: Background: Although emerging evidence shows angiotensin-receptor blockers (ARBs) may have a beneficial effect against Alzheimer's disease (AD), the association is not consistent. We investigated the association between ARB use and the risk of development of AD using a nationwide, population-based cohort database in Taiwan. Methods and Results: In total, 16,426 newly diagnosed hypertensive patients who were administered ARB without a previous diagnosis of AD were identified from the Taiwan National Health Insurance database. The comparison group consisted of hypertensive patients who did not receive ARB, and were matched to exposed individuals using propensity score by enrolled time, age, sex, and comorbidities. During an average of 5.24±2.01 years of follow-up, a total of 1,031 cases (3.13%) of new AD occurred. The log-rank test showed no significant difference in the AD occurrence rate between subjects exposed to ARBs and non-exposed controls [488 (2.97%) vs. 543 (3.29%), P=0.221]. After adjusting for age, sex, comorbidities, and medications, only advanced age [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.12-1.13, P<0.001), female sex (HR 1.18, 95% CI 1.04-1.33, P=0.011), diabetes (HR 1.53, 95% CI 1.31-1.79, P<0.001), but not ARB (HR 1.08, 95% CI 0.96-1.22, P=0.222) were independently associated with AD development. Conclusions: The use of ARB was not significantly associated with a reduction of risk of AD in Asian patients with essential hypertension.Circulation Journal 11/2012; · 3.77 Impact Factor -
Article: Association Between Panic Disorder and Risk of Atrial Fibrillation:A Nationwide Study.
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ABSTRACT: Objective The aim of the present study was to investigate the association between panic disorder (PD) and atrial fibrillation (AF).Methods We used a nationwide population-based data set from Taiwan. A total of 3888 patients with PD and without a diagnosis of AF from a sampled cohort data set of 1,000,000 were included in the study group. Ten people without PD and AF were selected for every 1 patient in the study group, matched by propensity score matching according to time of enrollment, age, sex, and comorbidities. We performed log-rank tests to analyze differences in accumulated AF-free survival rates between the two groups. Cox proportional hazard regressions were performed to evaluate the independent factors determining the longitudinal hazard of AF.ResultsDuring a maximal 7-year follow-up, 48 patients from the study group (1.2% of the patients with PD) and 358 from the control group (0.9% of the patients without PD) were newly diagnosed as having AF. Patients with PD had a significantly higher incidence of AF (hazard ratio [HR] = 1.54 [1.14-2.09]; log-rank test, p = .004). After Cox model adjustment for risk factors and comorbidities, PD (HR = 1.73, 95% confidence interval [CI] = 1.26-2.37), age (HR = 1.07, 95% CI = 1.06-1.08), male sex (HR = 1.26, 95% CI = 1.03-1.55), hypertension (HR = 2.00, 95% CI = 1.55-2.56), history of coronary artery disease (HR = 1.45, 95% CI = 1.15-1.82), congestive heart failure (HR = 2.46; 95% CI, 1.84-3.30), and valvular heart disease (HR = 2.83, 95% CI = 1.85-4.42) were independently associated with increased risk of AF.ConclusionsPD is independently associated with higher incidence of AF to be diagnosed in the future. Larger prospective studies or meta-analysis are suggested to confirm the findings.Psychosomatic Medicine 10/2012; · 3.97 Impact Factor -
Article: Hip fracture and risk of acute myocardial infarction: A nationwide study.
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ABSTRACT: Osteoporotic fractures are associated with increased mortality risk. However, few data are available on the risk of acute myocardial infarction (AMI) following hip fracture. Therefore, we investigated whether hip fracture increased the risk of AMI in a large, nationwide cohort study. We obtained data from 8,758 patients diagnosed with hip fracture from 2000 to 2009 and from 4 matched controls for each patient from the Longitudinal Health Insurance Database (LHID 2000), Taiwan. Controls were matched for age, gender, comorbid disorders, and enrollment date. All subjects were followed up from the date of enrollment until AMI, death, or the end of data collection (2009). Cox's regression model adjusted for age, gender, comorbid disorders, and medication was used to assess independent factors determining the risk of development of AMI. As expected, despite the matching, the hip fracture patients had more risk factors for AMI at baseline. A total of 8,758 subjects with hip fractures and 35,032 controls were identified. Among these patients, 1,183 (257 hip fracture patients and 926 controls) developed AMI during the median 3.2 year (interquartile range, 1.4-5.8 years) follow-up period. Patients with hip fractures had a higher incidence of AMI occurrence when compared to controls (8.7/1000 person-years versus 6.82/1000 person-years). Multivariate analysis adjusted for baseline covariates indicated that hip fracture was associated with a greater risk for AMI development (hazard ratio: 1.29, 95% confidence interval: 1.12-1.48, P < 0.001). We conclude that hip fracture is independently associated with a higher risk of subsequent AMI. © 2012 American Society for Bone and Mineral Research.Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 07/2012; · 6.04 Impact Factor -
Article: Oral alendronate use and risk of cancer in postmenopausal women with osteoporosis: A nationwide study.
