Gallbladder Stone Disease Is Associated with an Increased Risk of Migraines

Background: Several pathophysiological mechanisms are shared in both gallbladder stone disease (GSD) and migraines. We assessed the migraine risk for patients diagnosed with GSD. Methods: We identified 20,427 patients who were diagnosed with GSD between 2000 and 2011 from Taiwan’s National Health Insurance Research Database (NHIRD) as the study cohort. We randomly selected 81,706 controls from the non-GSD population with frequency matching by age and index year for the control cohort. All patient cases were followed until the end of 2011 to measure the incidence of migraines. Results: The cumulative incidence of migraines was greater in patients with GSD than in those without GSD (log-rank test: p < 0.001). The risk of migraine (3.89 vs. 2.30 per 10,000 person-years, adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI) = 1.41–1.73) was greater for the GSD cohort than that for the non-GSD cohort. The risk of migraine increased with the time of follow-up after a diagnosis of GSD. The risk of migraine contributed by GSD was greater for all age groups. The risk of migraine for GSD patients with depression (aHR = 2.89, 95% CI = 2.21–3.77), anxiety (aHR = 2.07, 95% CI = 1.58–2.70), and coronary artery disease (CAD) (aHR = 2.05, 95% CI = 1.69–2.48) tended to be greater than that for GSD patients without depression (aHR = 1.54, 95% CI = 1.39–1.72), anxiety (aHR = 1.62, 95% CI = 1.46–1.81), and CAD (aHR = 1.65, 95% CI = 1.47–1.85), respectively. Compared with the patients without GSD, the risk of developing migraines was greater in those GSD patients either with (aHR = 1.39, 95% CI = 1.19–1.63) or without (aHR = 1.67, 95% CI = 1.48–1.88) cholecystectomy. Compared with the GSD patients that have not had a cholecystectomy, the risk of developing migraines was lower in the GSD patients that had a cholecystectomy (aHR = 0.83, 95% CI = 0.69–0.99). Conclusions: GSD is associated with an increased risk of migraines in the Taiwanese population, but the risk diminishes after a cholecystectomy. Furthermore, in the development of migraines, GSD is synergic with some migraine-associated comorbidities, such as CAD, depression, and anxiety. Further study is necessary to clarify whether GSD is a causal risk factor for migraine.

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Erectile Dysfunction in Men With Gallbladder Stone Disease: A Nationwide Population-Based Study

American Journal of Men s Health ◽

10.1177/1557988319839589 ◽

2019 ◽

Vol 13 (2) ◽

pp. 155798831983958 ◽

Cited By ~ 2

Author(s):

Chien-Hua Chen ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Erectile Dysfunction ◽

Confidence Interval ◽

Stone Disease ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Protective Mechanism ◽

Study Cohort ◽

Research Database ◽

Gallbladder Stone ◽

Increased Risk

We assessed the risk of erectile dysfunction after the diagnosis of gallbladder stone disease. We identified 9,362 men aged ≥20 years diagnosed with gallbladder stone disease between 2000 and 2011 from Taiwan’s National Health Insurance Research Database as the study cohort, and we randomly selected 9,362 men from the nongallbladder stone disease population by 1:1 frequency-matching with the case cohort based on age, the index date for the diagnosis of gallbladder stone disease, and comorbidities as the control cohort. All subjects were followed until December 31, 2011, for measuring the erectile dysfunction incidence. The risk of organic erectile dysfunction was higher in the gallbladder stone disease cohort than the nongallbladder stone disease cohort (4.01 vs. 2.69 per 1,000 person-years, adjusted hazard ratio = 1.41, 97.5% confidence interval [1.12, 1.78]), but the risk of psychogenic erectile dysfunction was comparable between the gallbladder stone disease cohort and the nongallbladder stone disease cohort (0.40 vs. 0.28 per 1,000 person-years, adjusted hazard ratio = 1.37, 97.5% confidence interval [0.67, 2.79]). Moreover, gallbladder stone disease men with cholecystectomy exhibited a lower risk of developing organic erectile dysfunction than gallbladder stone disease men without cholecystectomy (adjusted hazard ratio = 0.58, 97.5% confidence interval [0.41, 0.80]). The risk of organic erectile dysfunction contributed by gallbladder stone disease was only significantly higher in men aged ≥65 years (adjusted hazard ratio = 2.21, 97.5% confidence interval [1.34, 3.63]) and in men with comorbidities (adjusted hazard ratio = 1.42, 97.5% confidence interval [1.09, 1.85]). The risk of psychogenic erectile dysfunction contributed by gallbladder stone disease was nonsignificant in each age group and in men with or without comorbidities. Gallbladder stone disease is associated with an increased risk of organic erectile dysfunction, but it has no association with psychogenic erectile dysfunction. History of cholecystectomy for gallbladder stone disease may ameliorate the risk of organic erectile dysfunction; it requires more studies to ascertain the protective mechanism and to clarify whether the existence of gallbladder stone disease is an epiphenomenon or independent risk factor of erectile dysfunction.

