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Sleep disorder (SD), especially sleep apnea, and its effect on atrial fibrillation (AF) are gathering attention. However, other SDs may also play an essential role in AF. The aim of the study is to investigate the effects of other SDs on the risk of atrial fibrillation development.This study investigated the risk of AF in people diagnosed with SD compared with that in age and sex-matched unaffected individuals. This longitudinal, nationwide, population-based cohort study was conducted using data from the Taiwan National Health Insurance Research Database (NHIRD) of individuals diagnosed with SD from January 1, 2001, to December 31, 2012.The sample consisted of 193,288 people with the SD, which include of 4406 people with sleep apnea, 73,704 people with insomnia, 107,395 people with sleep disturbance, 7,783 people with other SD, and 193,288 matched controls. A Cox proportional hazard regression was used to compute the risk of AF in people with SD and subgroup of SD, relative to that in people without SD. The AF incidences were 1.21-fold higher (95% CI 1.15-1.27) in the SD cohort, 1.19-fold higher (95% CI 0.91-1.56) in the sleep apnea cohort, 1.26-fold higher (95% CI 1.19-1.34) in the insomnia cohort, 1.15-fold higher (95% CI 1.08-1.22) in the sleep disturbance cohort, and 1.30-fold higher (95% CI 1.11-1.53) in other SDs, than in the control cohort, after age, sex, and comorbidities were adjusted.This nationwide population-based cohort study indicates a strong relationship between SD and incident AF, and insomnia has a higher impact on AF compared with other SD.

Background/Purpose: Currently, data on the real-world use of dronedarone, an antiarrhythmic drug for atrial fibrillation (AF), are contradictory and often based on patient populations comprised of Caucasians. We prospectively investigated the efficacy and safety of dronedarone and risk factors related to treatment outcomes in a real-world use setting. Methods: The prospective, observational, single-arm, multi-center study included a total of 824 Taiwanese patients with a diagnosis of paroxysmal or persistent AF and receiving dronedarone treatment. Risk factors analysis, efficacy, and safety of dronedarone were assessed with a follow-up of six months. Results: Of the 824 patients enrolled (mean age, 75.3 ± 7.2 years), 95.2% had at least one cardiovascular risk factor. An increase in the proportion of patients with sinus rhythm following treatment was seen (52.1% at baseline vs. 67.4% at 6 months). A decrease in the mean duration of AF episodes (388.4 min vs. 62.3 min) and an increase in total AFEQT (65.4 ± 16.2 vs. 74.0 ± 11.8) were also observed after 6 months of treatment. Females, those under the age of 75, and those with symptomatic AF had higher odds of treatment success. At 6 months, 10.5% of patients reported treatment-related AEs. However, only 0.2% of the AEs were both severe in nature and causally related to dronedarone. Conclusion: This six-month study showed dronedarone to be relatively safe and efficacious and to improve quality-of-life in Taiwanese patients with atrial fibrillation. Odds of treatment success were related to the patient's gender, age, and AF type. Keywords: Atrial fibrillation, Dronedarone, Observational, Safety, Quality of life

Some previous literature indicated an association between cardiovascular diseases and erectile dysfunction (ED). This case-control study purposed to evaluate the association between prior mitral valve prolapse (MVP) and ED using data from the Taiwan National Health Insurance Research Dataset. In this study, 48,755 patients with ED were identified as cases, and 195,020 propensity score-matched patients without ED were selected as controls. Conditional logistic regressions were conducted to evaluate the odds ratios (ORs) for previous MVP between cases and the matched controls. In all sampled patients, 4,565 (1.87%) patients had MVP before the index date. MVP was found in 1,304 (2.67%) cases and in 3,261 (1.67%) matched controls. Patients with ED had a significantly higher occurrence of MVP than the controls. In addition, after propensity score matching, a conditional logistic regression analysis showed that the OR of previous MVP for patients with ED was 1.63 (95% confidence interval [CI] 1.52 to 1.74) compared to the matched controls. The ORs of previous MVP for patients with ED aged ≤65 years and those >65 years were 1.68 (95% CI 1.56 to 1.81) and 1.49 (95% CI 1.30 to 1.70), respectively, compared with the matched controls. We found that patients with erectile dysfunction had significantly higher odds of previous MVP compared with matched control subjects without ED regardless of the age group.

