Stroke In Taiwan Research Articles

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.

Abstract T P55: The Safety and Efficacy of Alteplase for Acute Ischaemic Stroke in Chinese Patients

Background: The relationship between the dose of alteplase and its safety/efficacy for ischaemic stroke has not been well evaluated in the Asian population. In the present study, we assessed the safety/efficacy of different doses of alteplase for acute ischaemic stroke in Taiwan. Methods: A prospective observational study was conducted in Taiwan. Eligible patients (1,004) were classified according to the dose of alteplase (or rt-PA) received for managing acute ischaemic stroke: 0.90± 0.5 mg/kg (422 patients, mean 0.91 ± 0.05 mg/kg, median 0.9 mg/kg, range 0.86-1.26mg/kg) as the standard dose group and &lt; 0.85 mg/kg as the lower dose group, which was further divided into three subgroups: 0.80 ± 0.5 mg/kg (202 patients, mean 0.81 ± 0.03 mg/kg, median 0.81 mg/kg, range 0.76-0.85 mg/kg), 0.70 ± 0.5 mg/kg (199 patients, mean 0.71 ± 0.02 mg/kg, median 0.71 mg/kg, range 0.68-0.75 mg/kg) and 0.60 ± 0.5 mg/kg (181 patients, mean 0.62 ± 0.04 mg/kg, median 0.61 mg/kg, range 0.55-0.65 mg/kg). The primary outcome was: symptomatic intracerebral haemorrhage (SICH) and death within three months. The secondary outcome was good clinical outcome (modified Rankin scale (mRS) ≤ 1) at three months after thrombolytic therapy. Results: The overall SICH rates per the NINDS (6.8%) were comparable with the results of other observational studies, and the good functional outcomes (32.4%) were also similar after excluding patients aged ≥ 80 years and those with mRS score ≥ 2 before the index stroke. There was a significant trend for SICH with age ( P = 0.0025). From the lowest to the highest dose of alteplase in patients aged 71-80 years, we observed a significant trend of increasing SICH ( p =0.0130) and poorer functional outcome (P=0.0179). However, these trends did not exist in younger stroke patients. Conclusions: Consistent with our previous study, the standard dose of alteplase, 0.9 mg/kg, is not optimal for all acute ischaemic patients in an Asian population. In elderly patients (71-80 years), a lower dose of alteplase, 0.6 mg/kg, is associated with better safety/efficacy of thrombolytic therapy for ischaemic stroke in Chinese. However, randomized trials of lower versus higher dose are still needed.

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.

A Nationwide Plan for Postacute Care of Stroke in Taiwan

To the editor, Taiwan’s government is proud of its universal-coverage National Health Insurance (NHI) program (1). Stroke is among the top five critical illnesses covered by the NHI (2). About 26 098 patients were hospitalized for acute stroke in 2011; 16·2% had prolonged hospital stay (PHS, >30 days), which cost 56·4% of the NHI reimbursement for inpatient stroke care. To reduce the financial burden of PHS, the NHI program initiated a nationwide postacute care (PAC) plan for stroke in 2013. Its major goal is to develop a seamless system transfers for stroke patients from acute-care units to subacute rehabilitation or long-term care facilities. The Taiwan Stroke Society (TSS), coordinating with allied disciplines, took responsibility for the PAC plan from the NHI Administration in March 2013. Through infrastructure reforms, the plan is anticipated to improve patient outcome and reduce costs. During the TSS annual meeting this September, interest groups of stroke patients were invited to explain their unmet need for rehabilitation and other postacute care. Physical, occupational, and speech therapy associations were also invited to present their updated evidencebased guideline for stroke rehabilitation. For the first time, busy strokologists in Taiwan took a first step by shifting focus from acute care (e.g., thrombolytic therapy) to postacute care of stroke patients. Topics about stroke rehabilitation, social welfare, and the continuum of care have garnered more attention. We hope that we would not forget ‘the other 97%’ (3).

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.

