Unrecognized History of Transient Atrial Fibrillation at the Time of Discharge from an Index Stroke Hospitalization Is Associated with Increased Recurrent Stroke Risk / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Preceding episodes of paroxysmal atrial fibrillation (AF) among stroke patients can be easily overlooked in routine clinical practice. We aim to determine whether an unrecognized history of paroxysmal AF is associated with an increased risk of recurrent stroke. METHODS: We retrospectively identified all adult patients hospitalized with a primary diagnosis of ischemic stroke who had no AF diagnosis on their discharge records, using the Taiwan National Health Insurance Research Database between January 2001 and December 2012. Patients were categorized into two groups: unrecognized AF history and no AF. Patients with unrecognized AF history were defined as having documented AF preceding the index ischemic stroke hospitalization, but not recording at the index ischemic stroke. Primary endpoint was recurrent stroke within 1 year after the index stroke. RESULTS: Among 203,489 hospitalized ischemic stroke patients without AF diagnosed at discharge, 6,731 patients (3.3%) had an unrecognized history of prior transient AF. Patients with an unrecognized AF history, comparing to those without AF, had higher adjusted risk of all recurrent stroke ([original cohort: hazard ratio (HR), 1.41; 95% confidence interval [CI], 1.30 to 1.53], [matched cohort: HR, 1.51; 95% CI, 1.37 to 1.68]) and recurrent ischemic stroke ([original cohort: HR, 1.42; 95% CI, 1.30 to 1.55], [matched cohort: HR, 1.56; 95% CI, 1.40 to 1.74]) during the 1-year follow-up period. CONCLUSIONS: Unrecognized history of AF among patients discharged after an index ischemic stroke hospitalization is associated with higher recurrent stroke risk. Careful history review to uncover a paroxysmal AF history is important for ischemic stroke patients.

Kidney cancer and diabetes mellitus: a population-based case-control study in Taiwan

<p><b>INTRODUCTION</b>The purpose of this study was to explore whether diabetes mellitus (DM) correlates with the risk of kidney cancer in Taiwan.</p><p><b>MATERIALS AND METHODS</b>We designed a population-based case-control study from the Taiwan National Health Insurance Database, which consisted of 116 patients with newly diagnosed kidney cancer as cases and 464 subjects without kidney cancer as controls in 2000 to 2009. Both cases and controls were aged ≥20 years. Baseline comorbidities were compared between kidney cancer cases and controls.</p><p><b>RESULTS</b>Multivariable analysis showed no association was detected between DM and kidney cancer (OR 1.06, 95% CI, 0.58 to 1.94). Hypertension (OR 2.05, 95% CI, 1.23 to 3.42), chronic kidney diseases (OR 2.57, 95% CI, 1.23 to 5.37), cystic kidney diseases (OR 18.6, 95% CI, 1.84 to 187.6) and kidney stones (OR 4.02, 95% CI, 2.43 to 6.66) were significant comorbidities associated with increased risk of kidney cancer. Use of alpha-glucosidase inhibitor was associated with increased risk of kidney cancer (OR 4.31, 95% CI, 1.07 to 17.3).</p><p><b>CONCLUSION</b>DM does not correlate with the risk of kidney cancer. Hypertension, chronic kidney diseases, cystic kidney diseases, kidney stones and use of alpha-glucosidase inhibitors are associated with kidney cancer.</p>

Cardiovascular disease and colorectal cancer: a population-based observation in Taiwan

To explore the relationship between cardiovascular disease and colorectal cancer in Taiwan. Population-based cohort study. Using database of the Taiwan National Health Insurance program from 2000 to 2006, 89,034 patients [35 years or older] with newly diagnosed cardiovascular disease [CVD] which included coronary artery disease, heart failure, cerebrovascular disease, peripheral atherosclerosis, or hypertension, and 89,034 control subjects without CVD were studied. The incidence of colorectal cancer at the end of 2009 and the association with CVD and other co-morbidities were determined. The incidence of colorectal cancer was 1.19-fold higher in the CVD group compared with the non-CVD group [10.87 Vs 9.11 per 10,000 person-years, 95%CI = 1.05-1.36]. After adjustment for covariates, no association was found between CVD and colorectal cancer [95%CI = 0.87-1.13]. Men [HR = 1.53, 95%CI = 1.34-1.75], increasing age [HR = 1.07, 95%CI = 1.06-1.07], and colorectal adenoma [HR = 1.80, 95%CI = 1.06-3.05] were associated with colorectal cancer. No association between cardiovascular disease and colorectal cancer is found. Men, increasing age, and colorectal adenoma correlate with the increased risk of colorectal cancer