Cloud-based BP system integrated with CPOE at the point of care achieved better BP control compared to traditional care.Cloud BP records positively reinforced both BP measuring and medication adherence behaviors.Cloud-based BP system does not require any technical skills and is therefore suitable for every age group. BackgroundLess than 50% of patients with hypertensive disease manage to maintain their blood pressure (BP) within normal levels. ObjectiveThe aim of this study is to evaluate whether cloud BP system integrated with computerized physician order entry (CPOE) can improve BP management as compared with traditional care. MethodsA randomized controlled trial done on a random sample of 382 adults recruited from 786 patients who had been diagnosed with hypertension and receiving treatment for hypertension in two district hospitals in the north of Taiwan. Physicians had access to cloud BP data from CPOE. Neither patients nor physicians were blinded to group assignment. The study was conducted over a period of seven months. ResultsAt baseline, the enrollees were 50% male with a mean (SD) age of 58.18 (10.83) years. The mean sitting BP of both arms was no different. The proportion of patients with BP control at two, four and six months was significantly greater in the intervention group than in the control group. The average capture rates of blood pressure in the intervention group were also significantly higher than the control group in all three check-points. ConclusionsCloud-based BP system integrated with CPOE at the point of care achieved better BP control compared to traditional care. This system does not require any technical skills and is therefore suitable for every age group. The praise and assurance to the patients from the physicians after reviewing the Cloud BP records positively reinforced both BP measuring and medication adherence behaviors.

Depressive symptoms are linked to increased morbidity and mortality, and impaired health status in patients with heart failure. Elevating resilience may mitigate the negative consequences associated with depressive symptoms. However, the role of resilience in the relationship between depressive symptoms and health status in patients with heart failure remains unknown.To examine the relationships among depressive symptoms, resilience, and physical and psychological health status in patients with heart failure and to determine whether resilience plays a mediating or moderating role in the relationship between depressive symptoms and physical and psychological health status.Cross-sectional study design.Cardiac outpatient clinics in hospitals in Northern Taiwan.The sample comprised 128 community-dwelling and medically stable patients with echocardiographically documented heart failure.Hierarchical multiple regressions were conducted to determine whether depressive symptoms and resilience are associated with physical and psychological health status. The moderating role of resilience was examined by testing the significance of the interaction between depressive symptoms and resilience. The mediating role of resilience was analyzed using the PROCESS procedure in SPSS.Depressive symptoms were significantly associated with both physical and psychological health status (both p.01) in patients with heart failure after adjustment for sociodemographic variables, comorbidities, and the New York Heart Association functional class. Furthermore, resilience mediated the relationship between depressive symptoms and psychological health status (b=-0.05; confidence interval: -0.01, -0.001) but not that between depressive symptoms and physical health status (b=-0.004; confidence interval: -0.003, 0.003).Depressive symptoms are risk factors for poor health status in patients with heart failure. However, enhancing resilience may facilitate improving psychological health status in patients with depression and heart failure. Future studies should investigate further the design and feasibility of resilience-focused interventions for patients with depression and heart failure.

Nicorandil is an adenosine triphosphate-sensitive potassium channel opener with additional antioxidant properties. Doxorubicin (DOX) is an anticancer drug that exerts oxidation-mediated adverse cardiovascular effects. This study examined the effects of nicorandil on DOX-induced cytotoxicity in human umbilical vein endothelial cells (HUVECs) and underlying intracellular signaling mechanisms. Cultured HUVECs were pretreated with nicorandil (0.1, 0.3, 1, 3, and 10 μM) for 12 h and then treated with DOX (1 μM) for 24 h. Cell viability and cytotoxicity were measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays, respectively. Cell apoptosis was examined using a caspase-3 activity assay, and DNA fragmentation was detected through TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling) staining. Western blot analysis was conducted to determine the related protein expression. DOX markedly increased reactive oxygen species production, p53 expression, caspase-3 activity, cleaved caspase-3 levels, and TUNEL-positive cell numbers but reduced Bcl-2 expression and intracellular antioxidant enzyme levels; these effects were effectively antagonized through nicorandil (3 μM, 12 h) pretreatment, which resulted in HUVECs being protected from DOX-induced apoptosis. Activating transcription factor 3 (ATF3), a stress-induced transcription factor, was induced by nicorandil (3 μM). Furthermore, nicorandil (3 μM) enhanced nuclear factor erythroid 2–related factor 2 (Nrf2) translocation and heme oxygenase-1 (HO-1) expression. ATF3 short interfering RNA significantly attenuated nicorandil-mediated Nrf2 translocation, HO-1 expression, and inhibitory effects on DOX-stimulated reactive oxygen species production and cell apoptosis. In summary, nicorandil may protect HUVECs from DOX-induced apoptosis, in part through ATF3-mediated Nrf2/HO-1 signaling pathways, which potentially protect the vessels from severe DOX toxicity.