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Endometriosis and New-Onset Coronary Artery Disease in Taiwan: A Nationwide Population-Based Study

Frontiers in Medicine ◽

10.3389/fmed.2021.619664 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chun-Hui Wei ◽

Renin Chang ◽

Yu Hsun Wan ◽

Yao-Min Hung ◽

James Cheng-Chung Wei

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Age Groups ◽

Population Based ◽

Sensitivity Analyses ◽

Increased Risk ◽

Artery Disease ◽

Stratified Analysis ◽

New Onset

Endometriosis (EM) with chronic inflammation may accelerate the progression of atherosclerosis. Currently, no large or randomized clinical studies have assessed the incidence of cardiovascular events in patients with endometriosis in Asia to investigate whether incident EM is associated with a higher risk of new-onset coronary artery disease (CAD). In this study of a nationwide cohort in Taiwan, we identified 13,988 patients with newly diagnosed EM from 1 January, 2000, through 31 December, 2012. EM and non-EM groups were matched by propensity score at a ratio of 1:1. Of a total 27,976 participants, 358 developed CAD. The incidence rate in the EM group was higher than that in the non-EM group (1.8 per 1,000 person-years vs. 1.3 per 1,000 person-years) during the follow-up period. The adjusted hazard ratio (aHR) of CAD for the EM group was 1.52 with a 95% confidence interval (1.23–1.87, p < 0.001) after adjusting for demographic characteristics, comorbidities, surgical procedures, frequency of outpatient visits, and medications. Stratified analysis revealed that, among four age groups (20–39, 40–49, 50–54, and above 55 years), the 20–39 years sub-group was associated with a higher risk of CAD (aHR, 1.73; 95% CI, 1.16–2.59, p = 0.008). Several sensitivity analyses were conducted for cross-validation, and it showed consistent positive findings. In conclusion, this cohort study revealed that patients with symptomatic EM in Taiwan were associated with increased risk of subsequent CAD than patients without medical records of EM. Further prospective studies are needed to confirm this causal relationship.

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Effects of medical and surgical treatment on the risk of major adverse cardiovascular and cerebrovascular events in Asian women with endometriosis

10.21203/rs.2.15783/v1 ◽

2019 ◽

Author(s):

Hsin-Ju Chiang ◽

Kuo-Chung Lan ◽

Yao-Hsu Yang ◽

John Y. Chiang ◽

Fu-Tsai Kung ◽

...

Keyword(s):

Surgical Treatment ◽

General Population ◽

Therapeutic Effect ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Asian Women ◽

Study Cohort ◽

Research Database ◽

Cerebrovascular Events ◽

Increased Risk

Abstract Background: Endometriosis (EM) is linked to cardiovascular disease (CVD). However, whether this finding can be applied to the Asian population remained unanswered. Results are still conflicting in terms of therapeutic effect on the risk of CVD in patients with EM. Therefore, we investigated the association between EM and major adverse cardiovascular and cerebrovascular events (MACCE) and the therapeutic effect on the risk of MACCE in Asian women with EM. Methods: The Taiwan National Health Insurance Research Database was used for this retrospective population-based cohort study from 1997 to 2013. A total of 17 543 patients with EM aged between 18 and 50 years were identified from a general population of 1 million after excluding diagnoses of major CVD and cerebrovascular accident (CVA) prior to EM. The comparison group (n = 70 172) without EM was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. Demographic data and the frequency of comorbidities between groups were compared using the independent t test and chi-square test. The incidence and risk of MACCE were analyzed using the log-rank test and a multivariate Cox proportional hazards model. Results: During a median follow-up period of 9.2 years, Asian women with EM had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-EM counterparts (2.76% vs 2.18%, P < .0001). After adjustment for comorbidities, patients with EM had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .0053) and a higher cumulative incidence of MACCE compared with the normal population. Among women with EM, neither medical nor surgical treatment increased the risk of MACCE, including major CVD and CVA. Furthermore, medical treatment for EM appeared to be protective against MACCE. Conclusion: Asian women with EM not only had a substantially higher frequency of comorbidities but also an increased risk of MACCE compared with the general population. In terms of medical or surgical treatment of EM, the safety concern regarding MACCE was not evident.

