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1.
Circ J ; 84(2): 283-293, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31932560

RESUMO

BACKGROUND: In Asia, little information is available about contemporary real-world treatment patterns for venous thromboembolism (VTE).Methods and Results:Consecutive patients (n=11,414) from the Taiwan National Health Insurance Research Database with initial VTE and taking oral anticoagulants between May 1, 2014 and June 30, 2016 were included. The temporal trends of using oral anticoagulants and pharmacomechanical therapy during the study period were evaluated. The efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs. warfarin were compared. Propensity score analysis (NOACs n=3,647 vs. warfarin n=3,647) was used to balance covariates between groups, and Cox proportional hazards models with adjustment were used to estimate the risks of clinical outcomes. The use of NOACs increased from 0.3% to 60.2% for VTE treatment during the study period. Pharmacomechanical therapy was used in 9.60%, 8.22%, and 5.63% from 2014 through 2016. NOACs were associated with a 16% risk reduction (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.77-0.93) in all-cause mortality and a 21% risk reduction (aHR 0.79, 95% CI 0.65-0.96) in recurrent VTE vs. warfarin. Overall, NOACs were associated with a lower risk of major bleeding compared with warfarin (aHR 0.804, 95% CI 0.648-0.998). CONCLUSIONS: In real-world practice, NOACs have become the major anticoagulant used for Asians with VTE. Although NOACs had a lower risk of recurrent VTE and major bleeding compared with warfarin in Taiwan, we still need a large-scale randomized controlled trial to confirm the findings.

2.
Circ J ; 84(2): 136-143, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31852863

RESUMO

The Asia-Pacific Society of Cardiology (APSC) high-sensitivity troponin T (hs-TnT) consensus recommendations and rapid algorithm were developed to provide guidance for healthcare professionals in the Asia-Pacific region on assessing patients with suspected acute coronary syndrome (ACS) using a hs-TnT assay. Experts from Asia-Pacific convened in 2 meetings to develop evidence-based consensus recommendations and an algorithm for appropriate use of the hs-TnT assay. The Expert Committee defined a cardiac troponin assay as a high-sensitivity assay if the total imprecision is ≤10% at the 99th percentile of the upper reference limit and measurable concentrations below the 99th percentile are attainable with an assay at a concentration value above the assay's limit of detection for at least 50% of healthy individuals. Recommendations for single-measurement rule-out/rule-in cutoff values, as well as for serial measurements, were also developed. The Expert Committee also adopted similar hs-TnT cutoff values for men and women, recommended serial hs-TnT measurements for special populations, and provided guidance on the use of point-of-care troponin T devices in individuals suspected of ACS. These recommendations should be used in conjunction with all available clinical evidence when making the diagnosis of ACS.

3.
Nat Prod Res ; : 1-6, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31448637

RESUMO

Tetradium ruticarpum (Juss.) Benth. belong to the family of Rutaceae. The complete and nearly ripe fruits of T. ruticarpum is used as traditional Chinese medicine and phytochemical investigations have been conducted on extracts of the seeds of T. ruticarpum to provide scientific validation of its properties. In this study, we successfully isolated two new quinolone alkaloids (1-2) from the MeOH extractive of nearly ripe fruits of T. ruticarpum. The structure elucidation of these compounds was determined by one- and two-dimensional nuclear magnetic resonance, ultraviolet and electrospray ionisation time-of-flight mass spectrometry. This finding expands the understanding of the natural constituents of the Rutaceae, in particular, the Tetradium genera.

4.
J Chin Med Assoc ; 82(6): 447-451, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180944

RESUMO

Heart failure (HF) is a growing challenge in the Asia Pacific region. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established tool for diagnosis of HF; however, it is relatively underutilized in predicting adverse outcomes in HF. Multiple studies have demonstrated the prognostic role of NT-proBNP in HF. A single value of NT-proBNP >5000 pg/mL predicts a worse outcome in hospitalized patients with HF with reduced ejection fraction (HFrEF). In stable outpatients with HFrEF, NT-proBNP > 1000 pg/mL predicts a poorer prognosis. NT-proBNP provides the same prognostic information in patients with HF with preserved ejection fraction (HFpEF) as in those with HFrEF. An expert panel composed of cardiologists mainly from Asia Pacific region was convened to discuss the utility of NT-proBNP in HF prognostication. This article summarizes available scientific evidence and consensus recommendations from the meeting.