Background Vaccination against influenza may decrease the risk of an acute cardiovascular event in the elderly. The purpose of this study was to test the hypothesis that influenza vaccination could reduce hospitalizations for heart failure (HF) in patients with chronic obstructive pulmonary disease (COPD). Methods Using Taiwan National Health Insurance Research Dataset (NHIRD) 2000 to 2007, this cohort study comprised patients with a recorded diagnosis of COPD (n = 25,609) between January 1, 2000 and December 31, 2007. Each patient was followed up until the end of 2007. Cox proportional hazard regression analysis was used to evaluate the HF-free survival rates after adjusting for known confounding factors. Results We found that patients with COPD but no history of a cardiovascular event had a lower risk of hospitalization for HF after receiving influenza vaccination. After adjusting for potential confounders, there was a possible decrease in HF admission for the vaccinated group [hazard ratio (HR), 0.44, 95% confidence interval (CI), 0.35–0.55]. When stratified in terms of the patients' ages, the adjusted HR for hospitalization due to HF was 0.36 (95% CI, 0.28–0.46) for vaccinated patients over 64 years of age; however, the adjusted HR for HF in patients under 55 years of age who had received vaccination was not significant. Conclusion Our data show that there was a lower rate of hospitalization from HF in patients with COPD receiving influenza vaccination, but only in patients older than 65 years.

Research has indicated that inflammation promote all phases of atherosclerosis. The current study tested the hypothesis that rhinosinusitis is a risk marker for myocardial infarction (MI). Data on the general population were obtained from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). The study cohort comprised patients who had received a recorded diagnosis of rhinosinusitis ( N = 52,930) between January 1, 2004 and December 31, 2004. The comparison group consisted of patients who had not received a rhinosinusitis diagnosis, and who were matched for age and sex with the study group at a ratio of 4 controls to 1 study patient (1:4) ( N = 211,720). Each patient's condition was followed using database entries until the end of 2006. Cox proportional hazard regressions were used to evaluate the 3-year MI-free survival rates, after adjusting for known confounding factors. We found that patients with rhinosinusitis were more likely than the control group to have MI, after adjusting for potential confounders [adjusted hazard ratio (HR), 1.84; 95% confidence interval (CI), 1.44 ∼ 2.40]. Of the total 264 650 patients, 290 experienced MI during the 3-year follow-up period, including 8 acute sinusitis patients, 77 chronic sinusitis patients, and 205 control patients. The incidence rate of MI was 6.19 (95% CI 5.01–7.65) per 10,000 person-years for rhinosinusitis patients, compared to 3.51 (95% CI, 3.06–4.02) for the control patients. From this study, rhinosinusitis may be associated with MI. Further research in this important area of public health is warranted.

