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Background: Cold weather is reportedly a precipitator of reversible cerebral vasoconstriction syndrome (RCVS) in a few cases. We systematically investigated whether meteorological factors correlate with the occurrence of RCVS. Methods: We conducted a retrospective analysis of a cohort of patients diagnosed with RCVS or probable RCVS, based on International Classification of Headache Disorders, third edition (ICHD‐3) criteria, in a hospital‐based headache center from March 2005 to February 2014. Monthly averages of local weather data measured in Taipei were obtained from the Central Weather Bureau in Taiwan. Primary weather variables were compared with the number of monthly new‐onset cases of RCVS. Results: We recruited 226 patients with established RCVS and 72 patients with probable RCVS during a 108‐month study period. Incidence of RCVS was higher in winter than summer months (3.3 persons/month [SD: 2.0] vs 2.1 persons/month [SD: 1.5], P = .013). The monthly incidence of RCVS correlated negatively with mean daily temperature (r = −0.231, P = .016) and average precipitation (r = −0.269, P = .005), but positively with barometric pressure (r = 0.274, P = .004). These 3 correlated meteorological factors together explained about 10% of the variance in RCVS monthly incidence (R2 = 0.095, P = .015). Conclusion: RCVS was found to be more common in winter months and to be associated with weather variables in Taiwan. Further studies are needed to explore the underlying mechanisms of these associations. [ABSTRACT FROM AUTHOR]

Background: Evidence on the relationship between left atrial dimension and cardiovascular events is inconclusive. We explored the association between left atrial dimension and stroke and all-cause death in an ethnic Chinese population. Methods: We recruited 1,937 subjects undertaking echocardiographic examination without prior atrial fibrillation/stroke in the Chin-Shan Community Cardiovascular Cohort study. Left atrial dimension indexed by body mass index was used as left atrial dimension index (LADI) for analysis. The end points were stroke and all-cause death. A multivariate Cox regression analysis was used to estimate the relative risks between participants stratified by tertile of LADI within each gender. Results: During a median follow-up of 11.9 years, 21,733 person-years were accrued and 114 subjects with stroke and 364 all-cause deaths were identified. The adjusted relative risk of stroke was 2.44 (95% CI, 1.11 to 5.36, P for trend = 0.029) among women in the upper tertile of LADI compared with women in the lower tertile of LADI. Further adjusting for left ventricular mass index attenuated the relationship of LADI to stroke (adjusted relative risk 2.11, 95% CI, 0.88 to 5.02, P for trend = 0.09). In men, tertile of LADI was not associated with stroke. LADI was not associated with risk of all-cause death in both genders. Conclusions: We found an association between increased LADI and incident stroke in women but not in men in this ethnic Chinese population. LADI was not associated with all-cause death in both genders. (Echocardiography 2011;28:1054-1060) [ABSTRACT FROM AUTHOR]

Background: This study investigated the stroke risk in patients with head and neck cancers (HNCs) using population-based data.Methods: From claims collected in the Taiwan National Health Insurance database, we identified 13,390 HNC patients with diagnosis made in 2000-2002. A reference cohort of 53,517 non-cancer individuals matched for age, gender, and stroke risk factors was used for assessing stroke risk in follow-up to 2008.Results: The overall stroke incidence was 1.44-fold higher in the HNC than in the reference cohort (11.4 vs 7.9 per 1000 person-years). Adjusted hazard ratios (HRs) were 1.54 (95% confidence interval (CI): 1.40-1.68) for ischaemic stroke and 1.36 (95% CI: 1.09-1.69) for haemorrhagic stroke. The cancer-to-reference stroke incidence rate ratio was age dependent and the highest in the age group younger than 40 years (5.45, 95% CI: 3.78-7.87) and decreased with aging. Comparing different therapeutic modalities, HNC patients receiving both radiotherapy (RT) and chemotherapy (CT) had the highest stroke risk (HR: 1.46, 95% CI: 1.22-1.74), followed in sequence by those who had CT alone, RT alone, and without therapy.Conclusion: Patients with HNC are at increased risk of developing stroke, especially in the young age group and in those who received both RT and CT. [ABSTRACT FROM AUTHOR]

