Ischemic Stroke In Taiwan Research Articles

Increasing and high prevalence of moderate to severe obstructive sleep apnea in acute ischemic stroke in Taiwan

The prevalence of obstructive sleep apnea (OSA) after stroke is variable, likely due to the time of examination and patient population. Although risk factors for OSA are well established, those for OSA in patients with ischemic stroke have not yet been fully identified. Therefore, we examined the prevalence of OSA and identified risk factors for OSA in the acute stage of ischemic stroke in the Taiwanese population. A total of 103 patients with acute ischemic stroke were screened for OSA by performing polysomnography. The demographic and clinical data, Epworth Sleepiness Scale score, and other stroke risk factors were recorded. Sleep parameters, namely sleep efficiency, sleep stages, apnea-hypopnea index, and oxygen desaturation index were recorded. Logistic regression analysis was conducted to determine clinical and demographic risk factors for moderate to severe OSA in patients with stroke. We determined that 91.2% of the patients had OSA in the acute stage of ischemic stroke, and 70% of the patients had moderate to severe OSA. Multivariate logistic regression analysis revealed that patients aged ≥65 years had a significantly higher risk of moderate to severe OSA (adjusted OR: 3.04, 95% CI: 1.20-7.69, p<0.05) compared with patients with ischemic stroke aged <50 years. OSA is highly prevalent among patients with ischemic stroke in the acute stage, and those aged ≥65 years had a significantly increased risk of moderate to severe OSA. In clinical practice, routine PSG screening of OSA may be necessary among older patients with stroke.

Exploring the pivotal variables of tongue diagnosis between patients with acute ischemic stroke and health participants

Background and aimStroke is a major cause of disability worldwide, and ischemic stroke is the most common type of stroke. The prevention and treatment of ischemic stroke remain a challenge worldwide. Traditional Chinese medicine (TCM) is often sought to provide an alternative therapy for the prevention and rehabilitation intervention of ischemic stroke in Taiwan. Therefore, this study explored the pivotal variables of tongue diagnosis among acute ischemic stroke and healthy participants in middle and older age. Experimental procedureThis was a cross-sectional and case-controlled study. Data were collected from 99 patients with acute ischemic stroke and 286 healthy participants who received tongue diagnoses at Changhua Christian Hospital (CCH) from September 1, 2014, to December 31, 2016. Tongue features were extracted using the automatic tongue diagnosis system. Nine tongue features, including tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissures, ecchymoses, teeth marks, and red spots were analyzed. Results and conclusionObjective image analysis techniques were used to identify significant differences in the many tongue features between patients with acute ischemic stroke and individuals without stroke. According to the logistic regression analysis, pale tongue color (OR:5.501, p = 0.001), bluish tongue color (OR:4.249, p = 0.014), ecchymoses (OR:1.058, p < 0.001), and tongue deviation angle (OR:1.218, p < 0.001) were associated with significantly increased odds ratios for acute ischemic stroke. The research revealed that tongue feature abnormalities were significantly related to the occurrence of ischemic stroke.

Imaging-based pregenetic screening for NOTCH3 p.R544C mutation in ischemic stroke in Taiwan.

ObjectiveTo develop an easily applicable screening score to guide NOTCH3 p.R544C genetic testing for patients who presented with acute ischemic cerebrovascular events in Taiwan.Methods1734 patients who presented with ischemic cerebrovascular events were enrolled from the Formosa Stroke Genetic Consortium stroke registry and were screened for the NOTCH3 p.R544C mutation. Clinical and MRI characteristics of NOTCH3 p.R544C mutation carriers (n = 36) and a subset of noncarriers (n = 673) were tested in a logistic regression model to identify key features associated with the NOTCH3 p.R544C carrier status. Variables and their odds ratios in the regression model were used to develop the R544C screening score to predict positive NOTCH3 p.R544C test results.ResultsWe constructed the R544C screening score using five clinical and imaging characteristics, including stroke onset before 50 years of age, the small vessel occlusion subtype, a family history of stroke/TIA in siblings, external capsule involvement, and advanced deep white matter hyperintensity. The area under the ROC curve of the screening score was 0.867 (95% CI = 0.810‐0.924). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 0.75, 0.88, 0.13, 0.99, and 0.88, respectively, for a cutoff score of 5 points. In addition, the R544C screening score was validated in another cohort composed of 235 stroke patients with comparable performance (area under the ROC curve = 0.957, 95% CI = 0.916‐0.997).InterpretationsFor Taiwanese patients presenting with acute ischemic cerebrovascular events, the R544C screening score is easily applicable and can efficiently select high‐risk patients for NOTCH3 p.R544C mutation test.