Nicorandil is an adenosine triphosphate-sensitive potassium channel opener that combines an organic nitrate and a nicotinamide group which respectively confer to nicorandil the additional properties of being a nitric oxide (NO) donor and antioxidant; it also induces vasodilation, decreases the blood pressure, and protects the heart. However, the intracellular mechanism of nicorandil remains to be delineated. The aims of this study were to test the hypothesis that nicorandil alters strain-induced endothelin-1 secretion and NO production, and to identify the putative underlying signaling pathways in human umbilical vein endothelial cells (HUVECs). Cultured HUVECs were exposed to cyclic strain in the presence of nicorandil; endothelin-1 expression was examined by reverse-transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay. Activation of extracellular signal-regulated protein kinase (ERK), endothelial NO synthase (eNOS), and activating transcription factor (ATF)-3 was assessed by Western blot analysis. We show that nicorandil inhibited strain-induced endothelin-1 expression. Nicorandil also inhibited strain-increased reactive oxygen species formation and ERK phosphorylation. On the contrary, NO production, eNOS phosphorylation, and ATF3 expression were enhanced by nicorandil; however, L-NAME (an inhibitor of eNOS) and LY294002 (an inhibitor of phosphatidylinositol 3-kinase) inhibited nicorandil-increased ATF3 expression. Moreover, treatment of HUVECs with either an NO donor (NOC18; 3,3-bis[aminoethyl]-1-hydroxy-2-oxo-1-triazene) or an ATF3 activator (MG-132; carbobenzoxy-L-leucyl-L-leucyl-L-leucinal) resulted in repression of strain-induced endothelin-1 expression. Furthermore, L-NAME, and small interfering RNA transfection of eNOS also partially attenuated the inhibitory effect of nicorandil on strain-induced endothelin-1 expression. We demonstrate for the first time that nicorandil inhibits strain-induced endothelin-1 secretion via an increase in NO and upregulation of ATF3 in HUVECs. This study provides important new insights into the molecular pathways that may contribute to the beneficial effects of nicorandil in the cardiovascular system.

Background and Purposes The metabolic syndrome (MS) and abnormal nocturnal blood pressure (BP) dipping are both associated with increased risk of cardiovascular events. An association between MS and arterial stiffness was reported. This study aimed to examine the relationship between arterial stiffness as determined by the Cardio-Ankle Vascular Index (CAVI) and the nocturnal BP dipping pattern in normotensive individuals with one or more risk components of MS. Methods and Results A total of 73 normotensive individuals who met at least one of the five National Cholesterol Education Program Adult Treatment Panel III criteria were included. The MS score was calculated according to the GISSI Study. Ambulatory BP was recorded every 30 minutes for a 48-hour period. Individuals with MS and those without MS did not significantly differ in CAVI ( p = 0.040) or nocturnal systolic blood pressure (SBP) dipping ( p = 0.909). Controlling for age, CAVI was not significantly correlated with the MS score ( p = 0.067). CAVI significantly correlated with the magnitude ( ρ = 0.29, p = 0.014) and the percentage ( ρ = 0.29, p = 0.013) of nocturnal SBP dipping. CAVI independently predicted the magnitude of nocturnal SBP reduction ( β = 0.364, p = 0.002) even after adjusting for age and nighttime SBP. The extreme dippers had significantly higher CAVI values than the nondippers ( p = 0.012) and a trend toward higher CAVI than the dippers ( p = 0.031). Conclusion MS is associated with neither arterial stiffness nor nocturnal dipping pattern in normotensives. However, in normotensive individuals with risk components of the MS, arterial stiffness is related to an extreme dipping pattern.

Background Impairment of arterial properties has been suggested as a pathological link between diabetes and adverse cardiovascular (CV) events. Accumulating evidence has supported a role for reduced nocturnal blood pressure (BP) reduction in predicting CV risk. In light of the clinical importance of CV risk in diabetic patients, the question of whether normotensive Type 2 diabetic patients have increased CV risk as determined by augmentation index (AI) value deserves further attention. The association between AI value and the magnitude of nocturnal BP reduction is also of interest. Purpose This study aimed to compare AI between normotensive Type 2 diabetic patients and mildly hypertensive patients. The association between AI and the magnitude of nocturnal BP reduction in Type 2 diabetic patients was also examined. Methods A total of 113 participants were included in this study. AI was derived by pulse wave analysis using radial applanation tonometry coupled with the generalized transfer function. Ambulatory BP measurements were performed over a 24-hour period. Results There was no significant difference in AI between the diabetic patients and the mildly hypertensive patients after adjustment of age and body height. On the other hand, the diabetic patients exhibited a significantly lesser degree of nocturnal BP reduction than the mildly hypertensive patients even after adjusting conventional CV risk. AI was not correlated to the magnitude of nocturnal BP reduction in the diabetic patients. Conclusions The diabetic patients did not have higher AI than mild hypertensive patients, whereas the diabetic patients had significant blunted nocturnal BP reduction than the mildly hypertensive patients. The utility of AI as a maker for CV risk in normotensive Type 2 diabetic patients remained to be determined.