PHP70 A 3-Year Follow-Up Study on National Health Insurance Reimbursements Among Atrial Fibrillation Patients With/Without Stroke in Taiwan: A Population-Based Study

PHP70 A 3-Year Follow-Up Study on National Health Insurance Reimbursements Among Atrial Fibrillation Patients With/Without Stroke in Taiwan: A Population-Based Study

Vertigo and Stroke

To investigate the association between vertigo and stroke in Taiwan using the Bureau of National Health Insurance research database. Information on adult patients with an index vertigo attack in 2006 was retrieved from Bureau of National Health Insurance research database. All patients with specific diagnostic codes for vertigo were included. Occurrence of stroke during a 1-year follow-up period was identified. Risk factors for stroke were examined. Using χ test, t test, and a multilevel logistic regression model, patients with vertigo were categorized into stroke and nonstroke groups for comparative analyses. An age- and sex- matched control cohort was prepared for comparison. Patients with vertigo (n = 527,807) (mean age, 55.1 yr) accounted for 3.1% of the general Taiwanese adult population. The prevalence of stroke among vertigo patients of 0.5% (mean age, 67.8 yr) was slightly higher than that of the control group (0.3%; mean age, 72.3 yr; p < 0.0001). The types of stroke were ischemic (66.7%), nontypical (29.0%), and hemorrhage (4.3%). The prevalence of stroke increased with age (p < 0.001). Patients with vertigo had higher prevalence of comorbid conditions (p < 0.0001); those with diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, or atrial fibrillation had a higher prevalence of stroke (p < 0.001). Hypertension was the most significant predictor of stroke (odds ratio, 3.77; 95% confidence interval, 3.36-4.23; p < 0.001). Patients with vertigo had higher chance to develop stroke than the control group. Some strokes may initially manifest as peripheral vertigo, and some central vertigo may eventually evolve into a stroke. Middle aged male, diabetes, hypertension, dyslipidemia, coronary artery disease, and atrial fibrillation are risk factors for subsequent stroke in vertigo patients.

Panic Disorder and Risk of Stroke: A Population-Based Study

An estimate of the risk of stroke among patients with panic disorder was sought. A retrospective cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. A total of 1725 patients who were newly diagnosed with panic disorder between 2001 and 2007 and had no other psychiatric disorders or history of stroke were included. We then selected our control group by excluding patients with past history of stroke or other mental disorder (n = 388,584). Each patient was tracked from his/her index ambulatory care visit until the end of 2009 to identify whether a stroke was diagnosed during the follow-up periods. The hazard ratios of strokes in panic disorder patients and control group during the observation periods were analyzed with multivariable Cox proportional-hazards models adjusted for age, sex, concurrent medical conditions, and medications. In the control group, 19,060 patients (4.9%) had new-onset stroke whereas there were 88 patients (5.1%) in the panic disorder group during the follow-up periods. The risk of stroke was 1.38 times greater for patients with panic disorder than for patients in the control group; (hazard ratio [HR] = 1.38; 95% confidence interval [CI], 1.12-1.71, p = 0.0025). Our findings demonstrated that patients with panic disorder had an increased risk of stroke in Taiwan. Further experimental studies are needed to identify the underlying mechanisms that could lead to early interventions. For panic disorder patients, treatment of their symptoms may be warranted to prevent possible stroke.

Retinal Artery Occlusion and the 3-Year Risk of Stroke in Taiwan: A Nationwide Population-Based Study

To verify the association between retinal artery occlusion (RAO) and stroke with a large-scale nationwide study. Retrospective nationwide population-based administrative database study. Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), which contains claim data from 1 million randomly selected beneficiaries among Taiwan's 23 million residents. The study cohort consisted of all patients with a diagnosis of RAO from January 1999 through December 2006 (n = 464). The control group consisted of randomly selected patients (n = 2748) matched with the study group by age, sex, date of index medical care, and comorbid hypertension. Patients were tracked from their index date for 3 years. The Kaplan-Meier method was used to compute the stroke-free survival rate. Cox proportional hazard regressions were used to compute the adjusted stroke-free survival rate after adjusting for possible confounding factors. Ninety-one RAO patients (19.61%) and 280 controls (10.05%) had a stroke (P < .0001) during the 3-year follow-up period. Compared with the controls, the incidence rate ratios of stroke in RAO patients were 9.46 at 0-1 month, 5.57 at 1-6 months, and 2.16 at 0-3 years after RAO (P < .0001). After adjusting for age, sex, and selected comorbid disorders, the hazard ratio of having a stroke for RAO patients was still 2.07 times higher than that of controls and 3.34 times higher in the ≤60-year-old subgroup. RAO increases the risk for subsequent stroke. Early neurologic evaluation and secondary prevention for stroke are recommended for RAO patients.