P2782Specific air pollution indicators are related to recurrence of ischemic stroke-a nationwide cohort study with surveillance system by time-stratified case-crossover study design

Abstract Background and objective Ischemic stroke (IS) is the 2nd killer in Taiwan. There was no studies of air pollution indicators (API's) in nationwide database, on their relationship to IS recurrence. We aimed to analyze the IS incidences, its recurrence risk related to API's. Methods We used LHID 2005 (Longitudinal Health Insurance Database 2005) from National Health Institute Research Database (NHIRD), i.e. the entire original claim data of randomly sampled 1,000,000 beneficiaries in 2005. The national API surveillance database (PM2.5, PM10, CO, SO2, NO,NO2, NOx, O3) was incorporated with it. The IS incidences was computed by obtaining 1st admission for IS (ICD9–433, 434, 435), and the recurrence was on second IS within 30 days of 1st one. To minimize the confounding effect of comorbidities, we used a time-stratified case-crossover study design, proposed by Maclure (1991), for transient effects on acute events' risk; it is characterized by that each subject serves as his or her own control according to fixed individual characteristics, such as age, gender, lifestyle, socio-economic status, genetics and physiological status, etc. The API exposure was analyzed on the re-admission date (lag0), and 1 to 6 day before re-admission (lag1, lag2 ... lag6 etc.). Results The IS recurrence-readmission is strongly associated with SO2 peak level 5 days before (lag5 – 95% CI: 1.011–1.023, p=0.004) for patients above 20. Significant association of IS recurrence with PM2.5, SO2 O3, SO2 is noted in different patient groups. Table 1. Basic demographics of ischemic stroke in Taiwan (2005–2013) Ischemic stroke N % Age, mean ± SD 68.94±12.8 Male 11832 58% Other forms of chronic ischemic heart disease (ICD9–414) 1496 7% Diabetes mellitus (ICD9–250) 6679 32% Essential hypertension (ICD9–401) 9038 44% Disorders of lipoid metabolism (ICD9–272) 4142 20% Heart failure (ICD9–428) 670 3% Hypertensive heart disease (ICD9–402) 2333 11% Figure 1. Hazard Ratio of specific API's in IS (only shown with statistical significance): those left to line 1.0 with protective effect and vice versa (20–45, 46–64 and 65 above representative meaning for age range). Conclusion Specific API's are strongly associated with IS recurrence. We need a prospective cohort study designed on this topic.

Impact Of Sirt6 And Sirt7 Genetic Polymorphisms On Risk Of Early-Onset Ischemic Stroke

Background and Aims: SIRT6 and SIRT7 have been implicated in the repression of inflammation, oxidative stress, and aging. Polymorphisms in SIRT6 and SIRT7 may be important for increasing carotid plaque burden and promoting atherosclerosis. The aim of this study was to investigate the association of SIRT6 and SIRT7 genetic polymorphisms with risk of early-onset ischemic stroke in Taiwan.

Significant Associations Of Nrf1 Genetic Polymorphisms With The Risk Of Early-Onset Ischemic Stroke

Background and Aims: Nuclear respiratory factor 1 (NRF1) has been reported to regulate mitochondrial biogenesis. Mitochondrial dysfunction would result in increased oxidative stress and inflammation. Eventually, mitochondrial dysfunction may lead to the development of atherosclerosis and ischemic stroke. In this study, we aim to investigate the relationship between the genetic polymorphisms of NRF1 and the risk of early-onset ischemic stroke in Taiwan.

The outcomes of statin therapy in patients with acute ischemic stroke in Taiwan: a nationwide epidemiologic study.