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Abstract P85: Are Myocardial Bridges Associated With Increased Risk of Death or Myocardial Infarction?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap85 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Mouaz H Al-Mallah ◽

Kamal Kassem ◽

Owais Khawaja ◽

Thomas Song ◽

Chad Poopat ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Prognostic Value ◽

Cox Regression ◽

Study Cohort ◽

Risk Of Death ◽

Increased Risk ◽

Artery Disease

Background: Myocardial bridging (MB) is frequently seen on coronary CT angiography (CCTA). However, there has been conflicting data on the prognostic value of MB. The aim of this analysis is to determine the prognostic value of MB in patients without obstructive coronary artery disease (CAD) (<50 diameter stenosis). Methods: We included patients with no known prior coronary artery disease (CAD) who underwent CCTA for various clincial reasons. Patients with obstructive CAD on CCTA were excluded. The study cohort was followed for all cause mortality or myocardial infarction (MI) (median follow-up 1.7 years). Group comparisons were made between patients with patients with or without MB. Results: A total of 715 patients were included in this analysis of which 68 patients had MB (10%). 73% of the bridges were in the mid LAD and 22% had bridging in the distal LAD. 48% of the study cohort had normal coronaries, while 52% had evidence of non obstructive CAD. There were no differences in the baseline characteristics, symptomatic status or prevalence of non obstructive CAD between the two groups (all p>0.5). After a median follow-up duration of 1.7 years, 23 patients died and 10 patients experienced myocardial infarction. There were no statistically significant differences in the rate of death/MI between the two groups (figure). Using multivariable Cox regression, the presence of MB was not associated with increased risk for death/MI (Adjusted HR 0.4, 95% confidence interval 0.1 -2.8, p=0.34) Conclusions: In patients with non-obstructive CAD, MB is not associated with increased risk for all cause death or MI.

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The Effect of Cholecystectomy on the Risk of Colorectal Cancer in Patients with Gallbladder Stones

Cancers ◽

10.3390/cancers12030550 ◽

2020 ◽

Vol 12 (3) ◽

pp. 550 ◽

Cited By ~ 1

Author(s):

Chien-Hua Chen ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Cumulative Incidence ◽

Positive Association ◽

Rank Test ◽

Study Cohort ◽

Research Database ◽

Gallbladder Stones ◽

Log Rank Test

To evaluate the risk of colorectal cancer (CRC) after cholecystectomy for gallbladder stones (GBS). Methods: This nationwide population-based cohort study analyzed the inpatient data from the Taiwan National Health Insurance Research Database. The study cohort comprised of 83,963 patients aged ≥ 20 years undergoing cholecystectomy for GBS between 2000 and 2010. The control cohort comprised the GBS patients without cholecystectomy, who were propensity matched with the study cohort at a 1:1 ratio based on age, sex, comorbidities, and the index date for cholecystectomy. Results: The cumulative incidence of CRC within 6 months of follow-up was higher in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR (adjusted hazard ratio) = 7.90, 95% confidence interval (CI) = 6.27–9.94; log-rank test, p < 0.001). The cumulative incidence of CRC after 6 months of follow-up was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR = 0.66, 95% CI = 0.60–0.73; log-rank test, p < 0.001), but the reduced risk of CRC for the cholecystectomy cohort was statistically significant only in rectal cancer after separately considering females (aHR = 0.64, 95% CI = 0.46–0.88) and males (aHR = 0.59, 95% CI = 0.44–0.79). Conclusions: The positive association between cholecystectomy and the CRC risk within the first 6 months after cholecystectomy might be due to a detection bias or pre-existing CRC. However, cholecystectomy is associated with a decreased risk of rectal cancer, rather than proximal or distal colon cancer, after more than 6 months of follow-up.

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Effects of medical and surgical treatment on the risk of major adverse cardiovascular and cerebrovascular events in Asian women with endometriosis

10.21203/rs.2.15783/v2 ◽

2019 ◽

Author(s):

Hsin-Ju Chiang ◽

Kuo-Chung Lan ◽

Yao-Hsu Yang ◽

John Y. Chiang ◽

Fu-Tsai Kung ◽

...