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ABSTRACT: The association between use of oral bisphosphonates and cancer development in elderly women is still uncertain, and previous studies have shown controversial results. We used a nationwide, population-based database to explore the relationship between the use of alendronate, an oral bisphosphonate agent used for the treatment of osteoporosis, and the risk of all malignancies in women with osteoporosis and age over 55 years. In the study group, we included 6906 women with osteoporosis (age, mean ± SD, 73.4 ± 8.4 years) taking oral alendronate, who were selected from a 1,000,000 sample cohort dataset collected between January 1998 and December 2009. Another 20,697 age- and comorbidity-matched women (73.5 ± 8.4 years) without bisphosphonates treatment were included in the control group. No subjects had any history of being diagnosed with cancer before inclusion. We used a log-rank test to analyze the differences in accumulated cancer-free survival rates between these two groups. A Cox proportional-hazard model, adjusted for confounding factors, was used to evaluate the association between alendronate use and the development of all cancer events in postmenopausal women with osteoporosis. During the mean follow-up period of 4.8 years, 821 patients from the study group and 2646 patients from the control group had new cancers. There was no significant difference in cancer incidence between alendronate users and controls (11.9% versus 12.8%, p = 0.054). The person-year incidence of newly-developed cancer in alendronate users and controls was 28.0 and 29.4 per 1000 person-years, respectively. Alendronate use was not associated with increased risk of cancer development in women with osteoporosis (adjusted hazard ratio, 1.05; 95% confidence interval [CI], 0.97-1.13; p = 0.237). However, due to the limited study size and underpowered results, further larger prospective studies or meta-analysis are suggested to further confirm our findings.Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 04/2012; 27(9):1951-8. · 6.04 Impact Factor -
Article: The association of tooth scaling and decreased cardiovascular disease: a nationwide population-based study.
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ABSTRACT: Poor oral hygiene has been associated with an increased risk for cardiovascular disease. However, the association between preventive dentistry and cardiovascular risk reduction has remained undetermined. The aim of this study is to investigate the association between tooth scaling and the risk of cardiovascular events by using a nationwide, population-based study and a prospective cohort design. Our analyses were conducted using information from a random sample of 1 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed individuals consisted of all subjects who were aged ≥ 50 years and who received at least 1 tooth scaling in 2000. The comparison group of non-exposed persons consisted of persons who did not undergo tooth scaling and were matched to exposed individuals using propensity score matching by the time of enrollment, age, gender, history of coronary artery disease, diabetes, hypertension, and hyperlipidemia. During an average follow-up period of 7 years, 10,887 subjects who had ever received tooth scaling (exposed group) and 10,989 age-, gender-, and comorbidity-matched subjects who had not received tooth scaling (non-exposed group) were enrolled. The exposed group had a lower incidence of acute myocardial infarction (1.6% vs 2.2%, P<.001), stroke (8.9% vs 10%, P=.03), and total cardiovascular events (10% vs 11.6%, P<.001) when compared with the non-exposed group. After multivariate analysis, tooth scaling was an independent factor associated with less risk of developing future myocardial infarction (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.85), stroke (HR, 0.85; 95% CI, 0.78-0.93), and total cardiovascular events (HR, 0.84; 95% CI, 0.77-0.91). Furthermore, when compared with the non-exposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events (P for trend<.001). Tooth scaling was associated with a decreased risk for future cardiovascular events.The American journal of medicine 04/2012; 125(6):568-75. · 4.47 Impact Factor -
Article: Niacin improves ischemia-induced neovascularization in diabetic mice by enhancement of endothelial progenitor cell functions independent of changes in plasma lipids.
