Epidemiology, prescribing patterns and risk factors of coronary artery aneurysm in Taiwan

• Main Authors: Chein-Tang Fang, 方建棠
• Other Authors: Yi-Ping Fang
• Format: Others
• Language: en_US
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/12849058932656960265

碩士 === 高雄醫學大學 === 藥學系碩士班 === 104 === Background: Coronary artery aneurysm (CAA) was usually asymptomatic and a rare disease. The prevalence of CAA was around 0.2% to 6.0% in the literature. The most common cause of CAA was atherosclerosis, followed by Kawasaki disease and other factors. Information on management of CAA is scarce, which mainly focused on surgery. Considering that turbulent flow may occur in the aneurysm, antithrombotic agents are considered beneficial for the prevention of thrombosis. Study aim: Due to lacking data of the rare disease in Asia, we perform a population-based study to investigate the epidemiology, coexisting disease, prescribing patterns and risk factors of CAA. Methods: Data for analysis were retrieved from National Health Insurance Research Database in Taiwan. We identified CAA patients by using diagnostic code (ICD-9: 414.11) with CAA-related examinations. The incidence and mortality of CAA were calculated. The coexisting disease and prescribing patterns were investigated in the epidemiological study. Controls were selected with a ratio of 10:1 to cases by matching on age, sex and the index year. Risk for CAA between two groups were estimated by logistic regression with adjustment. Results: A total of 1397 CAA patients were identified during 2005 to 2011. The average annual incidence and mortality of CAA in Taiwan were 0.87 and 0.05 per 100,000 population. No significant difference in the incidence of CAA was found during 2005-2011. During the study period, 9.9% of adult patients died with a mean follow-up of 43.3 ± 25.8 months. The mean age of all CAA population was 37.76 ± 31.45 years, of which pediatric and adult patients accounted for 41.9% and 58.1% respectively. Among coexisting disease, Kawasaki disease predominated in 95.7% of children and coronary atherosclerosis was found in 72.5% of adults. Antithrombotic agents were prescribed more frequently after diagnosis of CAA, among which aspirin accounted for most use. After adjustment, cardiovascular risk factors including coronary atherosclerosis (OR: 7.97; 95% CI: 6.46-9.84), hypertension (OR: 2.09; 95% CI: 1.73-2.53), hyperlipidemia(OR: 2.48; 95% CI: 2.06-2.99) and diabetes (OR: 1.51; 95% CI: 1.26-1.81) showed significantly associated with the presence of CAA. For other risk factors, we also found aortic dissection (OR: 6.76; 95% CI: 1.89-24.14), aortic aneurysm (OR: 5.82; 95% CI: 2.02-16.83) and systemic lupus erythematosus (OR: 4.09; 95% CI: 1.32-12.62) positively associated with CAA. Conclusion: The epidemiology of CAA in Taiwan was low. Patients with CAA were mainly coexisted with Kawasaki disease in children and coronary atherosclerosis in adults. Antithrombotic agents were frequently used in CAA population. Aside from traditional risk factors, aortic disease and systemic lupus erythematosus were associated with CAA. Further investigation on the exact cause is warranted.