5.
Atherosclerosis ; 287: 54-63, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31212235

RESUMO

BACKGROUND AND AIMS: Thrombomodulin (TM) is an endothelial cell membrane-bound anticoagulant protein expressed in normal arteries. After vascular injury, medial and neointimal smooth muscle cells (SMCs) exhibit large amounts of TM. The purpose of this study was to investigate the physiological significance of vascular SMC-bound TM. METHODS: The morphology, expression of phenotype markers and cell behaviors of cultured aortic SMCs after knockdown of TM were observed. Transgenic mice with SMC-specific TM deletion were generated, and carotid neointima formation was induced by carotid ligation. RESULTS: Cultured human aortic SMCs displayed a synthetic phenotype with a rhomboid-shaped morphology and expressed TM. TM knockdown induced a spindle-shaped change in morphology with an increased expression of contractile phenotype marker and decreased expression of synthetic phenotype marker. TM knockdown not only attenuated the proliferation of SMCs but also reduced tumor necrosis factor-α-induced nuclear factor-κB activation and interlukin-6 production. In a carotid artery ligation model, transgenic mice with SMC-specific TM deletion (SM22-cretg/TMflox/flox) had significantly less cellular proliferation in arterial walls compared with wild type mice (SM22-cretg/TM+/+). The neointima area and neointima/media area ratio were smaller in SM22-cretg/TMflox/flox mice at 4 weeks after ligation. CONCLUSIONS: Our results indicate that vascular SMC-bound TM plays a role in changes of the SMC phenotype. It also influences SMC cell behavior and injury-induced neointima formation.

6.
Circ J ; 83(6): 1317-1323, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31061379

RESUMO

BACKGROUND: Little information is available in Asia about the real-world practice of dual antiplatelet therapy (DAPT) duration for acute coronary syndrome (ACS) and its influence on clinical outcomes.Methods and Results:The Taiwan ACS STENT Registry was a prospective, multicenter study to observe ACS patients using clopidogrel-based DAPT after percutaneous coronary intervention (PCI). The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. Overall, 2,221 ACS patients (62 years, 83% men) were included. DAPT duration was ≤9 months in 935 (42.1%). The incidence of primary outcome was higher in patients receiving DAPT ≤9 months compared with those receiving DAPT >9 months at 1 year (3.5% vs. 1.6%, P=0.0026). The incidence of stent thrombosis (overall 0.5%) was similar between groups. Multivariable analysis showed that DAPT >9 months was associated with a significantly lower risk of primary outcome (odds ratio 0.725, 95% confidence interval 0.545-0.965). CONCLUSIONS: Our data showed that short duration of DAPT (≤9 months) was common (42.1%) in Taiwan for ACS patients undergoing PCI. DAPT ≤9 months increased the risk of the primary outcome.

7.
J Formos Med Assoc ; 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31113748

RESUMO

Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease, cerebrovascular disease, and peripheral artery disease, carries a high morbidity and mortality. Risk factor control is especially important for patients with ASCVD to reduce recurrent cardiovascular events. Clinical guidelines have been developed by the Taiwan Society of Cardiology, Taiwan Society of Lipids and Atherosclerosis, and Diabetes Association of Republic of China (Taiwan) to assist health care professionals in Taiwan about the control of hypertension, hypercholesterolemia and diabetes mellitus. This article is to highlight the recommendations about blood pressure, cholesterol, and sugar control for ASCVD. Some medications that are beneficial for ASCVD were also reviewed. We hope the clinical outcomes of ASCVD can be improved in Taiwan through the implementation of these recommendations.

8.
Acta Cardiol Sin ; 35(1): 1-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30713394

RESUMO

Background: Patients with acute coronary syndrome (ACS), including ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation (NSTE)-ACS have a significant risk of morbidity and mortality. This study evaluated the practice patterns of ACS care in Taiwan from 2005 to 2018. Methods: Data from two nationwide ACS registries (2008-2010 and 2012-2015) were used. ACS patients who received percutaneous coronary interventions (PCIs) during admission were compared between the two registries. Results: In STEMI, the door-to-balloon time for primary PCI decreased by 25 min from a median of 96 to 71 min (p < 0.0001) from the first to second registry. More complex PCI procedures and drug-eluting stents were used for ACS. However, the onset-to-door time was still long for both STEMI and NSTE-ACS. The D2B time for NSTE-ACS was long, especially in the elderly and female patients. Although the prescription rate of secondary preventive medications for ACS increased, it was still relatively low compared with Western data, especially in NSTE-ACS. Conclusions: The registry data showed that ACS care quality has improved in Taiwan. However, areas including onset-to-door time and use of secondary preventive medications still need further improvements.