Acute stroke is the third leading cause of death in Taiwan. Although statin therapy is widely recommended for stroke prevention, little is known about the epidemiology of statin therapy after acute ischemic stroke (AIS) in Taiwan. To investigate the effects of statin therapy on recurrent stroke, intracranial hemorrhage (ICH), coronary artery disease (CAD), cost of hospitalization and mortality, we conducted a nationwide population-based epidemiologic study. Cases of AIS were identified from the annual hospitalization discharge diagnoses of the National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision codes from January 2001 to December 2010. We divided the AIS patients into three groups: non-statin, pre-stroke statin and post-stroke statin. A total of 422671 patients with AIS (including 365419 cases in the non-statin group, 22716 cases in the pre-stroke statin group and 34536 cases in the post-stroke statin group) were identified. When compared to the non-statin group, both statin groups had a lower recurrent stroke risk [pre-stroke statin: odds ratio (OR) = 0.84; 95% confidence interval (CI) = 0.82-0.87; P < 0.0001; post-stroke statin: OR = 0.89; 95% CI = 0.86-0.91; P < 0.0001], lower ICH risk (pre-statin: OR = 0.75; 95% CI = 0.69-0.82; P < 0.0001; post-stroke statin: OR = 0.75; 95% CI = 0.71-0.81; P < 0.0001), and a lower mortality rate (pre-stroke statin: OR = 0.56; 95% CI = 0.53-0.59; P < 0.0001; post-stroke statin: OR = 0.51; 95% CI = 0.48-0.53; P < 0.0001). In terms of CAD, only the post-statin group had a lower risk (OR = 0.81; 95% CI = 0.79-0.84; P < 0.0001) than the non-statin group. The post-statin group had the lowest 1-year medical costs after index discharge among the three groups. Statin therapy reduced the risks of recurrent stroke, CAD, ICH and the first year mortality in patients after AIS. Treatment with statin therapy after AIS is a cost-effective strategy in Taiwan.

Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study.

BackgroundBehçet’s disease (BD) is a recurrent, multisystemic, inflammatory disorder that mainly affects blood vessels. Because recurrent inflammation of blood vessels in the brain plays a crucial role in the development of ischemic stroke, we hypothesized that patients with BD might have an elevated risk of ischemic stroke. This potential association has been suggested in a few case reports, but not epidemiological studies. Hence, the present study aimed to examine the relation between BD and subsequent ischemic stroke in Taiwan using a nationwide, population-based database.MethodsTo establish a study cohort, the longitudinal data of 306 patients newly diagnosed with BD during 2000–2010 were extracted from the National Health Insurance Research Database, Taiwan. For comparison of ischemic stroke incidence, a control cohort of 1224 subjects without BD was established using a frequency-matched ratio of 1:4 for age, sex, and pre-existing comorbidities.ResultsDuring the 10-year follow-up, 13 (4.2%) patients with BD and 20 (1.6%) control subjects experienced ischemic stroke. Kaplan–Meier analysis revealed the higher prevalence of ischemic stroke in the BD group (log-rank test, p = 0.001). After adjusting for comorbidities and demographic characteristics, Cox regression analysis revealed that patients with BD had a 2.77-fold risk of ischemic stroke (95% confidence interval, 1.38–5.57) compared to control subjects.ConclusionsPatients with BD have an elevated risk of ischemic stroke. Hence, BD may affect the vascular system in the brain, resulting in a stroke event.

Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan

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.

Trends in vascular risk factors, stroke performance measures, and outcomes in patients with first-ever ischemic stroke in Taiwan between 2000 and 2012