Propofol-related infusion syndrome (PRIS) has a high mortality with myocardial failure and dysrhythmias. However, there is no detailed description of the serial cardiac conditions presenting during the critical and recovery periods during PRIS. We report the case of a 24-year-old man with a traumatic head injury who developed PRIS after propofol infusion. Cyanosis, hypotension, neck vein distension, cardiac arrest and ventricular tachycardia occurred. The patient survived PRIS by prompt cessation of propofol, the use of inotropic agents, and short-term hemofiltration. A timely Holter electrocardiogram (ECG) recording, serial echocardiograms and 12-lead ECGs revealed isolated right heart failure, sequential bradycardia, arrest, left bundle branch block-like ventricular tachycardia, and varied coved-type ST elevation in the right precordial leads. All these clinical abnormalities (symptoms, echocardiograms, and ECGs) subsided within a few hours after treatment. The patient was eventually discharged with clear consciousness and without any cardiopulmonary sequelae. Our cardiac survey implied that in PRIS, the right heart is severely injured, both mechanically and electrophysiologically. Injured right hearts can completely and rapidly recover if recognition and treatment are timely.

A 78-year-old woman presented with acute myocardial infarction, anterior wall, Killip III, with congestive heart failure. The finding of coronary angiographic examination was multiple congenital coronary artery fistulas with a huge aneurysm, with fistulas originating from both the right coronary artery and left anterior descending artery. The patient received surgery successfully without cardiopulmonary bypass. The finding of the pathologic examination revealed hyaline change in the aneurysmal vessel wall. In a two-year follow-up, the patient was found to be asymptomatic clinically with improved left ventricular function.

Stevioside, a natural glycoside isolated from the plant Stevia rebaudiana Bertoni, has been used as a commercial sweetening agent in Japan and Brazil for20 years. Previous animal and human studies have indicated that stevioside has an antihypertensive effect.This study was undertaken to investigate the long-term (2-year) efficacy and tolerability of stevioside in patients with mild essential hypertension. Secondary objectives were to determine the effects of stevioside on left ventricular mass index (LVMI) and quality of life (QOL).This was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese men and women aged between 20 and 75 years with mild essential hypertension (systolic blood pressure [SBP] 140-159 mm Hg and diastolic blood pressure [DBP] 90-99 mm Hg). Patients took capsules containing 500 mg stevioside powder or placebo 3 times daily for 2 years. Blood pressure was measured at monthly clinic visits; patients were also encouraged to monitor blood pressure at home using an automated device. LVMI was determined by 2-dimensional echocardiography at baseline and after 1 and 2 years of treatment. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Electrocardiographic, laboratory, and QOL parameters were assessed at the beginning of treatment, and at 6 months, 1 year, and 2 years.One hundred seventy-four patients (87 men, 87 women) were enrolled in the study, and 168 completed it: 82 (42 men, 40 women; mean [SD] age, 52 [7] years) in the stevioside group and 86 (44 women, 42 men; mean age, 53 [7] years) in the placebo group. After 2 years, the stevioside group had significant decreases in mean (SD) SBP and DBP compared with baseline (SBP, from 150 [7.3] to 140 [6.8] mm Hg; DBP, from 95 [4.2] to 89 [3.2] mm Hg; P0.05) and compared with placebo (P0.05). Based on patients' records of self-monitored blood pressure, these effects were noted beginning approximately 1 week after the start of treatment and persisted throughout the study. There were no significant changes in body mass index or blood biochemistry, and the results of laboratory tests were similar in the 2 groups throughout the study. No significant difference in the incidence of adverse effects was noted between groups, and QOL scores were significantly improved overall with stevioside compared with placebo (P0.001). Neither group had a significant change in mean LVMI. However, after 2 years, 6 of 52 patients (11.5%) in the stevioside group had left ventricular hypertrophy (LVH), compared with 17 of 50 patients (34.0%) in the placebo group (P0.001). Of those who did not have LVH at baseline, 3 of 46 patients (6.5%) in the stevioside group had developed LVH after 2 years, compared with 9 of 37 patients (24.3%) in the placebo group (P0.001).In this 2-year study in Chinese patients with mild hypertension, oral stevioside significantly decreased SBP and DBP compared with placebo. QOL was improved, and no significant adverse effects were noted.