9.
J Formos Med Assoc ; 118(10): 1385-1392, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30584005

RESUMO

Statin reduces low-density lipoprotein cholesterol and improves clinical outcomes in high risk patients. In general, statin is a safe and well-tolerated medication. However, varieties of adverse effects are reported in some patients and may interfere long-term drug compliance. Statin-associated muscle events and liver function change account for most of these adverse effects. Patients are regarded as statin intolerance if they need to discontinue statin therapy due to these adverse effects. To date, there is no universal standard definition of statin intolerance. But a pragmatic definition of statin intolerance is essential and helpful for clinicians in daily practice. In this article, after expert consensus meetings and literature review, criteria were recommended to identify patients with statin intolerance in Taiwan. The purpose of this statement is to help health care professionals in Taiwan to diagnose and manage individuals who develop muscular and hepatic side effects after statin therapy.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Doenças Musculares/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Crônica , Consenso , Humanos , Hepatopatias/complicações , Doenças Musculares/terapia , Fatores de Risco , Taiwan
10.
J Stroke Cerebrovasc Dis ; 28(3): 815-820, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30573284

RESUMO

BACKGROUND: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. METHODS: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antitrombinas , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Dabigatrana/antagonistas & inibidores , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Hemorragia Cerebral/induzido quimicamente , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Esquema de Medicação , Estudos de Viabilidade , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Taiwan/epidemiologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
11.
Can J Cardiol ; 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-32204951

RESUMO

BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends high-intensity statin (HIS) in patients with atherosclerotic cardiovascular disease, but little is known about the efficacy and safety of HIS in Asian ethnicity. We assessed the effects of HIS in Taiwanese with acute myocardial infarction (AMI). METHODS: Consecutive patients admitted for new AMI between January 2010 and December 2013 without prior statin use were enrolled from the Taiwan National Health Insurance Research Database. Patients were grouped based on the intensity of statin they took after discharge. The primary endpoint was the composite outcome of all-cause mortality, recurrent myocardial infarction, and stroke. We also compared the incidences of severe hepatitis and myopathy that need admission between HIS and non-HIS groups. We used propensity score analysis to match covariates between groups and Cox proportional hazards models with adjustment to estimate the risks of clinical outcomes. RESULTS: After 1:4 propensity score match, there were 4402 patients in the HIS group and 17,608 patients in the non-HIS group. After follow-up for 3 years, 668 patients (15.2%) in the HIS group and 2749 (15.6%) in the non-HIS group had the primary composite endpoint. Cox proportional-hazards analyses showed that HIS did not further reduce composite endpoint (adjusted hazard ratio, 0.975; 95% confidence interval, 0.896-1.062); however, HIS patients had a lower risk of ischemic stroke at 3-year follow-up. Regarding safety, HIS did not increase hospitalization rates for severe hepatitis and myopathy. CONCLUSIONS: Patients with AMI in Taiwan with HIS had similar clinical outcomes to those with non-HIS. Using HIS for the effective reduction of low-density lipoprotein cholesterol is safe in Taiwan.

12.
Am J Cardiol ; 122(12): 1996-2004, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30301543

RESUMO

Most studies about the trends of acute myocardial infarction (AMI) were based on the data from Western countries. In recent years, little information is available from Asia since 2010. This study assessed the nationwide trends of AMI in Taiwan from 2009 to 2015. Using data from the Taiwan National Health Insurance Research Database, we identified 100,570 adult patients hospitalized for AMI from 2009 to 2015 and examined the temporal trends in the incidence of AMI. Overall, the age- and gender-adjusted incidence of AMI (per 100,000 persons) remained constant from 49.8 in 2009 to 50.7 in 2015. The incidence of AMI increased 30.3% and 29.4% in the young male and female populations (<55 years), whereas in other age groups, the incidence decreased or remained unchanged. The ratio of non-ST-segment elevation MI (NSTEMI) to STEMI incidence increased from 1.93 in 2009 to 2.47 in 2015. In young men (<55 years), a 49.8% increase in NSTEMI was observed. The prevalence of dyslipidemia increased significantly and it was the most common risk factor of AMI in young patients. Despite being increasingly used, percutaneous coronary intervention and secondary preventive medications, including dual antiplatelet therapy, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, ß blocker and statin, were less prescribed for NSTEMI compared with STEMI. The in-hospital mortality of STEMI continued to decrease from 2013 to 2015 (8.8% to 7.6%), but not in NSTEMI (13.3% to 13.5%). In conclusion, our study revealed a marked increase of NSTEMI in young Taiwanese male population in recent years. Despite the increased utilization of percutaneous coronary intervention and guideline-recommended medications, the overall in-hospital mortality of NSTEMI remained stagnating in Taiwan.


