Tsung-Kun Lin

Purpose Proton pump inhibitors (PPIs) are widely prescribed for gastrointestinal disorders. Lansoprazole, a PPI, has been recognized for its potential effects of improving insulin resistance, reduction of oxidative stress, and improvement in atherosclerosis through peroxisome proliferator-activated receptor gamma (PPARγ) induction. This study aims to investigate whether lansoprazole poses a distinct risk of coronary heart disease (CHD) compared to other PPIs. Methods A retrospective cohort study utilized data from the National Health Insurance Research Database in Taiwan spanning from 2000 to 2013. The exposed cohort included 1666 patients with lansoprazole use, while the comparison cohort comprised 6664 patients using other PPIs. The primary outcome was incident CHD. Cox regression models were employed to assess the association between lansoprazole use and CHD risk, presenting hazard ratios (HRs) and 95% confidence intervals (CIs). Results Patients prescribed lansoprazole demonstrated a significantly reduced risk of CHD compared to those undergoing other PPI treatments in individuals without a history of CHD. Lansoprazole users exhibited a 25% lower risk of developing CHD compared to other PPI users (adjusted HR 0.75; 95% CI 0.65–0.87). Intriguingly, this inverse association between lansoprazole use and CHD risk was consistent across genders and various age groups. Conclusion This study suggests that lansoprazole is associated with a decreased risk of CHD in comparison to other PPIs in patients without a history of CHD. Further research is warranted to elucidate the clinical implications of these findings.

(1) Background: Recently, sodium–glucose cotransporter-2 inhibitors (SGLT2Is) have been reported to significantly reduce renal cell carcinoma (RCC) risk. However, the effect between individual SGLT2Is on RCC incidence in patients with type 2 diabetes (T2D) or heart failure is unclear. We conducted an observational analysis to explore type disparity in the prescription of SGLT2Is on RCC risk. (2) Methods: A nationwide retrospective cohort study using the Health and Welfare Data Science Center database (2016–2021) was conducted. Patients aged ≥40 years who took SGLT2Is were designated as the SGLT2I group, whereas propensity score 1:1-matched randomly selected patients without SGLT2Is were assigned to the non-SGLT2I group. The primary outcome was the risk of incident RCC between individual SGLT2Is. Multiple Cox regression modeling was conducted to analyze the association between individual SGLT2I use and RCC risk. (3) Results: After a 5.5-year follow-up, SGLT2I use was associated with a significantly lower risk of incident RCC (hazard: 0.62; 95% confidence interval [CI]: 0.44–0.89). Compared with non-users and after adjusting for the index year, sex, age, comorbidities, concurrent medication, and the risk of developing RCC, the hazard ratios of dapagliflozin, canagliflozin, and empagliflozin were 0.66 (95% CI: 0.53–0.83), 0.84 (95% CI: 0.46–1.30), and 0.71 (95% CI: 0.56–0.90), respectively. (4) Conclusions: Our data show a type-based effect of SGLT2Is on RCC risk. The type-based effect of SGLT2Is should be further studied for better clinical management information and for reducing RCC incidence in patients with T2D.

Patients with chronic kidney disease (CKD) are at a higher risk for developing dementia than the general population. Clinical studies have investigated the effects of statin use on new-onset dementia (NOD) in patients with CKD; however, the findings are inconsistent. This study examines the association between the use of statins and NOD in patients with CKD. We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed the risk of incident dementia by estimating the hazard ratios and 95% confidence intervals. Therefore, multiple Cox regression models were conducted to analyse the association between statin use and NOD in patients with CKD. There were 24,090 participants with statin use and 28,049 participants without statin use in patients with new-diagnosed CKD; the NOD event was 1390 and 1608, respectively. There was a trend of reduction association between statin users and NOD events after adjusted sex, age, comorbidities, and concurrent medication (adjusted HR 0.93, 95% CI 0.87 to 1.00) in the 14 years of the follow-up. Sensitivity test for the propensity score 1:1 matched analyses showed similar results (adjusted HR 0.91, 95% CI 0.81 to 1.02). The subgroup analysis also identified the use of statins as having a trend against developing NOD in patients with hypertension. In conclusion, statin therapy may effectively reduce the risk of NOD in patients with CKD. More studies are needed to credibly evaluate the effects of statin therapy on the prevention of NOD in patients with CKD.

