Significantly Increased Risk of Cardiovascular Disease among Patients with Gallstone Disease: A Population-Based Cohort Study

<div><p>Objective</p><p>To investigate whether gallstone disease (GD) increases the risk of developing cardiovascular disease (CVD) in a large population-based cohort.</p> <p>Methods</p><p>A study population including 6,981 patients with GD was identified from The Taiwan National Health Insurance Research Database between 2004 and 2005. GD patients were defined as patients with principal discharge diagnoses of cholelithiasis using the ICD-9-CM code 574. 27,924 patients without GD were randomly selected and matched for age and gender. All patients were followed for 6 years or until diagnosis for CVD. Cox proportional hazards regression model was used to assess the risk of developing CVD with adjustment for age, gender and co-morbid conditions.</p> <p>Results</p><p>During the six years follow-up period, 935 patients with GD and 2,758 patients without GD developed CVD. Patients with GD had an elevated risk of CVD (HR, 1.32; 95% CI, 1.22-1.43) when compared with those without GD. Similar relationship was observed when CVD was categorized i.e. stroke (HR, 1.15; 95% CI, 1.01-1.32), coronary heart disease (HR, 1.42; 95% CI, 1.28-1.58) and heart failure (HR, 1.31; 95% CI, 1.00-1.73). When GD was classified according to the level of severity, using patients without GD as reference, the risks of CVD were elevated in patients with non-severe GD (HR, 1.34; 95% CI, 1.24-1.46) as well as those with severe GD (HR, 1.20, 95% CI, 1.02-1.40), after adjusting for age, gender and comorbidities. In age-stratified analysis, patients aged 18-40 years with GD were at higher risk of developing CVD (HR, 1.42; 95% CI, 1.09-1.84) than older GD patients.</p> <p>Conclusion</p><p>This study found an increased risk of CVD in patients diagnosed with GD. The excess risk was particularly high in younger GD patients. Prevention of GD could help reduce the risk of developing CVD, and the better effect could be achieved for the younger age groups.</p> </div

Dynamic changes in functional needs for patients with severe disabilities after stroke.

<p>Dynamic changes in functional needs for patients with severe disabilities after stroke.</p

The lifetime health-adjusted survival of stroke patients.

<p>The survival probability (longdash line) multiplied by the proportion of patients with no disability (dotted line) over time after diagnosis results in the health-adjusted survival curve (solid line), which can be summed to estimate the expected life years without functional disabilities for stroke patients (shaded area).</p

Comparison of frequency distributions of stroke patients hospitalized under the National Health Insurance (NHI), at the National Taiwan University Hospital (NTUH), and a cross-sectional sample at the stroke clinics and rehabilitation wards.

*<p>P<0.001;</p>†<p>SD: standard deviation.</p

Mean (standard error, in years) duration of subjects with different levels and types of functional disabilities, as measured by the Barthel Index (BI) and stratified by stroke subtypes.

*<p>LAA: Large artery atherothrombosis;</p>†<p>CE: Cardio-embolism;</p>‡<p>ICH: Intracerebral hemorrhage.</p

Kaplan-Meier 6-year CVD event free probability curves for gallstone and non-gallstone disease groups.

<p>Kaplan-Meier 6-year CVD event free probability curves for gallstone and non-gallstone disease groups.</p

Estimation of life expectancy (LE, 95% confidence interval (CI), in years), EYLL (expected years of life loss, with standard error of mean in parenthesis), mean lifelong duration (95% CI, in years) of each functional disability state as measured by the Barthel Index (BI) and EYLD (expected years of living with disability) stratified by different stroke subtypes.

*<p>no disability (BI = 100);</p>†<p>mild disability (BI = 90–95);</p>‡<p>moderate disability (BI = 60–85);</p>§<p>severe disability (BI = ≤55);</p>| |<p>LAA:Large artery atherothrombosis;</p>#<p>CE: Cardio-embolism;</p>**<p>ICH: Intracerebral hemorrhage.</p

Head and abdominal imaging findings in HCC patients with pulmonary vein shunting due to direct diaphragm and pleura invasion.

<p>A right inferior phrenic artery angiogram showed prior embolized hepatic tumor with large adjacent recurrence. An early opacified pulmonary vein branch was seen (arrow head) (A); non-contrast chest CT at 2 days after CLE showed lipiodol pneumonitis at bilateral collapsed basal lung (arrow head) (B); on head non-contrast CT there were several hyperdense spots (arrow) in addition to typical disseminated lesions of increased attenuation of CLE at the cerebral hemispheres (C) and brain stem (D). At 3 weeks follow-up, head CT of the same patient showed disappearance of the previous hyperdense lesions (E & F).</p

Clinical Manifestations of 32 Reported Cases with Cerebral Lipiodol Embolism.

<p>CLE: cerebral lipiodol embolism; TAE/TACE: transarterial (chemo)embolization.</p><p>^aPoor outcome indicated death or vegetative status at the end of the case description</p><p>Clinical Manifestations of 32 Reported Cases with Cerebral Lipiodol Embolism.</p

Clinical and Radiological Manifestation of Eight Patients with Cerebral Lipiodol Embolism.

<p>M, male; F, female; HCC, hepatocellular carcinoma; PV, portal vein; BCLC, Barcelona Clinic Liver Cancer; ECOG PS: Eastern Cooperative Oncology Group Performance Status; TAE: trans-arterial embolization; TACE: trans-arterial chemoembolization;</p><p>RIPA: right inferior phrenic artery; LIPA: left inferior phrenic artery; RHA: right hepatic artery; LHA: left hepatic artery; LGA: left gastric artery; RSGA: Right superior gluteal artery</p><p>^a Patient No 6 had hypertension, diabetes mellitus, congestive heart failure and dyslipidemia</p><p>^b Multiple nodules defined as ≥ 3</p><p>^c TACE was referred as lipiodol mixed with doxorubicin 40 mg followed with injection of Gelfoam particles</p><p>^d Pneumonitis was diagnosed by chest CT and plain film after the procedure</p><p>^e The time determined the outcome was at discharge</p><p>Clinical and Radiological Manifestation of Eight Patients with Cerebral Lipiodol Embolism.</p