Assuntos
Gerenciamento Clínico , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Taxa de Sobrevida/tendências , Taiwan/epidemiologia
13.
Acta Cardiol Sin ; 34(5): 371-378, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30271086

RESUMO

Intensive lipid lowering therapy is important in patients with acute coronary syndrome (ACS) and stable coronary artery disease (CAD). The 2017 Taiwan Lipid Guidelines for High Risk Patients was recently published. The guideline suggests that low-density lipoprotein cholesterol (LDL-C) should be the primary target, and that the treatment goal of LDL-C is < 70 mg/dL for patients with ACS or stable CAD. A lower target of < 55 mg/dL is appropriate for patients with ACS and diabetes mellitus. Non-high-density lipoprotein cholesterol (non-HDL-C) < 100 mg/dL can be considered as the secondary target after achieving the LDL-C goal for patients with a triglyceride level > 200 mg/dL. Statins are usually the first-line therapy. Moderate or high intensity statins are preferred, and up-titration to the highest recommended and tolerable dose to reach the target is necessary. Combination therapy with statins and other lipid-lowering drugs can also be considered. We hope the clinical outcomes of patients with ACS or CAD can be improved in Taiwan through the implementation of the guideline recommendations.

14.
J Chin Med Assoc ; 81(10): 853-859, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29980360

RESUMO

Dyslipidemia is a major contributor in initiation, development and progression of atherosclerotic cardiovascular disease (ASCVD). Most lipid guidelines are from Europe and America and centered on the reduction of atherogenic lipids levels through lifestyle intervention and pharmacotherapy. Recently, the 2017 Taiwan lipid guidelines for high risk patients was published to facilitate the control of dyslipidemia in patients that are highly susceptible to ASCVD, including patients with preexisting ASCVD, diabetes, chronic kidney disease and familial hypercholesterolemia. Most recommendations outlined in the 2017 Taiwan lipid guidelines for high risk patients are in concordance with those of Western guidelines. However, based on evidence from the studies originating from Asia and local expert opinions, there are some recommendations different from the other guidelines. The purpose of the current review is to compare the similarities and differences between the perspectives of the 2017 Taiwan lipid guidelines for high risk patients and other Western guidelines in individuals at high risk of ASCVD. The definitions of high risk groups and treatment goals defined to achieve ASCVD risk reduction are specifically compared.


Assuntos
Dislipidemias/sangue , Lipídeos/sangue , Aterosclerose/sangue , Aterosclerose/tratamento farmacológico , Aterosclerose/etiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/sangue , Humanos , Hiperlipoproteinemia Tipo II/sangue , Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/sangue , Taiwan
16.
J Formos Med Assoc ; 117(9): 766-790, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30017533

RESUMO

In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment. Risk stratification should be performed to identify high risk patients for early coronary angiography. Through evaluation of the coronary anatomy and other clinical factors, the decision for coronary revascularization, either by percutaneous coronary intervention or coronary artery bypass grafting, should be decided by the heart team. The duration of dual antiplatelet therapy should be given for at least 12 months after discharge. Other secondary preventive medications are also recommended for long term use.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/classificação , Síndrome Coronariana Aguda/fisiopatologia , Anticoagulantes/uso terapêutico , Cardiologia/normas , Angiografia Coronária , Medicina de Emergência/normas , Humanos , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Medição de Risco , Fatores de Risco , Sociedades Médicas , Taiwan , Terapia Trombolítica
17.
J Formos Med Assoc ; 117(9): 814-824, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29945742

RESUMO

BACKGROUND: The aim of this study is to determine the relationship between the on-treatment lipid profiles and the CV events in CKD and non-CKD population. METHOD: This study was a multi-center observational registry, the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. This study follows up patients with CV diseases in Taiwan who have secondary prevention therapies. The primary outcome is the time of first occurrence of a major adverse cardiac events (MACEs). RESULT: 5388 patients with ASCVD were included and 1478 (27.4%) had CKD without dialysis. CKD patients had higher TG and lower LDL-C levels. The incidence of recurrent MACEs per 1000 person-years in CKD patients was 19.5 (95% CI 15.5-24.9), compared with 9.1 (95% CI 7.4-11.1) in non-CKD patients. In patients with statin therapy, there were no differences in MACE risk between each level of on-treatment LDL-C, TG and HDL-C level. Higher on-treatment non-HDL-C level was a significant predictor for higher MACE risk in patients without CKD, and borderline significant in CKD patients under statin therapy. Heart failure history was also associated with higher MACE risk in both group. Lower body mass index (BMI < 23 kg/m2) was associated with higher MACE risk in CKD patients. CONCLUSION: In ASCVD patients, on-treatment LDL-C was not a good CV outcome predictor. Instead, on-treatment non-HDL-C was a better predictor. Heart failure history was also associated with higher MACE risk in both group of patients. Lower BMI (<23 kg/m2) was associated with higher recurrent MACE risk in CKD patients.


