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      Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan

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          Abstract

          Background and Objectives: There are inconsistent results about the association between ischemic cerebrovascular disease and tamoxifen use in women with breast cancer. The study aimed to evaluate the association between the risk of ischemic cerebrovascular disease and tamoxifen use in older women with breast cancer in Taiwan.

          Methods: We designed a retrospective, nationwide, case-control study using the database of the Taiwan National Health Insurance Program. A total of 800 female subjects with breast cancer aged ≥65 years with the first episode of ischemic cerebrovascular disease from 2000 to 2011 were identified as the cases. Additionally, 2,876 female subjects with breast cancer aged ≥65 years without any type of cerebrovascular diseases were selected as the control subjects. The cases and the control subjects were matched with age and comorbidities. Ever use of tamoxifen was defined as a subject who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was defined as a subject who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for ischemic cerebrovascular disease associated with tamoxifen use.

          Results: After adjusting for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 2.5 for subjects with ever use of tamoxifen (95% CI 2.10, 2.97), compared with never use of tamoxifen. In addition, the adjusted OR of ischemic cerebrovascular disease was 1.15 (95% CI 1.10, 1.21) in subjects with ever use of tamoxifen as increase in use duration per 1 year. The adjusted OR of ischemic cerebrovascular disease was 2.54 (95% CI 2.03, 3.17) in subjects with ever use of tamoxifen as increase in dosage per 1 mg.

          Conclusions: Tamoxifen use is significantly associated with 2.5-fold increased odds of ischemic cerebrovascular disease among older women with breast cancer in Taiwan. There are duration-dependent and dose-dependent effects of tamoxifen use on the risk of ischemic cerebrovascular disease.

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          Most cited references49

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          Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study.

          Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted a population-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.We found that patients were older than controls, predominantly female, and more likely to use 5 or more drugs (22.2% vs. 9.3%, p or = 85 years who used 10 or more drugs than for those aged 65-74 years who used 0-1 drug after controlling for covariates (OR, 23.0; 95% CI, 3.77-140).We conclude that the risk of hip fracture in older people increases with the number of medications used, especially in women. Age interacts with the daily medications for the risk of hip fracture.
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            Diabetes mellitus correlates with increased risk of pancreatic cancer: a population-based cohort study in Taiwan.

            This study investigated whether diabetes mellitus (DM) increased the risk of pancreatic cancer and whether anti-diabetic drugs reduced the risk in Taiwan. We designed a population-based cohort study using the Taiwan National Health Insurance Database, which consisted of 49,803 patients aged 20 years and older with newly diagnosed DM as the diabetic group and 199,212 people without DM as the non-diabetic group during 1998-2007. The incidence of pancreatic cancer was higher in patients with diabetic duration less than 2 years, as compared to the non-diabetic group (27.81 vs 6.96 per 10,000 person-years, 95% confidence interval = 2.11-7.54). Age (aged 40-64, hazard ratio [HR] = 5.22, and aged 65 and older, HR = 7.59, respectively), chronic pancreatitis (HR = 19.40), gallstones (HR = 2.56), and hepatitis C infection (HR = 3.08) were also significant factors predicting pancreatic cancer. Patients with concurrent DM and chronic pancreatitis had an appreciably elevated risk of developing pancreatic cancer (HR = 33.52), as compared with subjects without these comorbidities. The association was not statistically significant between use of anti-diabetic drugs and the risk of pancreatic cancer. Diabetes < 2 years' duration is associated with pancreatic cancer and could be an early manifestation of pancreatic cancer. Long-standing diabetes was not found to be a risk factor for pancreatic cancer in Taiwan's patients. Old age, chronic pancreatitis, gallstones and hepatitis C infection are other risk factors for pancreatic cancer. These high-risk patients should undergo close follow-up programs for pancreatic cancer. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
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              Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study.

              Cryptogenic stroke is associated with an increased prevalence of patent foramen ovale. The Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) study hypothesized that patients with cryptogenic stroke have an increased prevalence of pelvic deep venous thrombosis (DVT). At 5 sites, patients 18 to 60 years of age received an MRI venogram (MRV) of the pelvis within 72 hours of new symptom onset. Clinical data were then determined. Radiologists blinded to clinical data later read the scans. The 95 patients who met entry criteria were scanned. Their mean+/-SD age was 46+/-10 years, and time from stroke onset to pelvic MRV scan was 49+/-16 hours. Compared with those with stroke of determined origin (n=49), patients with cryptogenic stroke (n=46) were significantly younger, had a higher prevalence of patent foramen ovale (61% versus 19%), and had less atherosclerosis risk factors. Cryptogenic patients had more MRV scans with a high probability for pelvic DVT (20%) than patients with stroke of determined origin (4%, P<0.03), with most having an appearance of a chronic DVT. In this study of young stroke patients evaluated early after stroke, patients with cryptogenic stroke showed differences in several clinical features compared with patients with stroke of determined origin, including increased prevalence of pelvic DVT. The results require confirmation but suggest that paradoxical embolus from the pelvic veins may be the cause of stroke in a subset of patients classified as having cryptogenic stroke.
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                Author and article information

                Contributors
                Journal
                Front Pharmacol
                Front Pharmacol
                Front. Pharmacol.
                Frontiers in Pharmacology
                Frontiers Media S.A.
                1663-9812
                17 October 2017
                2017
                : 8
                : 742
                Affiliations
                [1] 1Department of Medicine, China Medical University , Taichung, Taiwan
                [2] 2Department of Family Medicine, China Medical University Hospital , Taichung, Taiwan
                [3] 3Management Office for Health Data, China Medical University Hospital , Taichung, Taiwan
                [4] 4Department of Medicine, Tzu Chi University , Hualien, Taiwan
                [5] 5Department of Internal Medicine, Taichung Tzu Chi General Hospital , Taichung, Taiwan
                Author notes

                Edited by: Jean-Marie Boeynaems, Free University of Brussels, Belgium

                Reviewed by: Domenico Criscuolo, Genovax S.r.l., Italy; Sandor Kerpel-Fronius, Semmelweis University, Hungary

                *Correspondence: Kuan-Fu Liao kuanfuliaog@ 123456gmail.com

                This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology

                Article
                10.3389/fphar.2017.00742
                5651079
                2fa681d0-b0a9-41f5-a0d4-c0ac2a57e724
                Copyright © 2017 Lai, Lin and Liao.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 August 2017
                : 02 October 2017
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 52, Pages: 7, Words: 5054
                Categories
                Pharmacology
                Original Research

                Pharmacology & Pharmaceutical medicine
                breast cancer,ischemic cerebrovascular disease,woman,taiwan national health insurance program,tamoxifen

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