Abstract: Background: : Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. Methods: : A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. Result: : A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65–74 years vs. age 20–64 years, P =0.014; OR=1.652 for age over 75 years vs. age 20–64years, P <0.001), hypertension (HTN) (OR=2.656, P <0.001), diabetes mellitus (DM) (OR=1.341, P =0.005), heart failure (OR=1.611, P <0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P <0.001) and peripheral arterial disease (PAD) (OR=1.814, P =0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS2 and CHA2DS2-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Conclusion: : Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes. [Copyright &y& Elsevier]

As habitual heavy alcohol consumption is one of the major causes of cirrhosis in the western world, the majority of studies on the relationship between cirrhosis and stroke have focused on patients with alcohol-related liver diseases. Using a nationwide population-based dataset, this study therefore aimed to examine the risk of stroke among non-alcoholic cirrhosis patients over a 5-year period following their diagnosis with non-alcoholic cirrhosis, as compared with the general population during the same period. We used the 'Longitudinal Health Insurance Database', derived from the Taiwan National Health Insurance program. The study cohort comprised 2336 patients with cirrhosis and the comparison cohort consisted of 11 680 randomly selected subjects. Stratified Cox's proportional hazard regressions were performed to compare the 5-year stroke survival rate for the two cohorts. In the total sample of 14 016 patients, 1187 patients (8.5%) experienced stroke during the 5-year follow-up period: 176 from the study cohort (7.5% of the patients with cirrhosis) and 1011 from the comparison cohort (8.7% of patients without cirrhosis) ( P=0.076). After adjusting for the patients' geographical location, hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation and hyperlipidaemia, the regression analysis shows that patients with cirrhosis were less likely to experience stroke compared with those without cirrhosis during the 5-year period (hazard ratio=0.59, 95% confidence interval=0.52-0.67, P<0.001). We conclude that patients with non-alcoholic cirrhosis were at a reduced risk for stroke compared with the general population. [ABSTRACT FROM AUTHOR]

Background/Aims: To compare the influence of stroke risk factors between different stroke types and age groups in Taiwan. Materials and Methods: During the study period, March 2007 to August 2008, 1,161 patients with acute ischemic stroke were admitted to the neurological ward. All the patients had risk factors work up and stroke subtype categorization. Results: The study cohort included 736 men and 425 women. Patients were grouped into three age groups: below 50 years (153, 13.2%); 50-75 years, (702, 60.5%) and above 75 years (306, 26.4%). Stroke subtypes included: (1) large-artery atherosclerosis (14.6%), cardioembolism (12%), small-artery occlusion (39.4%), stroke of other determined etiology (1.5%) and stroke of undetermined etiology (32.6%). Older patient group had higher frequency of hypertension and diabetes mellitus. Younger age group of patients had high frequency of obesity and elevated serum triglyceride levels. Smoking and alcohol consumption were strongly related to men, and heart disease and obesity were related to women. Conclusions: The influence of risk factors at different ages is different. Awareness of the stroke risk factors before stroke and treatment with appropriate therapies or life modifications may have a bearing on the outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Chronic arsenic exposure is associated with a variety of diseases, including cancer, peripheral vascular disease, and diabetes. However, its association with cerebrovascular diseases (CVD) has not yet been resolved. The aim of this study is to explore this association in Taiwan using nation-wide data. Materials and methods: We analyzed mortality data in Taiwan from 1971 to 2005 and choose two geographic areas with populations suffering from chronic exposure to arsenic in drinking water for study, the blackfoot disease endemic area (BFDEA) in the southwest and Lan-Yang Basin (LYB) in the northeast parts of Taiwan. The Chia-Yi and Tainan Counties, which surround the BFDEA, and the nation of Taiwan as a whole were used as reference populations. Direct standardized mortality rates and gender-specific indirect standardized mortality ratios (SMRs) were calculated for the four populations. Results: The direct standardized mortality rate for CVD in Taiwan decreased from 2.46/103 person-year in 1971 to 0.63/103 person-year in 2005, and women had significantly lower mortality than men (SMR = 0.80; p < 0.05). The CVD mortality rates of populations with chronic arsenic exposure were significantly higher than the reference populations (SMR ranging from 1.06 to 1.09 in men and 1.12 to 1.14 in women; p < 0.05). The BFDEA had higher CVD mortality rates than the LYB, with SMR = 1.05 (p < 0.05) in men and SMR = 1.04 (p = 0.05) in women. Conclusion: In Taiwan, while CVD mortality decreased in both genders between 1971 and 2005, chronic arsenic exposure from drinking water was associated with increased risks of CVD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study examined compliance with prescribing guidelines for antithrombotic therapy in patients with atrial fibrillation (AF) in Taiwan, using the 2001 joint guideline from the American College of Cardiology, American Heart Association, and European Society of Cardiology. The study also sought to identify factors associated with the appropriate prescribing of antithrombotic therapy. Methods: Patients with AF were identified by the presence of ≥2 inpatient or outpatient claims with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 427.31 in the Taiwanese National Health Insurance claims database between July 1, 2003, and June 30, 2004. Patients were stratified according to their stroke risk (highest, high, low, or lowest) and antithrombotic medication (aspirin, warfarin, ticlopidine/clopidogrel, or none). Based on these categories, rates of prescribed treatments that were compliant with the antithrombotic guidelines were calculated. Antithrombotic therapies were considered guideline compliant when warfarin was prescribed for the highest- or high-risk patients, aspirin was prescribed for low-risk patients, and aspirin or no antithrombotic treatment was prescribed for the lowest-risk patients. Because the role of ticlopidine/clopidogrel in AF remains unclear, prescription of these drugs without aspirin or warfarin was considered noncompliant with the guidelines. Results: Of 39,541 identified patients with AF, 70.3% were at high risk for thromboembolic events and 18.3% were at highest risk; however, only 24.7% of the overall population received appropriate antithrombotic therapy. When patients with risk factors for bleeding were excluded, the rate of compliance increased to 26.2%. Factors that were inversely associated with prescription of warfarin included risk factors for bleeding (cancer, predisposition to falls, previous hemorrhage, history of peptic ulcer, cirrhosis, renal dialysis, and psychiatric disease), hypertension, coronary artery disease, thyrotoxicosis, and age ≥60 years. Conclusions: Most of these patients with AF in Taiwan did not receive appropriate antithrombotic therapy over the period studied. Bleeding risk factors, hypertension, coronary artery disease, thyrotoxicosis, and older age were associated with low rates of warfarin use. [Copyright &y& Elsevier]