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ABSTRACT: Niacin was shown to inhibit acute vascular inflammation and improves endothelial dysfunction independent of changes in plasma lipids. Here, we investigated whether niacin can increase blood flow recovery after tissue ischemia by enhancing endothelial progenitor cell (EPC) functions in diabetic mice. Starting at 4 weeks after the onset of diabetes, vehicle or niacin (40 mg/kg/day) was administered daily by gavage to streptozotocin (STZ)-induced diabetic mice and diabetic endothelial nitric oxide synthase (eNOS)-deficient mice. Unilateral hindlimb ischemia surgery was conducted after 2 weeks of vehicle or niacin treatment. Compared to the control group, the niacin group had significantly increased ischemic/non-ischemic limb blood perfusion ratio and higher capillary density. These effects were markedly reduced in STZ-induced diabetic eNOS-deficient mice. Flow cytometry analysis showed impaired EPC-like cell (Sca-1(+)/Flk-1(+)) mobilization after ischemia surgery in diabetic mice but augmented mobilization in the mice treated with niacin. Diabetes was induced by administering STZ to FVB mice that received eGFP mouse bone marrow cells to evaluate effects of niacin on bone marrow-derived EPC homing and differentiation to endothelial cells. Differentiation of bone marrow-derived EPCs to endothelial cells in the ischemic tissue around vessels in diabetic mice that received niacin treatment, was significantly increased than that in control group. By in vitro studies, incubation with niacin in high-glucose medium reduced H(2)O(2) production, cell apoptosis, and improved high glucose-suppressed EPC functions by nitric oxide-related mechanisms. Our findings demonstrate that niacin increases blood flow recovery after tissue ischemia in diabetic mice through enhancing EPC mobilization and functions via nitric oxide-related pathways.Angiogenesis 03/2012; 15(3):377-89. · 6.06 Impact Factor -
Article: Psoriasis and increased risk of ischemic stroke in Taiwan: a nationwide study.
The Journal of Dermatology 03/2012; 39(3):279-81. · 1.49 Impact Factor -
Article: Decreased circulating endothelial progenitor cell levels and function in patients with nonalcoholic fatty liver disease.
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ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is associated with advanced atherosclerosis and a higher risk of cardiovascular disease. Increasing evidence suggests that injured endothelial monolayer is regenerated by circulating bone marrow derived-endothelial progenitor cells (EPCs), and levels of circulating EPCs reflect vascular repair capacity. However, the relation between NAFLD and EPC remains unclear. Here, we tested the hypothesis that patients with nonalcoholic fatty liver disease (NAFLD) might have decreased endothelial progenitor cell (EPC) levels and attenuated EPC function. A total of 312 consecutive patients undergoing elective coronary angiography because of suspected coronary artery disease were screened and received examinations of abdominal ultrasonography between July 2009 and November 2010. Finally, 34 patients with an ultrasonographic diagnosis of NAFLD, and 68 age- and sex-matched controls without NAFLD were enrolled. Flow cytometry with quantification of EPC markers (defined as CD34(+), CD34(+)KDR(+), and CD34(+)KDR(+)CD133(+)) in peripheral blood samples was used to assess circulating EPC numbers. The adhesive function, and migration, and tube formation capacities of EPCs were also determined in NAFLD patients and controls. Patients with NAFLD had a significantly higher incidence of metabolic syndrome, previous myocardial infarction, hyperuricemia, and higher waist circumference, body mass index, fasting glucose and triglyceride levels. In addition, patients with NAFLD had significantly decreased circulating EPC levels (all P<0.05), attenuated EPC functions, and enhanced systemic inflammation compared to controls. Multivariate logistic regression analysis showed that circulating EPC level (CD34(+)KDR(+) [cells/10(5) events]) was an independent reverse predictor of NAFLD (Odds ratio: 0.78; 95% confidence interval: 0.69-0.89, P<0.001). NAFLD patients have decreased circulating EPC numbers and functions than those without NAFLD, which may be one of the mechanisms to explain atherosclerotic disease progression and enhanced cardiovascular risk in patients with NAFLD.PLoS ONE 01/2012; 7(2):e31799. · 4.09 Impact Factor -
Article: Association between Mycoplasma pneumonia and increased risk of ischemic stroke: a nationwide study.