BackgroundWith the aging of the population in Taiwan, the financial burden of stroke on the healthcare system is expected to rise. We aimed to investigate the trends in vascular risk factors, adherence to stroke performance measures, and stroke outcomes based on a nationwide representative sample. MethodsAdult patients hospitalized for first-ever ischemic stroke between 2000 and 2012 were identified from a nationwide administrative database. The study period was divided into 1-year intervals. The Cuzick test and the Cochran-Armitage test were used to determine the significance of changes over time. Trends in stroke outcomes as a function of year were assessed using logistic regression, controlling for age, sex, comorbidity, and stroke severity. ResultsA total of 11,462 patients (mean age 67.3years, female 40.9%) were hospitalized. Between 2000 and 2012, the prevalence of hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation increased while the prevalence of coronary artery disease decreased. The proportion of patients taking antihypertensive or antidiabetic medication prior to stroke decreased, whereas the proportion of patients taking lipid lowering medication increased. Adherence to the five selected performance measures significantly improved. A significant decreasing trend in the proportion of recurrent stroke or all-cause death within one year was observed regardless of whether adjustment for age, sex, comorbidity, and stroke severity was made. ConclusionsDespite the rising prevalence of vascular risk factors, improved adherence to stroke performance measures was accompanied by better stroke outcomes.

Association of Paroxysmal Supraventricular Tachycardia with Ischemic Stroke: A National Case-Control Study

Cardioembolic stroke accounts for approximately 15%-20% of all ischemic strokes. Atrial fibrillation constitutes one-half to two-thirds of all cardioembolic stroke events. The association of paroxysmal supraventricular tachycardia (PSVT) with ischemic stroke remains unclear. A national case-control study was conducted to identify the risk factors, including PSVT, for ischemic stroke in Taiwan. We designed a national case-control study comprising patients diagnosed with ischemic stroke (n = 5633) from 1997 to 2011; each patient from the case group was randomly matched with the control group (n = 30,895) in Taiwan. Data were retrospectively collected from Taiwan's National Health Insurance Research Database, which contains not only claims data on hospitalization, emergency room visits, and outpatient department visits, but also patient characteristics. Logistic regression analysis was used to identify the risk factors for ischemic stroke. Independent risk factors for ischemic stroke included age (in 5-year intervals; odds ratio [OR], 1.76; 95% confidence interval [CI], 173-1.78), the male sex (versus the female sex; OR, 1.88; 95% CI, 1.74-2.01), chronic kidney disease (OR, 3.09; 95% CI, 2.67-3.57), PSVT (OR, 2.05; 95% CI, 1.30-3.19), and aspirin use (OR, .04; 95% CI, .03-0.05). Our study is the first in Taiwan to identify PSVT as a significant risk factor for ischemic stroke. New antithrombotic regimens, including aspirin, can be recommended for the primary prevention of stroke and for reducing the burden of stroke for patients with PSVT.

Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011.

Background and PurposeThe burden of stroke is comparatively greater in Asian countries than in the Western world. While there has been a documented recent decline in the incidence of stroke in several Western nations due to better risk factor management, much less is known about the nature and trajectory of stroke in Asia over the last decade. The objective of this study was to explore risk factors, medication use, incidence, and one-year recurrence of stroke in Taiwan.MethodsWe conducted a nationwide cohort study by reviewing all hospitalized patients (≥ 18 years) with a primary diagnosis of ischemic stroke between 2001 and 2011 from Taiwan National Health Insurance Research Database.ResultsA total of 291,381 first-ever ischemic stroke patients were enrolled between 2000 and 2011. The average age was about 70 years and approximately 58.6% of them were men. While prevalence of diabetes mellitus and hyperlipidemia, as well as use of statins, antiplatelet agents, and oral anticoagulant agents for atrial fibrillation significantly increased; incidence (142.3 vs. 129.5 per 100,000 in 2000 and 2011, respectively) and one-year recurrence (9.6% vs. 7.8% in 2000 and 2011, respectively) of stroke declined during this period of time.ConclusionsOver the last decade in Taiwan, rates of primary ischemic stroke and one-year recurrent stroke decreased by 9% and 18% respectively.

Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011

Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011

Chinese Herbal Products for Ischemic Stroke

Traditional Chinese herbal products (CHPs) have been described in ancient medicine systems as treatments for various stroke-associated ailments. This study is aimed to investigate the prescription patterns and combinations of CHPs for ischemic stroke in Taiwan. Prescriptions of CHPs for ischemic stroke were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan. Every prescription with a leading diagnosis of ischemic stroke made during 2000-2010 was analyzed. Descriptive statistics were applied to the pattern of co-prescriptions. Multiple logistic regression models were used to assess demographic and risk factors that are correlated with CHP use. The dataset of inpatient claims data contained information on 15,896 subjects who experienced ischemic stroke from 2000 to 2010. There was an average of 5.82 CHPs in a single prescription for subjects with ischemic stroke. Bu-yang-huan-wu-tang (BYHWT) (40.32%) was by far the most frequently prescribed formula CHP for ischemic stroke, and the most commonly used combination of two-formula-CHP was BYHWT with Shu-jin-huo-xue-tang (SJHXT) (4.40%). Dan Shen (16.50%) was the most commonly used single CHP for ischemic stroke, and the most commonly used combination of two single CHPs was Shi Chang Pua with Yuan Zhi (4.79%). We found that BYHWT and Dan Shen were the most frequently prescribed formula and single CHP for ischemic stroke, respectively. These results provide information about individualized therapy and may contribute to further pharmacologic experiments and clinical trials.

Mitochondrial DNA association study of type 2 diabetes with or without ischemic stroke in Taiwan

BackgroundThe importance of mitochondrial DNA (mtDNA) polymorphism in the prediction of type 2 diabetes (T2D) in men and women is not well understood. We questioned whether mtDNA polymorphism, mitochondrial functions, age and gender influenced the occurrence of T2D with or without ischemic stroke (IS).MethodsWe first designed a matched case–control study of 373 T2D patients and 327 healthy unrelated individuals without history of IS. MtDNA haplogroups were determined on all participants using sequencing of the control region and relevant SNPs from the coding region. Mitochondria functional tests, systemic biochemical measurements and complete genomic mtDNA sequencing were further determined on 239 participants (73 healthy controls, 33 T2D with IS, 70 T2D only and 63 IS patients without T2D).ResultsMtDNA haplogroups B4a1a, and E2b1 showed significant association with T2D (P <0.05), and haplogroup D4 indicated resistance (P <0.05). Mitochondrial and systemic functional tests showed significantly less variance within groups bearing the same mtDNA haplotypes. There was a pronounced male excess among all T2D patients and prevalence of IS was seen only in the older population. Finally, nucleotide variant np 15746, a determinant of haplogroup G3 seen in Japanese and of B4a1a prevalent in Taiwanese was associated with T2D in both populations.ConclusionsMen appeared more susceptible to T2D than women. Although the significant association of B4a1a and E2b1 with T2D ceased when corrected for multiple testings, these haplogroups are seen only among Taiwan Aborigines, Southeast Asian and the Pacific Ocean islanders where T2D is predominant. The data further suggested that physiological and biochemical measurements were influenced by the mtDNA genetic profile of the individual. More understanding of the function of the mitochondrion in the development of T2D might indicate ways of influencing the early course of the disease.

Stroke: morbidity, risk factors, and care in taiwan.

Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.

National Survey of Thrombolytic Therapy for Acute Ischemic Stroke in Taiwan 2003-2010

Data on thrombolytic therapy at the national level is scarce in Asia. Understanding current practice pattern is important for a policy maker in decision making. This cross-sectional study analyzed the utilization pattern of thrombolytic therapy for acute ischemic stroke (AIS) in Taiwan from 2003 through 2010 and identified factors associated with post-therapy intracerebral hemorrhage (ICH) and mortality. From the Taiwan National Health Insurance Research Database, we retrieved inpatient claims for patients with AIS. The frequency of thrombolytic therapy in AIS admissions and its association with the characteristics of patients, physicians, and hospitals were analyzed. Factors predicting ICH and in-hospital mortality were also analyzed using multiple logistic regressions. Of 394,988 patients with AIS, 2385 (.60%) had received thrombolytic therapy. The utilization rate increased from .03% in 2003 to 1.51% in 2010. Thrombolytic therapy was adopted earlier in a belt of high-frequency counties across rural midwestern Taiwan, twice the rate in the Taipei and Kaohsiung cities. The neurology specialty and hospital's service volume were the most dominant factors related to higher utilization, in addition to weekend admission and the patient's age and comorbidities. ICH and in-hospital mortality rates were 3.48% and 7.71%, respectively. Patients given thrombolytic therapy in hospitals with thrombolysis cases more than the 5.5/year had a lower risk of ICH (odds ratio: .53; 95% confidence interval: .31-.88). Compared with most developed countries, there is indeed much unmet need for stroke thrombolysis in Taiwan. Effective mechanism should be implemented to increase the thrombolysis rate safely and improve outcome for patients with AIS.

