Gwo-Ping Jong

Statins and New-Onset Diabetes: A Retrospective Longitudinal Cohort Study

BACKGROUND Statins have been linked to new-onset diabetes (NOD); however, the effect of statins on the development of NOD in patients with hypertension and dyslipidemia has not been well studied. OBJECTIVE The goal of this study was to investigate the association between statins and NOD. METHODS This was a retrospective cohort study performed by using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2006 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazards ratios (HRs) of NOD associated with statin use. Nondiabetic subjects served as the reference group. RESULTS A total of 1360 (8.5%) NOD cases were identified among 16,027 patients with hypertension and dyslipidemia during the study period. The risk of NOD after adjusting for sex and age was higher among users of pravastatin (HR, 1.34 [95% CI, 1.15-1.55]) and atorvastatin (HR, 1.29 [95% CI, 1.16-1.44]) than among nonusers. Patients who took fluvastatin (HR, 0.45 [95% CI, 0.34-0.60]), lovastatin (HR, 0.71 [95% CI, 0.61-0.84]), and rosuvastatin (HR, 0.54 [95% CI, 0.39-0.77]) were at lower risk of developing NOD than nonusers. Simvastatin was not associated with risk of NOD. Furthermore, the risk of NOD after adjusting for concomitant medication usage and mean dose of statins was neutral among users of atorvastatin. Pravastatin, fluvastatin, lovastatin, simvastatin, and rosuvastatin produced similar results as adjusting for sex and age. CONCLUSIONS These outpatients with hypertension and dyslipidemia who took fluvastatin, lovastatin, and rosuvastatin were at lower risk of NOD, whereas patients who took pravastatin were at greater risk. Simvastatin and atorvastatin seemed to have a neutral effect. Our study also demonstrated that atorvastatin has a dose-response effect on NOD risk. Because this was a descriptive study, temporality and subsequent causality of all statins and NOD could not be shown. Further study and independent confirmation of the causality between statin use and NOD in larger clinical trials are warranted.

The Long-Term Effect of Statins on the Risk of New-Onset Diabetes Mellitus in Elderly Taiwanese Patients with Hypertension and Dyslipidaemia

Background: HMG-CoA reductase inhibitors (statins) have been linked to new-onset diabetes (NOD). Individual statins may differ in the extent to which they increase the risk for NOD; however, the effect of statins on the development of NOD in elderly hypertensive and dyslipidaemic patients has not been well studied.Objective: The aim of this study was to investigate the relative risk for NOD among elderly (age ≥65 years) hypertensive and dyslipidaemic Taiwanese patients who received different statins.Methods: This was a retrospective cohort study performed using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2004 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazard ratios (HRs) of NOD associated with statin use. Non-diabetic subjects served as the reference group.Results: A total of 2735 NOD cases were identified among 15 637 elderly hypertensive and dyslipidaemic patients during the study period. The risk of NOD after adjusting for sex, age, concomitant medication and mean dose of prescription was lower among users of atorvastatin (HR 0.77; 95% CI 0.71, 0.83) and rosuvastatin (HR 0.65; 95% CI 0.51, 0.82) than among non-users. Patients who took lovastatin (HR 1.38; 95% CI 1.26, 1.50) or simvastatin (HR 1.30; 95% CI 1.14, 1.48) were at higher risk of developing NOD than non-users. Pravastatin and fluvastatin were not associated with increased risk of NOD.Conclusions: The results of this study suggest that elderly hypertensive and dyslipidaemic patients who take atorvastatin or rosuvastatin are at lower risk of NOD. Lovastatin and simvastatin were associated with a significant increase in the risk of NOD.

