Validation of the Framingham General Cardiovascular Risk Score and Pooled Cohort Equations in a Community-Based Population: A Prospective Cohort Study Analysis 2006-2017.

Background: The 10-year atherosclerotic cardiovascular disease (ASCVD) risk - as assessed using the Framingham general cardiovascular risk score (FRS-CVD) or pooled cohort equations (PCE) - is commonly used in Western cohorts for the primary prevention of cardiovascular disease (CVD). However, the FRS-CVD and PCE have not been validated in Taiwanese cohorts. Objectives: We aimed to validate the FRS-CVD and PCE for assessing the 10-year ASCVD risk using a Taiwanese community-based population. Methods: We extracted patient data from the Landseed Integrated Outreaching Neighborhood Screening registry, a community-based prospective cohort study established in 2006. Cardiovascular events from 2006 to 2017 were determined from electronic medical records. The discriminative power and calibration of the FRS-CVD and PCE were evaluated. Results: Overall, 5,139 subjects were analyzed; the 10-year follow-up rate was 99.6%. The mean age at baseline was 52.8 ± 13.1 years, and 44.6% of the subjects were male. In total, 430 of 4,631 (9.3%) and 227 of 4,022 (5.6%) of the FRS-CVD- and PCE-like cohorts, respectively, had ASCVD events. The calibration χ2 of the FRS-CVD was 7.0267 (p = 0.6343) in males and 7.8845 (p = 0.5458) in females; the χ2 of PCE was 13.007 (p = 0.1623) in males and 38.785 (p < 0.001) in females. The area under the receiver operating characteristic curve (AUROC) of the FRS-CVD was 0.76 (0.72-0.79) in males and 0.71 (0.67-0.74) in females; the AUROC of PCE was 0.68 (0.62-0.73) in males and 0.61 (0.56-0.67) in females. Conclusions: Except for PCE in females, the FRS-CVD and PCE provided good calibration and modest discrimination in statin-naïve Taiwanese individuals without prior CVD.

Does coffee drinking have beneficial effects on bone health of Taiwanese adults? A longitudinal study.

BACKGROUND: Results from studies investigating the association between coffee consumption and osteoporosis or bone mineral density (BMD) have been inconsistent. This longitudinal study was performed to assess the effect of coffee drinking on bone health of Taiwanese adults. METHODS: Data were retrieved from the Li-Shin (Landseed) Hospital in Taoyuan City. In 2006, 6152 participants completed a questionnaire on coffee drinking and other lifestyle factors. In 2014, 5077 of them were followed up. Nonetheless, a total of 2395 participants with incomplete data were excluded. The final analyses included 2682 participants comprising 1195 men and 1487 women (706 premenopausal and 781 postmenopausal). T-scores were derived from the osteo-sono assessment index (OSI) which is a surrogate of BMD. Coffee drinking was categorized as "no, medium, and high" based on the number of cups that were consumed per week in both 2006 and 2014. RESULTS: In general, medium and high coffee drinking were associated with higher T-scores. However, significant results were observed only among high drinkers (ß = 0.158; P = 0.0038). Nonetheless, the test for linear trend was significant (P = 0.0046). After stratification by sex, medium and high coffee drinking were associated with higher T-scores. However, significant results were prominent only among high male drinkers (ß = 0.237; P = 0.0067) and the test for trend was significant (P = 0.0161). Based on menopausal status, coffee drinking was associated with higher T-scores. Nevertheless, significant results were found only among premenopausal women (ß = 0.233; P = 0.0355 and ß = 0.234; P = 0.0152 for medium and high coffee drinking, respectively. The test for linear trend was significant (P = 0.0108). CONCLUSION: Coffee drinking was significantly associated with higher T-scores hence, a lower risk of osteoporosis in men and premenopausal women.

Increased risk of chronic kidney disease among users of non-prescribed Chinese herbal medicine in Taiwan.