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

Predictors for readmission of acute ischemic stroke in Taiwan

Hospital readmission rates are usually higher for stroke than for other chronic conditions. To prevent readmission, effective clinical services and accurate estimates of the absolute readmission rates are required. This study examined the patterns of care received by patients with ischemic stroke, estimated stroke readmission rates, and identified predictors related to readmission in Taiwan. A retrospective analysis of the claims database of the Bureau of National Health Insurance in 2004-2007 was performed. This study included ischemic stroke patients who survived hospitalization and whose initial admission occurred in 2006. Time-dependent Cox regression models were developed separately to identify predictors of readmission within 1 month, 6 months, and 1 year after index discharge. We identified 1194 patients from the data set. At the initial stroke, the care provided was almost fully concordant with evidence-based practice guidelines, and the prevalence of antiplatelet therapy was 87.8%. The percentage of patients regularly taking antiplatelet agents within 1 month, 6 months, and 1 year after the index discharge was 65.0%, 18.8%, and 8.0%, respectively. The stroke readmission rates for survivors at 1 month, 6 months, and 1 year after the index discharge were 9.9%, 23.0%, and 30.7%, respectively. Older age, diabetes, longer length of stay for the index admission, and continuous use of antiplatelet agents less than 9months after the index discharge were all predictors of readmission for acute ischemic stroke. Stroke readmissions are not related to receipt of less than optimum or below standard health care during index admission in Taiwan. Additional stroke readmissions in Taiwan might be avoided if more patients used antiplatelet agents for a longer period.

Common Carotid End-Diastolic Velocity and Intima-Media Thickness Jointly Predict Ischemic Stroke in Taiwan

In Asian populations, few studies investigated the association between stroke and common carotid artery intima-media thickness (IMT). Our previous case-control studies showed that low end-diastolic velocity (EDV) in common carotid artery, a potential hemodynamic marker of intracranial resistance, was associated with ischemic stroke. Therefore, we investigated the relationship between both EDV and IMT and incident ischemic stroke in an Asian population. Baseline data from 3175 adults (30 years or older) in the Cardiovascular Diseases Risk Factor Two-Township Study were linked to incidental ischemic stroke status derived from insurance claims and death certificate records. Hazard ratios for risk of ischemic stroke for high IMT and low EDV values measured in common carotid artery were calculated using Cox proportional hazard models. With 9.85 years (median) of follow-up, 184 persons had ischemic stroke develop. Compared with the first tertile of IMT, hazard ratios were 2.03 (95% confidence intervals, 1.27-3.25) for the second tertile and 3.87 (95% confidence intervals, 2.36-5.69) for the third tertile. Hazard ratios of EDV were 5.31 (95% confidence intervals, 3.52-7.99; first tertile) and 1.94 (95% confidence intervals, 1.21-3.09; second tertile) compared with the third tertile. The individuals with high IMT and low EDV had >2-fold ischemic stroke risk compared to those with low IMT and high EDV (2.10; 95% confidence intervals, 1.35-3.26) after adjusting for age, sex, and traditional cardiovascular risk. Common carotid IMT and EDV jointly and independently predicted future ischemic stroke in this Taiwanese population. More prospective studies are required in various ethnic groups to understand the significance and implication of the current findings, particularly with respect to EDV.

Pilot Scheme of Health Policy in Stroke Adjuvant Acupuncture Therapy for Acute and Subacute Ischemic Stroke in Taiwan

To reduce the health care burden of strokes, the Taiwan Department of Health launched the Pilot Scheme of the Health Policy in Stroke Adjuvant Acupuncture Therapy (HPSAAT) in 2006. This cross-sectional, hospital-based, match-controlled study at Chang Gung Memorial Hospital-Kaohsiung Medical Center during 2006∼2008 retrospectively evaluated the clinical characteristics of acute and subacute ischemic stroke patients who electively joined the HPSAAT. The study also evaluated the safety and clinical benefits of adjuvant acupuncture in treating acute and subacute ischemic stroke patients. Twenty-six HPSAAT participants and 52 age-sex matched random controls were enrolled. The stroke baseline of the HPSAAT participants was more severe than the non-HPSAAT controls. Although the stroke severity closely correlates to mortality and comorbidity, this study noted no significant complications in the HPSAAT participants during the acupuncture treatment course. Adjuvant acupuncture was considered safe at the acute and subacute stages of ischemic stroke. Due to uneven baseline severity, the clinical benefits in reducing neurological deficits and functional recovery were not concluded in this study.