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ABSTRACT: Infections have been hypothesized to play a role in vascular disease. The association between Mycoplasma pneumoniae (MP) infection and ischemic stroke remained undetermined. A total of 1094 patients with MP infection were enrolled as the study group and compared with 5168 sex-, age-, and comorbidity-matched subjects without MP, to be followed up prospectively from January 2003 to December 2007 for development of ischemic stroke. During a maximum 5-year follow-up period, 49 patients with ischemic stroke were identified. Subjects with MP infection were significantly associated with increased risk of ischemic stroke compared with controls (1.10% versus 0.72%, respectively; P=0.01). The logrank test showed that patients with MP had significantly higher incidence of stroke development than did those without MP (P=0.046). After Cox model adjustment for risk factors and comorbidities, MP infection was still independently associated with increased risk of stroke (hazard ratio [HR], 2.07; 95% CI, 1.05-4.03). We conclude that MP infection is independently associated with risk of subsequent ischemic stroke development.Stroke 07/2011; 42(10):2940-3. · 5.73 Impact Factor -
Article: Herpes simplex virus infection and risk of atrial fibrillation: A nationwide study.
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ABSTRACT: BACKGROUND: Currently, precise mechanisms of atrial fibrillation (AF) are uncertain but proved to be associated with inflammation. There has been no specific study to evaluate the risk of AF after diagnosis of herpes simplex virus (HSV) infection. METHODS: To investigate the relationship between HSV infection and the occurrence of AF, we used a nation-wide population-based dataset from Taiwan. A total of 15,180 patients with diagnosis of HSV infection were included in the study group from a 1,000,000 sampling cohort dataset between January 2000 and December 2003. Another 73,197 age-, gender-, and comorbidity-matched subjects without HSV infection were included in the control group. The log-rank test was performed to analyze the differences in accumulated AF-free survival rates between these 2 groups. Cox proportional hazard regressions were performed to evaluate the independent factor in determining the longitudinal hazard of AF. RESULTS: During a 3-year follow-up period, 240 patients from the study group (1.6%) and 801 patients from the comparison group (1.1%) had newly developed AF. The log-rank test showed that patients with HSV had significantly higher incidence of AF development than those without HSV (p<0.001). After Cox model adjustment for risk factors and comorbidities, HSV infection was independently associated with increased risk of AF development (hazard ratios [HR], 1.39; 95% confidence interval [CI], 1.2-1.60; p<0.0001). CONCLUSION: Our study concludes that HSV infection may be independently associated with an increased risk of future AF development.International journal of cardiology 07/2011; · 7.08 Impact Factor -
Article: The severity of non-alcoholic fatty liver disease correlates with high sensitivity C-reactive protein value and is independently associated with increased cardiovascular risk in healthy population.
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ABSTRACT: We aimed to investigate the correlation between non-alcoholic fatty liver disease (NAFLD) and risk of cardiovascular disease (CVD). We analyzed 724 subjects without CVD according to presence or absence of NAFLD. Logistic regression model was used to determine if NAFLD was an independent risk factor of CVD. Subjects with NAFLD had increased percentage of 10-year cardiovascular risk ≧10% compared to those without NAFLD (p<0.001). The severity of NAFLD significantly correlated with increasing Framingham risk score and C-relative protein (CRP) value. After adjusting for conventional CVD risk factors, the presence of NAFLD was an independent predictor for future CVD risk ≧10% [odds ratio: 1.89, p=0.004]. Subgroup analysis showed the predictive value of NAFLD was significant among aged subjects and those with increased baseline hsCRP level. NAFLD is independently associated with increased CVD risk, especially among elderly subjects and those with increased CRP level.Clinical biochemistry 12/2010; 43(18):1399-404. · 2.02 Impact Factor
Top co-authors
Top Journals
Institutions
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2010–2013
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Taipei Veterans General Hospital
- Cardiology Division
Taipei, Taipei, Taiwan
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2011–2012
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National Yang Ming University
- School of Medicine
Taipei, Taipei, Taiwan
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