BACKGROUND: Taiwan has the highest incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Chinese herbal medicine (CHM) has been linked to CKD/ESRD in Taiwan. The specific effects and frequency of CHM on the risk of CKD are unknown. METHODS: A hospital-based case-control study was performed from August 2006 through December 2009. The cases were consecutive nephrology outpatients 20years of age or older, with a first-time diagnosis of CKD, and without cancer or pre-existing renal disease. The controls were randomly selected outpatients that did not have CKD and were matched 1:1 to cases for age, gender and date of outpatient visit. RESULTS: Four hundred and twenty-four patients were recruited. Among 212 cases, 23.6% took non-prescribed CHM, compared to 6.6% among the controls (p<0.001). Multivariate analysis showed that illiteracy [odds ratio (OR) 6.3, 95% confidence interval (CI) 2.4-16.6], hypertension (OR 5.4, 95% CI 2.9-9.8) and occasional use of non-prescribed CHM (OR 6.2, 95% CI 1.8-21.6) were positively associated with CKD, whereas regular exercise was inversely associated with CKD (OR 0.5, 95% CI 0.3-0.9). CONCLUSION: Occasional use of non-prescribed CHM was associated with the risk of CKD in Taiwan.

Risk factors of in-hospital mortality of intracerebral hemorrhage and comparison of ICH scores in a Taiwanese population.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is associated with substantial morbidity and mortality. This study aimed to explore the risk factors associated with mortality and unfavorable outcome of ICH in Taiwan and to compare the predictive power with the existing ICH scores. METHODS: Medical records of the ICH patients consecutively admitted to a regional hospital between January 2003 and December 2006 were reviewed retrospectively. The demographics, outcome, clinical and radiological characteristics were also analyzed. RESULTS: A total of 61 among 285 (21.4%) ICH patients died during hospitalization. Diabetes mellitus, lower scores of initial Glasgow Coma Scale, initial ICH volume >30 ml, and intraventricular hematoma were identified as major independent risk factors associated with in-hospital mortality in the logistic regression model. In comparison to the predictive power for mortality and unfavorable outcome, Barthel Index <40 at discharge, the results showed no significant difference among the scores derived from our study, the ICH score by Hemphill and the modified ICH score developed in Taiwan. CONCLUSIONS: Although these ICH scores developed with various measurements, no significant difference in predicting mortality and unfavorable functional outcomes was found. The results supporting the ICH score by Hemphill may provide a good prediction in acute outcome across ethnic groups.

Changes in High-Density Lipoprotein Cholesterol Levels in Relation to Coffee Consumption Among Taiwanese Adults.

PURPOSE: High-density lipoprotein cholesterol (HDL-C) is essential for cardiometabolic health. Coffee consumption influences the body's ability to regulate serum lipid profile. Although there is extensive information on coffee and cholesterol, not much is known whether changes in HDL-C concentrations are affected by coffee with or without flavoring substances. MATERIALS AND METHODS: Using historical data collected from 1272 participants in Li-Shin (Landseed) International Hospital in Northern Taiwan, we examined the relationship between HDL-C and consumption of plain black coffee with and without additives. Data on coffee consumption between 2006 and 2019 were collected based on self-reported questionnaires while HDL-C measurements were obtained from the electronic medical records of the hospital. t-test, chi-square test and multivariate linear regression analysis were used for analysis. RESULTS: In our primary analysis, we found that coffee consumption of ≥5 cups per week was positively associated with HDL-C (ß = 1.9586, p=0.0442) compared with the lowest level (<1 cup/week) of consumption. We found in a separate model that higher (≥5 cups/week) or lower (1-4 cups/week) consumption of plain black coffee without additives was associated with higher HDL-C. The corresponding ß values were 4.0674 (p = 0.0007) and 4.1253 (p = 0.0008), respectively. However, HDL-C levels were not affected by coffee with additives. CONCLUSION: We found that consumption of black coffee without additives was associated with higher concentrations of HDL-C among Taiwanese adults over the age of 30. However, HDL-C levels did not change significantly among individuals who consumed black coffee with additives.