Correspondence on 'Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease' Globally, coronary artery disease (CAD) is one of the leading causes of mortality in patients with rheumatoid arthritis (RA). 1 2 The major pathological changes in RA-associated CAD are high rate of unstable coronary plaque and increased local inflammation, as inferred from autopsy reports. 3 Recently, Løgstrup et al 4 reported that RA was significantly associated with a 10-year risk of myocardial infarction, major adverse cardiovascular events and all-cause mortality regardless of the presence of CAD in patients undergoing coronary angiography (CAG). While the patients with RA associated CAD carry the largest risk, the additive risk of RA in patients without CAD is minor. These findings were published in the September 2020 issue of the Annals of the Rheumatic Diseases. Certainly, the findings of Løgstrup et al hold significance for clinicians; however, four points remain unaddressed, and we wish to communicate these to the authors. First, low-density lipoprotein cholesterol (LDL-C) plays a vital role in the perpetuation and pathogenesis of CAD. 5 The elevated level of LDL-C is a strong independent predictor of cardiovascular events, and lowering the LDL-C to <70 mg/ dL has proved to be effective in the primary and secondary prevention of CAD. 5-7 In recent reports, it has been stated that emphasising the importance of optimal LDL-C control early in life at a younger age. 8 However, the LDL level was not described in the baseline characteristics of these four groups. Therefore, the conclusions may not be rigorous without considering these vital factors. Second, several previous clinical trials in patients with CAD have demonstrated that high-intensity statin therapy significantly reduces cardiovascular events when compared with moderate-intensity statin therapy. 9-12 Furthermore, it has been established that higher-dose statin therapy was associated with a lower risk for cardiovascular events than moderate-dose statin therapy in patients with CAD. 13 However, the percentages of patients using statin were not comparable and the type and dosage of statin were not described in the baseline characteristics of these four groups. These issues might have nullified some of the results related to this study. Third, despite the higher risk for cardiovascular events, treatment compliance was poor in patients with RA because these patients are given many oral drugs. 14 In this situation, the comparison between those with and without CAD among the patients with RA may be influenced by treatment compliance. In particular, there was a low rate of compliance in long-term (over 10 years) follow-up. Thus, treatment compliance rates for patients with RA were probably suboptimal in this study and hence may act as a confounding variable. Finally, during the baseline participation in this study, only patients undergoing CAG were recruited, and the decision was made by the physician to either perform CAG or not. Propensity score matching (PSM) may be suggested to form comparable groups with a priori risk for cardiovascular events and to magnify hidden confounding variables. 15 It is not known what motivates the clinician to ask any given RA patient to undergo CAG. Thus, it is not possible to eliminate the bias introduced by the physician's decision.

Background: Proton pump inhibitor (PPI) lansoprazole acts as a liver X receptor agonist, which plays a crucial role in the crosstalk of osteoblasts and osteoclasts in vitro and during bone turnover in vivo. However, epidemiological studies on the association between the use of lansoprazole and osteoporosis risk are limited. We aimed to determine the risk of developing osteoporosis in patients with lansoprazole use. Methods: A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study includes 655 patients with lansoprazole use (the exposed cohort) and 2620 patients with other PPI use (the comparison cohort). The main outcome was the primary diagnosis of osteoporosis. The hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the association between the use of lansoprazole and risk of osteoporosis. Results: Patients receiving lansoprazole treatment had a reduced risk of osteoporosis as compared with those undergoing other PPI therapy (adjusted HR, 0.56; 95% CI, 0.46–0.68). Moreover, this inverse association is evident in both sexes and in various age groups. Conclusions: This population-based cohort study demonstrated that lansoprazole use was associated with a reduced risk of osteoporosis. The clinical implications of the present study need further investigations.

We aimed to determine the association between proton pump inhibitor (PPI) use and incident asthma in patients with coronary artery disease (CAD). This nationwide cohort study collected claims data from the Taiwanese Bureau of National Health Insurance from 2004 to 2013. The primary outcome, i.e., the risk of incident asthma, was assessed by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). The adjusted HR of asthma development was estimated using the Cox regression model. Sensitivity and subgroup analyses were also conducted. A total of 8894 PPI users and 12,684 H2-receptor antagonist (H2RA) users were included in patients with CAD. Compared with H2RA use, an increased risk of incident asthma was found between PPI use and the risk of incident asthma in patients with CAD after adjusting for sex, age, urbanization, and low income (HR: 1.41; 95% CI: 1.04–1.89). The sensitivity analysis results were consistent with the main analysis results. However, the subgroup analysis revealed no association of incident asthma in patients with diabetes mellitus, hyperlipidemia, stroke, allergic rhinitis, pneumonia, cancer, or depression in the PPI group compared with those in the H2RA group. In conclusion, PPI use increased the risk of asthma development in patients with CAD.

, et al. Yonsei Med J. 2013 Mar;54(2):543-543. http://dx.doi.org/10.3349/ymj.2013.54.2.543