Craniocervical Arterial Dissection: A Cause of Childhood Arterial Ischemic Stroke in Taiwan

To describe the clinical characteristics and imaging findings of craniocervical dissection in childhood ischemic stroke, in a tertiary medical center. In this retrospective study, we investigated children (aged 1 month to 18 years) with symptoms and radiographic confirmation of ischemic stroke from January 1996 to January 2007. Stroke work-up included neuroimaging (magnetic resonance imaging, computed tomography, conventional angiography, and magnetic resonance angiography), cardiac assessment, prothrombotic assays, immunoassays, infection screening, and metabolic screening. Among 95 children with arterial ischemic stroke, arterial dissection was identified as the underlying risk factor in nine patients (7 boys and 2 girls; age range, 1.9 17.2 years). All the patients had focal neurological signs and two had warning symptoms. A history of trauma was noted in two patients and another two had stroke during physical exertion. The other five patients had spontaneous dissection. Six patients had anterior circulation arterial dissection. Three patients had posterior circulation arterial dissection, and the most common location was in the vertebral artery. Antiplatelet treatment was given to five patients and anticoagulants to one. Endovascular treatment was given to one patient with dissecting aneurysm. One patient died at the acute stage and another seven had neurological deficits after 9 months to 8 years follow-up. The ninth patient had no residual neurological impairment. No patients had recurrent stroke. Arterial dissection should be considered in childhood ischemic stroke. Spontaneous arterial dissection is an important factor in this group. Early investigation and treatment can improve the outcome.

The Effect of Cuts in Reimbursement on Stroke Outcome

As healthcare costs keep rising, cuts in reimbursement such as the Balanced Budget Act in the United States or global budgeting have become the key to healthcare reform efforts. Limited information is available, however, concerning whether reimbursement cuts are associated with changes in stroke outcomes. The objective of this study is to determine whether 30-day mortality rates for patients with ischemic stroke changed under increased financial strain from global budgeting in Taiwan. We analyzed all 258 167 patients with ischemic stroke admitted to general acute care hospitals in Taiwan over the period 1998 to 2007 through Taiwan's National Health Insurance Research Database. Multilevel logistic regression analysis was used to examine whether 30-day stroke mortality rates varied after the implementation of hospital global budgeting since July 2002 adjusted for patient, physician, and hospital characteristics. The magnitude of payment reduction on overall hospital net revenues was between 4.3% and 10.0%. The 30-day mortality rates for patients with ischemic stroke in Taiwan increased after the implementation of hospital global budgeting after adjustment for patient gender and age, comorbidities, surgery, physician age and volume, specialty, hospital volume, ownership, accreditation level, bed size, geographic location, competition, and trend. The mortality rate of patients with stroke rose under increased financial strain from cuts in reimbursement. Therefore, stroke outcomes are more likely to be affected by hospital financial pressures. It is imperative to monitor stroke outcomes and develop strategies to maintain levels of stroke care as cuts in reimbursement are adopted.

Comparison of the Prevalence of Metabolic Syndrome Between the Criteria for Taiwanese and Japanese and the Projected Probability of Stroke in Elderly Hypertensive Taiwanese