Biological risk factors relevant to chronic disease in three ethnic groups in Taiwan: results from Li-Shin Outreaching Neighborhood Screening (LIONS A1).

OBJECTIVES: Few population-based studies have compared risk factors related to chronic diseases across multiethnic groups of Chinese people. Consequently, we report the prevalence of common chronic disorders that make up the metabolic syndrome and compare their distribution in three ethnic subgroups: the offspring of Hakka, Minnan, and mainlander women. METHODS: We included 6854 participants in the Li-Shin Outreaching Neighborhood Screening (LIONS) project: 3088 (45.1%) Hakkas, 2461 (35.9%) Minnans, and 1305 (19.0%) mainlanders. Information on demographic features and recognized lifestyle factors was collected by using questionnaires; data on biological markers of metabolic syndrome were collected from serum samples by using standard biochemical analyses. RESULTS: Miscegenation averaged 22%. Smoking, alcohol consumption, and betel chewing varied across the three subpopulations. After controlling for demographic features and these three risk factors, men with mainlander mothers had more body fat. Compared with offspring with Hakka mothers, attendees whose mothers were from Minnan had higher uric acid concentrations. CONCLUSIONS: Despite the rarity of racial miscegenation in the three ethnic groups, most biological markers of metabolic syndrome were identical across the groups. Disparities were found for hyperuricemia in attendees whose mothers were from Minnan and for obesity in men whose mothers were mainlanders. These findings can help design health policy for the early detection of chronic disease in different ethnic Chinese groups.

HDL and associated factors stratified by sex and menopausal status: results from a community-based survey in Taiwan.

AIM: To investigate factors, especially modifiable factors associated with high-density lipoprotein (HDL) in Taiwanese based on sex and menopausal status. MATERIALS AND METHODS: Participants comprised 2022 men and 2392 women (1267 menopausal and 1125 non-menopausal) aged ≥30 years who resided in Pingzhen district, Taoyuan from 2006-2011. Their data, obtained through questionnaires and measurements were retrieved from the Li-Shin Hospital. RESULTS: Higher HDL was associated with total cholesterol, underweight, and alcohol drinking in both men and women. It was also associated with education, blood group B, and marital status in men as well as with age in women. Moreover, it was associated with total cholesterol, underweight, and age in both menopausal and non-menopausal women. Furthermore, it was associated with marital status in non-menopausal women and alcohol drinking in menopausal women. Lower HDL was associated with triglycerides, low-density lipoprotein (LDL), overweight, obesity, waist-hip ratio (WHR), uric acid, and smoking in both men and women and with coffee drinking in only women. It was also associated with uric acid, triglycerides, LDL, overweight, obesity, WHR, and body fat in both menopausal and non-menopausal women. Moreover, it was associated with coffee drinking in menopausal women. CONCLUSION: Modifiable factors associated with HDL differ according to sex and menopausal status. Sex and menopausal status should be considered when implementing lifestyle changes to raise HDL. For example, both men and women should maintain a normal weight as well as quit smoking.

Prescribed Renoprotective Chinese Herbal Medicines Were Associated with a Lower Risk of All-Cause and Disease-Specific Mortality among Patients with Chronic Kidney Disease: A Population-Based Follow-Up Study in Taiwan.

Chinese herbal medicines (CHMs) containing aristolochic acid (AA) are associated with chronic kidney disease (CKD), but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM) was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk.) Sacc.), da huang (Rheum palmatum L), huang qi (Astragalus membranaceus), dan shen (Salvia miltiorrhiza Bge.), and dong quai (Angelica sinensis (Oliv.) Diels) or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang). Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR) for all-cause mortality was 0.6 (p < 0.001) and 0.6 (p = 0.013) among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025). The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients.

Correlation between transition percentage of minute volume (TMV%) and outcome of patients with acute respiratory failure.

