Shyi-Jang Shin

Hypoadiponectinemia Is Associated With Ischemic Cerebrovascular Disease

Objective—Adiponectin, an adipocyte-derived peptide with antiinflammatory and antiatherogenic effects, is known to protect against the initiation and progression of atherosclerosis. In this study, we investigate whether hypoadiponectinemia is present in patients with ischemic cerebrovascular disease (CVD). Methods and Results—In this case-control study, plasma adiponectin concentration was measured by an enzyme-linked immunosorbent assay in type 2 diabetic and nondiabetic subjects with or without ischemic CVD. A total of 534 subjects were studied. The mean plasma level of adiponectin of the 228 patients with ischemic CVD was significantly lower than that of 306 subjects without CVD. When the analysis was stratified according to diabetes status, plasma levels of adiponectin in CVD subjects with or without type 2 diabetes were significantly lower than those of their counterparts. Decreasing concentrations of adiponectin were independently and significantly associated with a higher risk of CVD when concentrations were analyzed by quartile and as a continuous variable. When patients with CVD were subgrouped according to the comorbidity with or without type2 diabetes, the same trend of association between plasma adiponectin and risk of CVD was observed in each group. Conclusion—These data show that there are significantly lower levels of plasma adiponectin in patients with ischemic CVD.

Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis.

Objectiveu2002 Epicardial adipose tissue (EAT) is a part of visceral fat deposited around the heart between the pericardium and myocardium along the distribution of coronary arteries. EAT thickness is reported to be associated with coronary atherosclerosis; however, no study has measured EAT volume in patients with type 2 diabetes or investigate its association with coronary artery disease.

Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus.

There is increasing evidence that leukocytes play a central role in obesity, glucose intolerance, type 2 diabetes mellitus (T2DM), and cardiovascular diseases, but the role of differential leukocytes in metabolic syndrome (MetS) and atherosclerosis is largely unknown. The aim of this study was to examine the relationship between the component features of MetS and peripheral leukocyte counts and to explore whether leukocyte counts are associated with clustering of MetS and macrovascular diseases in patients with T2DM.

Elevated Visfatin/Pre-B-cell Colony-enhancing Factor Plasma Concentration in Ischemic Stroke

BACKGROUNDnVisfatin/pre-B-cell colony-enhancing factor is a cytokine that is expressed as a protein in several tissues (e.g., liver, skeletal muscle, immune cells), including adipose tissue, and is reported to stimulate inflammatory cytokine expressions and promote vascular smooth cell maturation. Visfatin may act as a proinflammatory cytokine and be involved in the process of atherosclerosis. In this study, we investigated whether plasma visfatin levels were altered in patients with ischemic stroke.nnnMETHODSnPlasma visfatin concentrations were measured through enzyme immunoassays in patients with ischemic stroke and in control subjects without stroke.nnnRESULTSnThe mean plasma concentration of visfatin in the 120 patients with ischemic stroke was significantly higher than that of the 120 control subjects without stroke (51.5 +/- 48.4 v 23.0 +/- 23.9 ng/mL, P < .001). Multiple logistic regression analysis confirmed plasma visfatin to be an independent factor associated with ischemic stroke. Increasing concentrations of visfatin were independently and significantly associated with a higher risk of ischemic stroke when concentrations were analyzed as both a quartile and a continuous variable. The multiple logistic regression analysis-adjusted odds ratios and 95% confidence intervals for ischemic stroke in the second, third, and fourth quartiles were 2.3 (0.7-7.7), 6.9 (2.2-23.3), and 20.1 (4.9-97.7), respectively. Plasma visfatin concentration was positively associated with high-sensitivity C-reactive protein levels and negatively associated with low-density lipoprotein cholesterol.nnnCONCLUSIONSnOur results indicate that higher visfatin levels are associated with ischemic stroke in the Chinese population.

ENPP1 K121Q polymorphism is not related to type 2 diabetes mellitus, features of metabolic syndrome, and diabetic cardiovascular complications in a Chinese population.

BACKGROUNDnEctoenzyme nucleotide pyrophosphate phosphodiesterase 1 (ENPP1) is known to influence insulin sensitivity by inhibiting insulin receptor signaling. A DNA polymorphism in the ENPP1 gene at exon 4 (K121Q) was demonstrated to be associated with insulin resistance, type 2 diabetes mellitus (T2DM), and a risk of early myocardial infarction, albeit with controversy. Our aim was to investigate any association of ENPP1 K121Q alleles with T2DM, features of the metabolic syndrome, and diabetic cardiovascular complications in a Chinese population of Han origin.nnnMETHODSnThe ENPP1 K121Q polymorphism was determined by a restriction fragment-length polymorphism-polymerase chain reaction in 1,862 patients with T2DM and 844 non-diabetic subjects.nnnRESULTSnThe genotype distributions or Q-allele frequency were not statistically different between the diabetic and non-diabetic groups. The anthropometric parameters, systolic and diastolic blood pressures, lipid profiles, and serum creatinine levels of subjects with different ENPP1 K121Q polymorphisms were not statistically different in the two groups or even in the pooled data. When sub-group analyses of diabetic subjects were stratified according to BMI levels (greater or less than 27), gender, age of diabetes onset (older or younger than 60 years), and the presence or absence of a diabetic family history; this polymorphism was still not associated with T2DM. Nor was the ENPP1 K121Q polymorphism associated with the prevalence of coronary artery disease and ischemic cerebrovascular disease in patients with T2DM.nnnCONCLUSIONnThe ENPP1 K121Q polymorphism is not related to T2DM, features of the metabolic syndrome, or diabetic macrovascular complications in a Chinese population.

Areca nut chewing is associated with metabolic syndrome: role of tumor necrosis factor-alpha, leptin, and white blood cell count in betel nut chewing-related metabolic derangements.

Areca nut ( Areca catechu )/betel quid (BQ) is said to be the fourth most commonly used psychoactive substance in the world and is chewed regularly by at least 10% of the world’s population (1). High prevalences of BQ chewing were observed especially in South and Southeast Asia (1). High prevalences of insulin resistance and metabolic syndrome were also observed in this area (2). Specific areca alkaloids act as competitive inhibitors of γ-aminobutyric acid receptors …

Cost-Effectiveness of Diabetes Pay-for-Performance Incentive Designs

Background:Taiwan’s National Health Insurance (NHI) Program implemented a diabetes pay-for-performance program (P4P) based on process-of-care measures in 2001. In late 2006, that P4P program was revised to also include achievement of intermediate health outcomes. Objectives:This study examined to what extent these 2 P4P incentive designs have been cost-effective and what the difference in effect may have been. Research Design and Method:Analyzing data using 3 population-based longitudinal databases (NHI’s P4P dataset, NHI’s claims database, and Taiwan’s death registry), we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in each phase. Propensity score matching was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings, and incremental cost-effectiveness ratios. Results:QALYs for P4P patients and non-P4P patients were 2.08 and 1.99 in phase 1 and 2.08 and 2.02 in phase 2. The average incremental intervention costs per QALYs was TWD

Vascular endothelial growth factor polymorphisms and extent of coronary atherosclerosis in Chinese population with advanced coronary artery disease.

335,546 in phase 1 and TWD

The association between participation in a pay-for-performance program and macrovascular complications in patients with type 2 diabetes in Taiwan: A nationwide population-based cohort study ☆

298,606 in phase 2. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD

Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions

602,167 in phase 1 and TWD