Antihypertensive Drugs and New-Onset Diabetes: A Retrospective Longitudinal Cohort Study

Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined. We aimed to investigate the association between antihypertensive drugs and NOD. This was a retrospective cohort study performed using data from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2002 to December 2007. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. A total of 4233 NOD cases were identified in 24,688 hypertensive patients during the study period. The risk of NOD after adjusting for sex and age was higher among users of diuretics (OR = 1.10, 95% confidence interval [CI]= 1.01-1.20), beta-blockers (BBS; OR = 1.12, 95% CI = 1.04-1.21), and calcium channel blockers (CCBs; OR = 1.10, 95% CI = 1.02-1.18) than among nonusers. Patients who take angiotensin-converting enzyme (ACE) inhibitors (OR = 0.92, 95% CI = 0.84-1.00), angiotensin receptor blockers (ARB; OR = 0.90, 95% CI = 0.81-0.98), or alpha-blockers (OR = 0.88, 95% CI = 0.80-0.98) are at a lower risk of developing NOD than nonusers. Vasodilators were not associated with the risk of NOD. The results of this study suggest that hypertensive patients who take ACE inhibitors, ARBs, or alpha-blockers are at a lower risk of NOD. Diuretics, BBs, and CCBs were associated with a significant increase in the risk of NOD.

The relationship between antihypertensive combination therapies comprising diuretics and/or β-blockers and the risk of new-onset diabetes: a retrospective longitudinal cohort study

We investigate the associations of antihypertensive drugs in double and triple combination regimens comprising diuretics and/or β-blockers on the development of new-onset diabetes (NOD). This study was a retrospective cohort study carried out using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance (BNHI) in Taiwan from January 2001 to December 2006. We estimated the odds ratios (ORs) of NOD associated with antihypertensive combination therapy use; non-NOD individuals served as the reference group. A total of 2361 NOD cases were identified among the 12 386 hypertensive patients (6143 men and 6243 women, aged 28–86 years (mean age: 68+11)) during the study period. The risk of NOD was higher after adjusting for age and sex among users of double combinations of diuretics plus β-blockers (adjusted OR, 1.25; 95% confidence interval (CI): 1.12–1.58), diuretics plus calcium channel blockers (CCBs; adjusted OR: 1.14; 95% CI: 1.06–1.26) and β-blockers plus calcium channel blockers (adjusted OR: 1.12; 95% CI: 1.04–1.29) than that among non-users. Patients who took angiotensin-converting enzyme (ACE) inhibitors, or α-blockers as part of a double-drug regimen were at a lower risk of developing NOD than were non-users. Double- or triple-drug combinations comprising angiotensin receptor blockers (ARBs) and vasodilators were not associated with risk of NOD. The results of this study suggest that users of double-drug combination therapies containing diuretics and/or β-blockers and an ACE inhibitor or α-blocker are at a significantly lower risk of developing NOD than are other classes.

Long-term effect of antihypertensive drugs on the risk of new-onset atrial fibrillation: a longitudinal cohort study

Antihypertensive drugs have been linked to new-onset atrial fibrillation (NAF); however, the way in which these drugs affect the development of NAF in hypertensive patients has not been thoroughly examined. Herein, we report a population-based study in which we investigated the relationship between antihypertensive drug therapy and the risk of NAF. The population sample consisted of 47 682 hypertensive patients identified from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan between January 2005 and December 2010. Prescriptions for antihypertensive drugs prescribed before the index date were retrieved from a prescription database. From these data, we estimated the hazard ratio (HR) of NAF associated with antihypertensive drug use; non-NAF subjects served as the reference group. After adjusting for age and sex, we observed that the risk of NAF was higher among the patients taking diuretics (HR, 1.39; 95% confidence interval (CI), 1.06–1.82) compared with the patients not taking diuretics. Patients who took angiotensin-converting enzyme (ACE) inhibitors (HR, 0.79; 95% CI, 0.65–0.97) showed a lower risk of developing NAF compared with the nonusers of ACE inhibitors. Angiotensin receptor blockers, alpha-blockers, beta-blockers and calcium channel blockers were not associated with a risk of NAF. The results of this study suggest that hypertensive patients who take diuretics have a significant increase in the risk of NAF, whereas patients who take ACE inhibitors are at lower risk of NAF.

