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Background: To determine the bidirectional link between periodontitis and fibromyalgia.Methods: In this cohort study, 196,428 periodontitis patients and 196,428 propensity score-matched non-periodontitis controls were enrolled. A Cox proportional hazard model was utilized to estimate the risk of fibromyalgia and survival analysis was adopted to assess the time-dependent effect of periodontitis on fibromyalgia. Subgroup analyses stratified by age, sex, and tracking period were conducted to identify susceptible populations. A parallel and symmetrical cohort that recruited 141,439 fibromyalgia patients and 141,439 propensity score-matched non-fibromyalgia controls ascertained the inverse effect of fibromyalgia on incident periodontitis.Results: Patients with periodontitis were more likely to develop fibromyalgia than non-periodontitis controls (HR = 1.42, 95% CI = 1.39-1.44, P < 0.001), which persisted in the survival analysis (log-rank test P < 0.0001). This effect was significant in both sexes and all age subgroups, and was particularly evident in males (HR = 1.52, 95% CI = 1.48-1.56, P < 0.001) and younger periodontitis patients (HR = 1.55, 95% CI = 1.50-1.60, P < 0.001). Fibromyalgia patients who never had periodontitis presented with greater risk for periodontitis over time (HR = 1.43, 95% CI = 1.40 - 1.45, P < 0.001; log-rank test P < 0.0001).Conclusions: Patients of both sexes and all age subgroups with periodontitis presented with a greater risk of fibromyalgia. Subgroups that were the most susceptible to periodontitis-associated fibromyalgia were periodontitis patients that were males and below 30 years old. Risks of periodontitis were also greater in fibromyalgia patients who never had periodontitis. [ABSTRACT FROM AUTHOR]

Background& Aims: Type 2 diabetes mellitus (T2DM) management in patients with cirrhosis is complicated. No clinical trials have investigated appropriate antidiabetic drug use in these patients. This study compared the risks of all‐cause mortality, major adverse cardiovascular events (MACE) and hepatic outcomes between patients with T2DM and cirrhosis using and not using thiazolidinedione (TZD). Methods: We selected 1,705 propensity score–matched TZD users and nonusers from a Taiwan National Health Insurance Research Database cohort of T2DM patients with compensated cirrhosis between January 1, 2000, and December 31, 2012 and followed them until December 31, 2013. Cox proportional hazards models with robust sandwich standard error estimates were used to assess risks of investigated outcomes for TZD users. Results: MACE incidence rates during follow‐up were 2.14 and 1.30 per 100 patient‐years for TZD users and nonusers, respectively (adjusted hazard ratio [aHR] 1.70; 95% confidence interval [CI], 1.32‐2.19). On the basis of TZD use, the aHRs (95% CIs) for stroke, ischemic heart disease and heart failure were 1.81 (1.28‐2.55), 1.59 (1.03‐2.44) and 2.09 (1.22‐3.60) respectively. Compared with TZD nonusers, rosiglitazone users had significantly higher aHR [1.67 (1.26‐2.20)] and pioglitazone users had no significant difference of aHR [1.12 (0.90‐1.64)]. All‐cause mortality, hepatocellular carcinoma, decompensated cirrhosis and hepatic failure risks did not differ significantly between TZD users and nonusers. Conclusions: Compared with nonuser, TZD users demonstrated significantly higher MACE risks. Therefore, the risks of cardiovascular complications should be considered when prescribing TZDs to patients with T2DM and cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Many patients with obesity in Taiwan seek Chinese herbal medicines (CHM) from traditional Chinese medicine (TCM) clinics. This study aimed to estimate the risk of major adverse cardiovascular events (MACEs) in adults diagnosed with obesity, with or without CHM., Methods: Patients with obesity aged 18 to 50 years were identified using diagnostic codes from Taiwan's National Health Insurance Research Database between 2008 and 2018. We randomized 67,655 patients with or without CHM using propensity score matching. All patients were followed up from the start of the study until MACEs, death, or the end of 2018. A Cox proportional regression model was used to evaluate the hazard ratios of MACEs in the CHM and non-CHM cohorts., Results: During a median follow-up of 4.2 years, the CHM group had a higher incidence of MACEs than the non-CHM control cohort (9.35 versus 8.27 per 1,000 person-years). The CHM group had a 1.13-fold higher risk of MACEs compared with the non-CHM control (adjusted hazard ratio [aHR] = 1.13; 95% confidence interval [CI]: 1.07-1.19; p <0.001), especially in ischemic stroke (aHR = 1.18; 95% CI: 1.07-1.31; p <0.01), arrhythmia (aHR = 1.26; 95% CI: 1.14-1.38; p <0.001), and young adults aged 18 to 29 years (aHR = 1.22; 95% CI: 1.05-1.43; p <0.001)., Conclusion: Although certain CHMs offer cardiovascular benefits, young and middle-aged obese adults receiving CHM exhibit a higher risk of MACEs than those not receiving CHM. Therefore, TCM practitioners should be cautious when prescribing medications to young patients with obesity, considering their potential cardiovascular risks., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024, the Chinese Medical Association.)