Keyword(s):

Surgical Treatment ◽

General Population ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Asian Women ◽

Study Cohort ◽

Research Database ◽

Cerebrovascular Events ◽

Increased Risk ◽

The Impact

Abstract Background: Endometriosis is linked to major adverse cardiovascular and cerebrovascular events (MACCE). However, whether this finding can be applied to the Asian population remained unanswered. Additionally, results are still inconsistent for the impact of endometriosis treatment on incidental MACCE. Thus, we intended to investigate the association between endometriosis and MACCE, and study the effect of endometriosis therapies on the risk of MACCE among Asian women. Methods: The Taiwan National Health Insurance Research Database was used for this retrospective population-based cohort study from 1997 to 2013. A total of 17 543 patients with endometriosis aged between 18 and 50 years were identified from a general population of 1 million after excluding diagnoses of major cardiovascular disease (CVD) and cerebrovascular accident (CVA) prior to endometriosis. The comparison group (n = 70 172) without endometriosis was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. Demographic data and the frequency of comorbidities between groups were compared using the independent t test and chi-square test. The incidence and risk of MACCE were analyzed using the log-rank test and a multivariate Cox proportional hazards model. Results: During a median follow-up period of 9.2 years, Asian women with endometriosis had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-endometriosis counterparts (2.76% vs 2.18%, P < .001). After adjustment for comorbidities, patients with endometriosis had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .005) and a higher cumulative incidence of MACCE compared with the normal population. Among women with endometriosis, neither medical nor surgical treatment increased the risk of MACCE, including major CVD and CVA. Furthermore, medical treatment for endometriosis appeared to be protective against MACCE in the endometriosis females. Conclusion: Asian women with endometriosis not only had a higher frequency of comorbidities but also an increased risk of MACCE compared with the general population. In addition, the safety concern about medical or surgical treatment of endometriosis on the risk of MACCE was not evident in this study.

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Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-91356-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sze-Wen Ting ◽

Sze-Ya Ting ◽

Yu-Sheng Lin ◽

Ming-Shyan Lin ◽

George Kuo

Keyword(s):

Cohort Study ◽

Herpes Zoster ◽

Population Based ◽

Research Database ◽

Newly Diagnosed ◽

Increased Risk ◽

Taiwan National Health Insurance ◽

Reduced Risk ◽

Systemic Therapies

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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Prognostic value of serum soluble ST2 in stable coronary artery disease: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-94714-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hack-Lyoung Kim ◽

Jung Pyo Lee ◽

Nathan Wong ◽

Woo-Hyun Lim ◽

Jae-Bin Seo ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Stable Condition ◽

Baseline Serum ◽

Soluble St2 ◽

Increased Risk ◽

Artery Disease ◽

Stable Cad

AbstractThe role of ST2 in stable coronary artery disease (CAD) has not yet been well defined. This study was performed to investigate baseline serum soluble ST2 (sST2) level can predict clinical outcomes in patients with stable CAD. A total of 388 consecutive patients with suspected CAD (65 years and 63.7% male) in stable condition referred for elective invasive coronary angiography (ICA) was prospectively recruited. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization (90 days after ICA), and ischemic stroke during clinical follow-up was assessed. Most of the patients (88.0%) had significant CAD (stenosis ≥ 50%). During median follow-up of 834 days, there was 29 case of MACE (7.5%). The serum sST2 level was significantly higher in patients with MACE than those without (47.3 versus 30.6 ng/ml, P < 0.001). In multiple Cox regression model, higher sST2 level (≥ 26.8 ng/ml) was an independent predictor of MACE even after controlling potential confounders (hazard ratio, 13.7; 95% confidence interval 1.80–104.60; P = 0.011). The elevated level of baseline sST2 is associated with an increased risk of adverse clinical events in stable CAD patients. Studies with larger sample size are needed to confirm our findings.

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The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.621330 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tzu-Yuan Wang ◽

Hsin-Hung Chen ◽

Chun-Hung Su ◽

Sheng-Pang Hsu ◽

Chun-Wei Ho ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Pleural Empyema ◽

Arterial Disease ◽

Population Based ◽

Rank Test ◽

Research Database ◽

Increased Risk ◽

Using Data ◽

Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

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Perioperative changes of response to antiplatelet medication in vascular surgery patients

PLoS ONE ◽

10.1371/journal.pone.0244330 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244330

Author(s):

Thomas Hummel ◽

Saskia Hannah Meves ◽

Andreas Breuer-Kaiser ◽

Jan-Ole Düsterwald ◽

Dominic Mühlberger ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Vascular Surgery ◽

Reactive Protein ◽

Antiplatelet Medication ◽

Impedance Aggregometry ◽

Increased Risk ◽

Potential Risk Factors ◽

Artery Disease

Introduction Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.

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