Adjunctive Chinese Herbal Products Therapy Reduces the Risk of Ischemic Stroke Among Patients With Rheumatoid Arthritis.

Hsuan-Shu Shen,Jen-Huai Chiang,Nai-Huan Hsiung

doi:10.3389/fphar.2020.00169

Abstract

We performed a retrospective cohort study to investigate the association between the risk of ischemic stroke (IS) and the use of Chinese herbal products (CHP) in combination with western medicine (WM) among patients with rheumatoid arthritis (RA). The data were sourced from the registry for beneficiaries, inpatient and ambulatory care claims, and Registry for Catastrophic Illness from the National Health Insurance Research Database (NHIRD) in Taiwan between 1997 and 2011. Patients, who were newly diagnosed with RA between 1997 and 2010, were classified as the CHP group or non-CHP group depending on the presence of absence the adjunctive use of CHP following a diagnosis of RA. A total of 4,148 RA patients were in both the CHP and non-CHP groups after 1:1 matching. Patients in the CHP group had a significantly lower risk of IS compared to patients in the non-CHP group (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.52–0.86). In the CHP group, patients who used CHP for more than 30 days had a lower risk of IS than their counterparts (aHR: 0.61, 95% CI: 0.40–0.91). Gui-Zhi-Shao-Yao-Zhi-Mu-Tang, Shu-Jin-Huo-Xie-Tang, and Du-Huo-Ji-Sheng-Tang might be associated with a lower risk of IS. Finally, the use of CHP in combination with WM was associated with a decreased risk of IS in patients with RA, especially among those who had used CHP for more than 30 days. A further randomized control trial is required to clarify the casual relationship between these results.

Highlights

Patients with rheumatoid arthritis (RA) are at a greater risk of ischemic stroke (IS), which may be a leading cause of mortality and can lead to severe long-term disability (Benjamin et al, 2017)
Patients in the Chinese herbal products (CHP) group were more likely to have a lower risk of IS compared to their counterparts in the non-CHP group
This is the first nationwide retrospective cohort study designed to investigate the association between the risk of IS and the combined use of CHP in patients with RA

Summary

Introduction

Patients with rheumatoid arthritis (RA) are at a greater risk of ischemic stroke (IS), which may be a leading cause of mortality and can lead to severe long-term disability (Benjamin et al, 2017). Chinese Herbal Products Decreasing Stroke (Lindhardsen et al, 2012; Liou et al, 2014) Another prospective cohort study of 114,342 American women with RA found that the relative risk for IS was 1.48 (95% confidence interval [CI]:0.70–3.12) (Solomon et al, 2003). A possible mechanism might be the systemic inflammatory response in patients with RA who have elevated levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF)-a. This kind of chronic inflammation underlies the accelerated atherosclerosis, and is thought to be the main pathologic process of IS (Sattar et al, 2003; Hansson, 2005)

Methods

Results

Conclusion