Assuntos
Anticolesterolemiantes/uso terapêutico , Aterosclerose/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Insuficiência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Prevenção Secundária , Taiwan/epidemiologia
18.
Acta Cardiol Sin ; 34(3): 201-210, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29844641

RESUMO

Antiplatelet therapy is a key component in the treatment of acute coronary syndrome (ACS). The management of ACS has evolved considerably over recent years with the development of new and more potent antiplatelet agents. Clinical trials on ACS have demonstrated that potent antiplatelet agents can more effectively reduce cardiovascular events. However, there is a tipping point between safety and efficacy, beyond which the risk of bleeding and other adverse effects can outweigh the benefits of antiplatelet therapy. Striking a balance between safety and efficacy remains a major challenge. A consensus meeting of an expert panel composed of Taiwanese experts was held to provide recommendations for the management of adverse effects in patients with ACS receiving antiplatelet therapy. The common adverse effects of antiplatelet therapy include upper gastrointestinal bleeding, ecchymosis, hematuria, epistaxis and ticagrelor-related dyspnea. In this study, a literature review of these adverse events was performed and recommendations for the management were made.

19.
J Am Coll Cardiol ; 71(11): 1273-1283, 2018 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-29544612

RESUMO

Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate. However, all were improved, either by changing National Health Insurance policy or through continuous education for physicians and patients. Thus, specific cardiovascular disease registries could help examine the status of real-world practice, find inadequacies in guideline implementation and understanding of rare diseases, facilitate lobbying to policy makers and education for physicians and patients, and influence and improve cardiovascular patient care.


Assuntos
Doenças Cardiovasculares , Administração dos Cuidados ao Paciente , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Sistema de Registros , Taiwan/epidemiologia
20.
J Chin Med Assoc ; 81(3): 189-222, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29453020

RESUMO

The global incidence and prevalence of type 2 diabetes have been escalating in recent decades. Patients with type 2 diabetes have an increased risk of atherosclerotic cardiovascular disease (ASCVD). About two-thirds of death in type 2 diabetes are due to ASCVD, including 40% from coronary heart disease (CHD), 15% from heart failure (HF), and 10% from stroke. The association between hyperglycemia and elevated CV risk has been demonstrated in multiple cohort studies. However, clinical trials of intensive glucose reduction did not significantly reduce macrovascular outcomes. It remains unclear whether the absence of demonstrable benefits is attributed to the inclusion of patients with far advanced ASCVD in whom a short treatment period is barely enough for CV protective effects to be shown, or complications associated with the treatment such as hypoglycemia hamper the beneficial effects to manifest, or simply glucose-lowering per se is ineffective. Since the US FDA issued a mandate in December 2008 that every new anti-diabetic agent requires rigorous assessments of its CV safety, there have been more than 200,000 patients enrolled in a number of randomized controlled trials (RCTs), and around half of them have been completed and published. The results of these CV outcome trials are important for clinicians in their clinical practice, and also provide an opportunity for academic society to formulate treatment guidelines or consensus to provide specific recommendations for glucose control in various CV diseases. The Taiwan Society of Cardiology (TSOC) and the Diabetes Association of Republic of China (DAROC), aiming to formulate a treatment consensus in type 2 diabetic patients with CVD, have appointed a jointed consensus group for the 2018 Consensus of TSOC/DAROC (Taiwan) on the Pharmacological Management of Patients with Type 2 Diabetes and CV Diseases. The consensus is comprised of 5 major parts: 1) Treatment of diabetes in patients with hypertension, 2) Treatment of diabetes in patients with CHD, 3) Treatment of diabetes in patients with stage 3 chronic kidney disease, 4) Treatment of diabetes in patients with a history of stroke, and 5) Treatment of diabetes in patients with HF. The members of the consensus group comprehensively reviewed all the evidence, mainly RCTs, and also included meta-analyses, cohort studies, and studies using claim data. The treatment targets of HbA1c were provided. The anti-diabetic agents were ranked according to their clinical evidence. The consensus is not mandatory. The final decision may need to be individualized and based on clinicians' discretion.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Consenso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cardiologia , Taxa de Filtração Glomerular , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Sociedades Médicas , Taiwan
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