Background and Purpose: The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years. Methods: Both the IgG and IgM isotypes of aCL were measured in 273 patients (>40 years of age) hospitalized for first-ever ischemic stroke and in 181 non-stroke controls. Results were defined as: negative (<10 IgG phospholipid units [GPL] or <7.5 IgM phospholipid units [MPL]); low positive (10-20 GPL or 7.5-15 MPL); or, high positive (>20 GPL or >15 MPL). Odds ratios (OR) were estimated by logistic regression with adjustment for potential confounders. Results: A high positive IgG aCL was present in 4.4% of the stroke patients and 1.2% of the controls. Age- and sex-adjusted analysis showed a borderline association between a high positive level for aCL IgG titer and stroke, with an OR of 4.01 (95% CI 0.87-18.37; p = 0.0739). Final analysis, with adjustments for age, sex, hypertension, diabetes, tobacco smoking, atrial fibrillation, left ventricular hypertrophy and hyperlipidemia, revealed an OR of 5.25 (95% CI 1.06-25.89; p = 0.0419). Conclusions: The results of this study suggest that elevated titer of aCL IgG (>20 GPL) is associated with first-ever ischemic stroke in Taiwanese patients aged over 40 years. High positive aCL titer is related to ischemic stroke after adjustment for conventional cerebrovascular risk factors, indicating that it is probably an independent risk factor for ischemic stroke. [ABSTRACT FROM AUTHOR]

The author focuses on whether antidepressants increase the risk of stroke. He comments on a large-population-based analysis of stroke risk among users of antidepressants in Taiwan published in the issue. He notes the difference between antidpressant users and non-users on a broad range of factors capable of affecting risk of cerebrovascular events. He comments on the implications of the study and complications affecting their findings.

Examines the link found in Taiwan between air pollution coupled with warm weather and ischaemic and haemorrhagic strokes. Study results showing how many stroke victims have been affected by air pollution and warm weather; Relation between hot weather and pollution, including its health effects; Profile of the city of Kaohsiung, the city where the study was done; Possible explanations of how the pollution and weather factors could be a cause of strokes.