PURPOSE: We have previously shown in patients receiving adaptive support ventilation (ASV) that there existed a Transition %MinVol (TMV%) where the patient's work of breathing began to reduce. In this study, we tested the hypothesis that higher TMV% would be associated with poorer outcome in patients with acute respiratory failure. MATERIALS AND METHODS: In this prospective observational study, we recruited patients with acute respiratory failure on ASV between December 2012 and September 2013 in a mixed ICU. The TMV% was determined by adjusting % MinVol until mandatory respiratory frequency was between 0 and 1breath/min. TMV% was measured on the first two days of mechanical ventilation. RESULTS: A total of 337 patients (age: 70±16years) were recruited. In patients whose TMV% increased between Day 1 and Day 2, aOR for mortality was 7.0 (95%CI=2.7-18.3, p<0.001) compared to patients whose TMV% decreased. In patients whose TMV% was unchanged between Day 1 and Day2, aOR for mortality was 3.91 (95%CI=1.80-8.22, p<0.01). CONCLUSIONS: An increase, or lack of decrease, of TMV% from Day 1 to Day 2 was associated with higher risk of in-hospital death.

Non-aristolochic acid prescribed Chinese herbal medicines and the risk of mortality in patients with chronic kidney disease: results from a population-based follow-up study.

OBJECTIVES: To evaluate the relationship between the use of non-aristolochic acid (AA) prescribed Chinese herbal medicines (CHMs) and the risk of mortality in patients with chronic kidney disease (CKD). DESIGN: Nationwide population-based follow-up study. SETTING: Longitudinal health insurance database sampled from the Taiwan National Health Insurance Research Database. PARTICIPANTS: A total of 47 876 patients with CKD were identified. Participants who had ever used AA-containing CHMs, had cancer or HIV prior to the diagnosis of CKD, died within the first month of CKD diagnosis and who were not Taiwanese citizens were excluded. A total of 13 864 participants were eligible for final analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: All-cause mortality among patients with CKD between 2000 and 2008. RESULTS: After controlling for potential confounders, we found that participants who started to receive non-AA prescribed CHMs after the diagnosis of CKD had a lower risk of mortality as compared with non-users of non-AA prescribed CHMs (adjusted HR (aHR) 0.6; 95% CI 0.4 to 0.7, p<0.001). Moreover, participants who had used non-AA prescribed CHMs prior to and after the diagnosis of CKD also had a lower risk of mortality than non-users (aHR 0.6; 95% CI 0.5 to 0.8, p<0.001). In subgroup analyses, we found that such an inverse association was present only among patients who were not eligible to receive erythropoietin therapy (ie, serum creatinine ≦6 mg/dL and/or haematocrit value ≧28%). CONCLUSIONS: Patients who received non-AA prescribed CHMs after the diagnosis of CKD, yet before the start of erythropoietin therapy had a lower risk of mortality than those who did not.

Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography.

OBJECTIVE: To construct a predictive model to foretell congenital muscular torticollis (CMT) on the basis of clinical correlates. DESIGN: Correlation study. SETTING: Regional hospital. PARTICIPANTS: A consecutive series of 1021 newborn infants. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participants underwent portable ultrasonography to diagnose CMT. Significant clinical correlates were identified to construct a predictive model using the logistic regression model. RESULTS: Forty of 1021 infants were diagnosed with CMT using ultrasonography, yielding an overall incidence of 3.92%. Birth body length (odds ratio [OR]=1.38; 95% confidence interval [CI], 1.49-2.38), facial asymmetry (OR=21.75; 95% CI, 6.6-71.7), plagiocephaly (OR=22.3; 95% CI, 7.01-70.95), perineal trauma during delivery (OR=4.26; 95% CI, 1.25-14.52), and primiparity (OR=6.32; 95% CI, 2.34-17.04) were significant correlates. A predictive logistic regression model with the incorporation of these 4 correlates was developed. We used cross-validation with a receiver operating characteristic curve to validate the predictive model. CONCLUSIONS: Our study successfully developed a quantitative predictive model for estimating the risk of CMT on the basis of clinical correlates only. This model has good discriminative ability for classifying CMT and non-CMT by yielding acceptable values of false-negative and false-positive cases.