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      Statin use and Vital Organ Failure in Patients With Asthma–Chronic Obstructive Pulmonary Disease Overlap: A Time-Dependent Population-Based Study

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          Abstract

          Objective: The effects of statins on the risk of hepatic, renal, respiratory, and heart failure among patients with asthma–chronic obstructive pulmonary disease overlap (ACO) have not been reported.

          Design: Time-dependent population-based study.

          Setting: Patient data from 2000 to 2010 were retrieved from the Taiwan National Health Insurance Research Database.

          Patients: We divided patients with ACO into cohorts of statin use (N = 1,211) and nonuse (N = 7,443).

          Measurements and Main Results: The cumulative incidence rates of hepatic, renal, respiratory, and heart failure were analyzed through Cox proportional regression analysis with time-dependent variables. After adjustment for multiple confounding factors, including age, sex, comorbidities, and medications [statins, inhaled corticosteroid (ICS), or oral steroid (OS)], the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] for hepatic, renal, respiratory, and heart failure were 0.50 (0.40–0.64), 0.49 (0.38–0.64), 0.61 (0.27–2.21), and 0.47 (0.37–0.60), respectively. The aHRs (95% CIs) for statin use with [ICS, OS] for hepatic, renal, and heart failure were [0.36 (0.20–0.66), 0.52 (0.39–0.70)]; [0.82 (0.51–1.34), 0.46 (0.33–0.63)]; and [0.66 (0.40–1.07), 0.48 (0.37–0.64)], respectively.

          Conclusions: The ACO cohort with statin use exhibited lower risk of hepatic, renal, and heart failure than any other cohort, regardless of age, sex, comorbidities, or ICS or OS use. Regarding the combined use of statins and ICS, the risks of hepatic failure were lower. For the combined use of statins and OS, hepatic, renal, and heart failure were less frequent.

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          Most cited references54

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          Validation of Acute Myocardial Infarction Cases in the National Health Insurance Research Database in Taiwan

          Background The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosis coding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoses listed in the NHIRD with those in the medical records obtained from a medical center in Taiwan. Methods This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medical center (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewing the relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement in comorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the two databases was evaluated. Results We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent complete chart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPV of 0.88. The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yielding a PPV over 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMI cases. Conclusions The NHIRD appears to be a valid resource for population research in cardiovascular diseases.
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            Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes.

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              The Coexistence of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Prevalence and Risk Factors in Young, Middle-aged and Elderly People from the General Population

              Background The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. Methods A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Results A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged <65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. Conclusion Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.
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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
                16 August 2019
                2019
                : 10
                : 889
                Affiliations
                [1] 1Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi, Taiwan
                [2] 2Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science , Tainan, Taiwan
                [3] 3College of Medicine, China Medical University , Taichung, Taiwan
                [4] 4Department of Nursing, Mei-Ho University , Pingtung, Taiwan
                [5] 5Management Office for Health Data, China Medical University Hospital , Taichung, Taiwan
                [6] 6College of Medicine, China Medical University , Taichung, Taiwan
                [7] 7Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University , Taichung, Taiwan
                [8] 8Department of Computer Science and Information Engineering, Asia University , Taichung, Taiwan
                [9] 9Department of Nuclear Medicine and PET Center, China Medical University Hospital , Taichung, Taiwan
                [10] 10Department of Bioinformatics and Medical Engineering, Asia University , Taichung, Taiwan
                Author notes

                Edited by: James Cheng-Chung Wei, Chung Shan Medical University, Taiwan

                Reviewed by: Yao Tung Wang, Chung Shan Medical University Hospital, Taiwan; Stefano Giovagnoli, University of Perugia, Italy; Meng-Che Wu, Taichung Veterans General Hospital, Taiwan

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

                Article
                10.3389/fphar.2019.00889
                6707404
                e8af46af-4b74-49ae-9d2d-95867ebc09bf
                Copyright © 2019 Yeh, Syue, Lin, Hsu, Shae and Kao

                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) and the copyright owner(s) 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
                : 29 April 2019
                : 15 July 2019
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 63, Pages: 11, Words: 6613
                Categories
                Pharmacology
                Original Research

                Pharmacology & Pharmaceutical medicine
                asthma–chronic obstructive pulmonary disease overlap (aco),hepatic failure,renal failure,heart failure,respiratory failure

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