BACKGROUND:

Factors of cancer occurrence among Parkinson disease patients are still not well known, although genetic predilection has been investigated. The aim of this study is to evaluate the medication effect of dopamine agonists of Parkinson disease on incidence of cancers from the Taiwan National Health Insurance Research Database.

METHODS:

We conducted a population-based nested case-control study by using the resources of the Taiwanese National Health Insurance from 1996 to 2000 and analyzed the prevalence of cancer among patients with Parkinson disease. A nested analysis was then implemented among those patients with both Parkinson disease and cancer, focusing separately on the use of ergot- and nonergot-derived-dopamine agonists.

RESULTS:

We reviewed 6211 patients with Parkinson's disease and found 329 patients with cancer. The ergot-derived dopamineagonists users were associated with an increased odds ratio for cancer, compared with nonergot-derived dopamine agonist users, with an adjusted odds ratio of 2.16 (95% confidence interval, 1.55-2.99). Among all the cancer types, we observed the higher occurrence of liver cancer among the ergot-derived dopamine agonist users.

CONCLUSION:

The association of ergot-derived-dopamine agonist use and cancers, especially the liver cancers, has provided us the information to further understand the drug-cancer interaction. We hope this result would prompt further investigations on the risk and benefit of the dopamine agonists use among the Parkinson's disease patients.

BACKGROUND:

Few studies have investigated the relationship between carbon monoxide (CO) poisoning and risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we conducted a nationwide longitudinal cohort study in Taiwan to determine whether patients with CO poisoning are associated with increased risk of developing DVT and PE.

METHODS:

This study investigated the incidence and risk factors for DVT and PE in 8316 patients newly diagnosed with CO poisoning from the Taiwan National Health Insurance Research Database between 2000 and 2011. The comparison cohort contained 33 264 controls without CO poisoning from the general population. Follow-up was initiated on the date of initial diagnosis of CO poisoning and continued until the date of a DVT or PE event, censoring or December 31, 2011. Cox proportional hazard regression models were used to analyse the risk of DVT and PE according to sex, age and comorbidities.

RESULTS:

The incidences of DVT and PE were higher in the patients with CO poisoning than in the controls (5.67 vs 1.47/10 000 person-years and 1.97 vs 1.02/10 000 person-years, respectively). After adjusting for age, sex and comorbidities, the patients with CO poisoning were associated with a 3.85-fold higher risk of DVT compared with the comparison cohort, and non-significantly associated with risk of PE. CO poisoning patients with a coexisting comorbidity or acute respiratory failure were associated with significantly and substantially increased risk of DVT.

CONCLUSION:

Risk of DVT is significantly higher in patients with CO poisoning than in the general population.

Carbon monoxide (CO) poisoning is considered one of the most crucial health concerns. Few studies have investigated the correlation between CO poisoning and the risk of developing cardiovascular diseases (CVDs). Therefore, we conducted a population-based, longitudinal cohort study in Taiwan to determine whether patients with CO poisoning are associated with higher risk of developing subsequent CVDs, including arrhythmia, coronary artery disease (CAD) and congestive heart failure (CHF). This retrospective study used the National Health Insurance Research Database. The study cohort comprised all patients aged ≥20 years with a diagnosis of CO poisoning and hospitalized during 2000 to 2011 (N = 8381), and the comparison cohort comprised randomly selected non-CO-poisoned patients (N = 33,524) frequency-matched with the study cohort by age, sex, and the year of index date. Each patient was individually tracked to identify those who develop CVD events during the follow-up period. Cox proportional hazards regression model was performed to calculate the hazard ratios of CVDs after adjusting for possible confounders. The overall incidences of arrhythmia, CAD, and CHF were higher in the patients with CO poisoning than in the controls (2.57 vs 1.25/1000 person-years, 3.28 vs 2.25/1000 person-years, and 1.32 vs 1.05/1000 person-years, respectively). After adjusting for age, sex, and comorbidities, the patients with CO poisoning were associated with a 1.83-fold higher risk of arrhythmia compared with the comparison cohort, and nonsignificantly associated with risk of CAD and CHF. CO-poisoned patients with coexisting comorbidity or in high severity were associated with significantly and substantially increased risk of all 3 CVDs. CO poisoning is associated with increased risk of subsequent development of arrhythmia. Future studies are required to explore the long-term effects of CO poisoning on the cardiovascular system.

This study aimed to examine whether poor glycemic control, measured by glycated hemoglobin A1C (HbA1c) and other cardiovascular risk factors, can predict diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (DM).Patients aged ≥30 years with type 2 DM, enrolled in the National Diabetes Care Management Program, and free of DPN (n = 37,375) in the period 2002 to 2004 were included and followed up until 2011. The related factors were analyzed using Cox proportional hazards regression models.For an average follow-up of 7.00 years, 8379 cases of DPN were identified, with a crude incidence rate of 32.04/1000 person-years. After multivariate adjustment, patients with HbA1c levels 7 to 8%, 8 to 9%, 9 to 10%, and ≥10% exhibited higher risk of DPN (adjusted HR: 1.11 [1.04-1.20], 1.30 [1.21-1.40], 1.32 [1.22-1.43], and 1.62 [1.51-1.74], respectively) compared with patients with HbA1c level 6 to 7%. There was a significant linear trend in DPN incidence with increasing HbA1c (P < 0.001) and significant HRs of DPN for patients with HbA1c level ≥7%, blood pressure ≥130/85 mm Hg, triglycerides (TG) ≥150 mg/dL, high density of lipoprotein-cholesterol (HDL-C) <40 mg/dL in males and <50 mg/dL in females, low density of lipoprotein-cholesterol (LDL-C) ≥100 mg/dL, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m.Patients with type 2 DM and HbA1c ≥7.0% exhibit increased risk of DPN, demonstrating a linear relationship. The incidence of DPN is also associated with poor glucose control and cardiovascular risk factors like hypertension, hyper-triglyceridemia, low HDL-C, high LDL-C, and decreased eGFR.

BACKGROUND:

To investigate the effect of carvedilol on the incidence of cancer in a large population-based cohort study.

METHODS:

Data were obtained from the Taiwan National Health Insurance Research Database. The cohort study included 6771 patients who received long-term carvedilol treatment between 2000 and 2010 (carvedilol cohort) and 6771 matched controls (noncarvedilol cohort). A Cox proportional hazards model was used to evaluate the risk of cancer in the patients treated with carvedilol.

RESULTS:

With the mean follow-up period of 5.17 years and 4.93 years in the carvedilol and noncarvedilol cohorts, respectively, the patients in the carvedilol cohort had a 26% reduction of cancer risk compared with those in the noncarvedilol cohort (hazard ratio [HR]=0.74; 95% confidence interval [CI]=0.63-0.87; p<.001). The sex-specific carvedilol to noncarvedilol relative risk was lower for both women (HR=0.73; 95% CI=0.56-0.94) and men (HR=0.75; 95% CI=0.61-0.92). Moreover, stratified by cancer site, treatment with carvedilol in the carvedilol cohort resulted in significantly lower incidence of stomach and lung cancers than in the noncarvedilol cohort.

CONCLUSION:

This nationwide population-based cohort study demonstrated that long-term treatment with carvedilol is associated with reduced upper gastrointestinal tract and lung cancer risk, indicating that carvedilol could be a potential agent in these cancers prevention.