The cutoff of abdominal circumference for metabolic syndrome (MS) defined by the Bureau of Health Promotion (BHP) of Taiwan for Taiwanese (men, 90cm; women, 80cm) and by the International Diabetes Federation (IDF) for Japanese (men, 85cm; women, 90cm) differs. This study aimed to examine the impact of this difference on the prevalence of MS and the impact of an MS diagnosis on the projected risk of stroke in hypertensive Taiwanese. MS was examined in a sample of 3,472 hypertensive patients (aged 55–80 years; 1,709 women) across Taiwan. The 10-year probability of stroke estimated from the Framingham equation was compared between MS and non-MS patients. The prevalence of MS using the BHP criteria was 59.2% using the BHP criteria (95% confidence interval, CI, 57.6–60.8%; men, 52.5%; women, 66.1%) and 48.9% by the IDF criteria (95% CI, 47.2–50.5%; men, 61.3%; women, 36.1%). Both criteria showed that, compared with non-MS, MS has higher predicted 10-year probability of stroke (BHP, 0.153 ± 0.115 vs. 0.133 ± 0.105; IDF, 0.159 ± 0.109 vs. 0.132 ± 0.112; both p < 0.001) because of the difference in women (BHP, 0.143 ± 0.124 vs. 0.102 ± 0.091; IDF, 0.147 ± 0.121 vs. 0.118 ± 0.110; both p < 0.001) rather than men (BHP, p = 0.21; IDF, p = 0.29). Both criteria demonstrate that MS is highly prevalent in elderly hypertensive patients in Taiwan. Additionally in women, but not men, the predicted probability of stroke is higher in MS than in non-MS patients. The diagnosis of MS is potentially useful for identifying elderly hypertensive females with an elevated risk of stroke in Taiwan.

Response to Letter by Spengos and Vemmos

Response: We are delighted to notice the growing interest on stroke in young adults. In their study involving 250 patients, Spengos and Vemmos report astonishing similarities between young Finnish1 and Greek2 ischemic stroke patients regarding demographics, risk factor profile, and etiology. Strong evidence supports the protecting effects of Mediterranean diet on cardiovascular diseases,3 but in young adults, with only few having stroke attributable to atherosclerosis, the diet may apparently not play a major role. With regards to those with stroke of other determined etiology, we would, however, expect clear differences between their patients and ours due to genetic and geographic …

Readmission after hospitalization for stroke in Taiwan: Results from a national sample

BackgroundData on hospital readmission after stroke, which reflects burden of disease, are limited. Our aim was to evaluate readmission and readmission diagnosis within one year after stroke. MethodsWe studied administrative claims data of a randomly sampled cohort (n=200,000) of National Health Insurance beneficiaries in Taiwan. Patients aged ≥18 years and admitted with stroke (International Classification of Diseases, 9th revision, Clinical Modification codes 430 to 438) as principal (first-listed) discharge diagnosis in 2000 were selected for analysis. Each patient's data from January 2000 to December 2001 were obtained. Data analysis was undertaken using descriptive statistics and logistic regression. ResultsAmong 515 patients identified, 50.1% were ischemic, 20.4% hemorrhagic, 18.3% ill-defined, 10.3% TIA and 1.0% the remainder. Neurologists were admitting physicians for 45.2% of patients. Patients died in hospital (n=11) and those who were presumed dead during study period (n=29) or without sufficient follow-up data (n=7) were excluded. Within one year following discharge from the index admission, approximately half of the patients (232 of 468) were readmitted. The most frequently reported readmission diagnosis was stroke (26.3%), followed by infection (15.1%). Multivariable regression analysis showed that factors significantly associated with increased risk of readmission included age, length of stay of the index admission, medical specialty of admission other than neurology/neurosurgery, and level of hospital, after adjustment for sex, Charlson comorbidity index score, and primary discharge diagnosis (ischemic/hemorrhagic stroke versus others). ConclusionsStroke patients who were admitted to disciplines other than neurology/neurosurgery seemed to have higher risk of readmission.

Phosphodiesterase 4D (PDE4D) Gene Variants and Risk of Ischemic Stroke in the Taiwanese Population

Objectives: It has been suggested that genetic variants in the phosphodiesterase 4D (PDE4D) gene confer risk of ischemic stroke. However, the cerebral infarction/cerebral hemorrhage ratio is lower in Asian populations compared with those in Caucasian and black populations. Thus, the association between variations in the PDE4D gene and ischemic stroke in Taiwan needs to be replicated. In the present study, we evaluated whether the PDE4D gene polymorphism confers a risk of ischemic stoke in Taiwanese patients. Methods: Two single-nucleotide polymorphisms (SNPs) covering the PDE4D gene were genotyped using genomic DNA sequencing and a high-throughput TaqMan PCR assay in 100 patients who had suffered an ischemic stroke and 270 healthy individuals. Results: No significant associations with ischemic stroke were observed with the SNP87 (rs2910829) or SNP41 (rs152312) SNPs from PDE4D, which were a part of the Icelandic at-risk haplotypes. Conclusions: The present data does not support a significant role for PDE4D polymorphisms in genetic susceptibility to ischemic stroke in the Taiwanese population.