Long-term effect of statins on the risk of new-onset osteoporosis: A nationwide population-based cohort study

Background Several observational cohort and meta-analytical studies in humans have shown that statin users have a lower risk of fractures or greater bone mineral densities (BMD) than nonusers. However, some studies including randomized clinical trials have the opposite results, particularly in Asian populations. Objective This study investigates the impacts of statins on new-onset osteoporosis in Taiwan. Methods In a nationwide retrospective population-based cohort study, 45,342 subjects aged between 50–90 years having received statin therapy (statin-users) since January 1 2001, and observed through December 31 2013 were selected from the National Health Insurance Research Database of Taiwan. Likewise, 115,594 patients had no statin therapy (statin-non-users) were included as controls in this study. Multivariable Cox proportional hazards analysis for drug exposures was employed to evaluate the association between statin treatment and new-onset of osteoporosis risk. We also used the long-rank test to evaluate the difference of probability of osteoporosis-free survival. Results During the 13-year follow-up period, 16,146 of all enrolled subjects (10.03%) developed osteoporosis, including 3097 statin-users (6.83%) and 13,049 statin-non-users (11.29%). Overall, statin therapy reduced the risk of new-onset osteoporosis by 48% (adjusted hazard ratio [HR] 0.52; 95% CI 0.50 to 0.54). A dose-response relationship between statin treatment and the risk of new-onset osteoporosis was observed. The adjusted hazard ratios for new-onset osteoporosis were 0.84 (95% CI, 0.78 to 0.90), 0.56 (95% CI, 0.52 to 0.60) and 0.23 (95% CI, 0.21 to 0.25) when cumulative defined daily doses (cDDDs) ranged from 28 to 90, 91 to 365, and more than 365, respectively, relative to nonusers. Otherwise, high-potency statins (rosuvastatin and atorvastatin) and moderate-potency statin (simvastatin) seemed to have a potential protective effect for osteoporosis. Conclusions In this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders. The osteoprotective effect of statins seemed to be more prominent with a dependency on the cumulative dosage and statin intensity.

High-potency statins but not all statins decrease the risk of new-onset osteoporotic fractures: a nationwide population-based longitudinal cohort study

Background Statins have been linked to new-onset osteoporotic fractures (NOFs), and different statins may alter the risk for the development of NOFs. Aim In this study, we investigated the association between different statins and the development of NOFs. Patients and methods This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance, including case patients with NOFs from January 2004 to December 2013 and non-NOF subjects. We estimated the hazard ratios (HRs) of NOFs associated with statin use. Nonuser subjects served as the reference group. Results A total of 44,405 patients with NOFs were identified from among 170,533 patients with hyperlipidemia during the study period. The risk of developing NOFs after adjusting for age, sex, comorbidities, and concurrent medication use was lower among users of atorvastatin (HR, 0.77; 95% CI, 0.71–0.84) and rosuvastatin (HR, 0.72; 95% CI, 0.64–0.81) than among simvastatin users. Lovastatin, pravastatin, fluvastatin, and pitavastatin were not associated with the risk of developing NOFs compared with simvastatin users. Conclusion This study supports previous reports regarding a beneficial effect of statin use and NOF risk, but not all statins. Patients taking atorvastatin or rosuvastatin were at lower risk of developing NOFs compared with simvastatin users during the 10-year follow-up. Other statins such as pravastatin, fluvastatin, lovastatin, and pitavastatin were not associated with NOFs. This study also highlighted that high-potency statin has a dose–response effect on lower NOF risk.

Retrograde Emboli in an Occluded Arteriovenous Graft in Percutaneous Transluminal Angioplasty Complicated Acute Basilar Artery Occlusion

We reported the case of a 65-year-old man with chronic renal failure. After percutaneous transluminal angioplasty for an occluded arteriovenous graft, acute loss of consciousness occurred suddenly. Emergent neurological consultation resulted in activation of an acute stroke protocol. Intra-arterial thrombolysis with recombinant tissue plasminogen activator was performed, resulting in recanalization. Echocardiography, carotid Doppler sonography, and vascular intervention excluded other possible etiologies. Retrograde thromboemboli in the occluded arteriovenous graft was highly suspected. (J Intern Med Taiwan 2014; 25: 15-19)

Hyperosmolar, Hyperglycemic, Nonketotic Coma Associated with Acute Myocardial Infarction: A Case Report

One of the precipitating factors of hyperosmolar, hyperglycemic, nonketotic coma is acute myocardial infarction. Although the relationship between acute myocardial infarction and hyperglycemic, nonketotic coma has been well described, the coexistence of hyperglycemic, nonketotic coma and acute myocardial infarction is still rare clinically. We present a patient who suffered an acute myocardial infarction after going into a hyperosmolar, hyperglycemic, nonketotic coma in the intensive care unit.