Epidemiology and disease burden of ischemic stroke in Taiwan

Background: The incidence and prevalence of ischemic stroke (IS) are increasing in Asian countries. We conducted this retrospective database research to investigate epidemiology and disease burden of IS in Taiwan. Methods: We identified cases from the National Health Insurance Research Database during period from 2000 to 2005 to calculate prevalence and mortality. We analyzed the relationship between disease burden and gender in Taiwan during the period from 2000 to 2005 using Dismod II. Results: From study period, stroke mortality increased from 50 to 2300 per 100 000 among individuals aged 50–90 years, with a higher prevalence among females than males. The highest prevalence was observed among men aged 80–84 years, but prevalence among women was highest in patients aged >85 years. The burden of stroke during the period per 1000 population was estimated as follows: the sum of the years of life lost as a result of premature mortality of 55–80 years, years lost as a result of disability of 11–19 years, and disability-adjusted life years (DALYs) of 70–80 years. Most of the DALYs of stroke occurred among those aged 65–69 years. The DALY value was higher among women than among men before 2005; there was no clear trend in 2005. Conclusions: Stroke is a significant health concern in Taiwan. The associated disease burden was found to increase each year, especially among individuals aged 65–69 years. Overall, the DALY value increased from 2000 to 2005, which suggests that the associated disease burden will continue to increase over time.

Association between genetic variant on chromosome 12p13 and stroke survival and recurrence: a one year prospective study in Taiwan

BackgroundThe association between ischemic stroke and 2 single nucleotide polymorphisms (SNPs) on chromosome 12p13, rs12425791 and rs11833579 appears inconsistent across different samples. These SNPs are close to the ninjurin2 gene which may alter the risk of stroke by affecting brain response to ischemic injury. The purpose of this study was to investigate the association between these two SNPs and ischemic stroke risk, as well as prognostic outcomes in a Taiwanese sample.MethodsWe examined the relations of these two SNPs to the odds of new-onset ischemic stroke, ischemic stroke subtypes, and to the one year risk of stroke-related death or recurrent stroke following initial stroke in a case-control study. A total of 765 consecutive patients who had first-ever ischemic stroke were compared to 977 stroke-free, age-matched controls. SNPs were genotyped by Taqman fluorescent allelic discrimination assay. The association between ischemic stroke and SNPs were analyzed by multivariate logistic regression. Cox proportional hazard model was used to assess the effect of individual SNPs on stroke-related mortality or recurrent stroke.ResultsThere was no significant association between SNP rs12425791 and rs11833579 and ischemic stroke after multiple testing corrections. However, the marginal significant association was observed between SNP rs12425791 and large artery atherosclerosis under recessive model (OR, 2.30; 95%CI, 1.22-4.34; q-value = 0.062). Among the 765 ischemic stroke patients, 59 died or developed a recurrent stroke. After adjustment for age, sex, vascular risk factors and baseline stroke severity, Cox proportional hazard analysis indicated that the hazard ratios were 2.76 (95%CI, 1.34-5.68; q-value, 0.02) and 2.15 (95%CI, 1.15-4.02; q-value, 0.03) for individuals with homozygous variant allele of rs12425791 and rs11833579, respectively.ConclusionsThis is a precedent study that found genetic variants of rs12425791 and rs11833579 on chromosome 12p13 are independent predictors of stroke-related mortality or stroke recurrence in patients with incident ischemic stroke in Taiwan. Further study is needed to explore the details of the physiological function and the molecular mechanisms underlying the association of this genetic locus with ischemic stroke.

Psoriasis and increased risk of ischemic stroke in Taiwan: A nationwide study

Psoriasis and increased risk of ischemic stroke in Taiwan: A nationwide study