Publications by authors named "Chern-En Chiang"
Article Synopsis
- * The FINEARTS-HF trial compared the effectiveness of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, against a placebo, measuring primary outcomes like cardiovascular death and HF worsening events.
- * Results showed that lower KCCQ Total Symptom Scores (TSS) indicated a higher risk of adverse events, but finerenone significantly reduced event risks across all KCCQ TSS tertiles, suggesting it may improve outcomes for patients with varying levels of symptom severity.
Article Synopsis
- The study aimed to compare the kidney and heart health outcomes between two diabetes medications: DPP-4 inhibitors (DPP-4is) and SGLT-2 inhibitors (SGLT-2is) in patients with diabetic kidney disease (DKD).
- Using Taiwan's health databases, researchers matched users of both medications and analyzed their effects on kidney and cardiovascular issues over two years.
- Results showed that SGLT-2i users had significantly better outcomes, including lower risks of kidney failure and cardiovascular events, suggesting DPP-4is should be used less frequently in favor of SGLT-2is for adults with DKD.
Background: Heart failure (HF) with improved ejection fraction (HFimpEF) is a recently identified phenotype of HF, which had better cardiovascular outcomes compared with persistent HF with reduced ejection fraction (HFrEF). The present study aimed to investigate the predictive value of tissue inhibitor of metalloproteinase (TIMP)-1 and matrix metalloproteinases-9 (MMP-9) in the recovery of left ventricular ejection fraction (LVEF).
Methods: Subjects who presented with acute decompensated HF and reduced LVEF of ≤40% were eligible for this study.
Article Synopsis
- * The guidelines address various aspects of ASCVD, including chronic coronary syndrome and cerebrovascular diseases, while promoting health education and the management of clinical risk factors like diet, exercise, and smoking.
- * A catchy slogan and a memorable acronym were proposed to reinforce lifestyle changes related to modifiable risk factors, emphasizing the importance of healthy eating, physical activity, and overall well-being for ASCVD prevention.
Article Synopsis
- Steroidal mineralocorticoid receptor antagonists help patients with heart failure and reduced ejection fraction, but their effectiveness in those with mildly reduced or preserved ejection fraction is unclear, indicating a need for further research on finerenone.
- In a double-blind study, patients with heart failure (ejection fraction 40% or greater) were assigned to receive either finerenone or a placebo to assess its impact on heart failure events and cardiovascular death.
- Results showed that finerenone led to fewer worsening heart failure events and a lower overall rate of primary outcome events compared to placebo, although it also carried a higher risk of hyperkalemia.
Background: Type 2 diabetes mellitus (T2DM) is increasingly being diagnosed in older adults. Our objective is to assess the advantages and potential drawbacks of different glucose-lowering medications in this specific population.
Methods: A network meta-analysis was conducted to identify randomized controlled trials that examined patient-centered outcomes in adults aged ≥65 years with T2DM.
Aims: Compared to heart failure (HF) with reduced ejection fraction, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF) are increasing in prevalence, yet little is known about the geographic variation in patient characteristics, treatments and outcomes among these two HF phenotypes. The aim of this study was to investigate geographic differences in HFpEF and HFmrEF.
Methods And Results: We conducted an individual patient analysis of five clinical trials enrolling patients with HFpEF or HFmrEF from North America (NA), Latin America (LA), Western Europe (WE), Central/Eastern Europe and Russia (CEER), and Asia-Pacific (AP).
Background: This systematic review assesses the likelihood of developing dementia and cognitive impairment in patients with atrial fibrillation (AF) receiving non-vitamin K antagonist oral anticoagulants (NOACs) as opposed to vitamin K antagonists (VKAs).
Methods: We performed a systematic review with meta-analysis and trial sequential analysis (TSA), which encompassed both randomized controlled trials (RCTs) and observational studies. The objective was to assess the impact of NOACs and VKAs on the incidence of dementia in individuals diagnosed with AF.
Background: Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, is an epochal oral antidiabetic drug that improves cardiorenal outcomes. However, the effect of early dapagliflozin intervention on left ventricular (LV) remodeling in patients with type 2 diabetes free from cardiovascular disease remains unclear.
Methods And Results: The ELUCIDATE trial was a prospective, open-label, randomized, active-controlled study that enrolled 76 patients with asymptomatic type 2 diabetes with LV ejection fraction ≥50%, randomized to the dapagliflozin 10 mg/day add-on or standard-of-care group.
Background: The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on-treatment systolic blood pressure on major adverse cardiovascular events (MACEs) is uncertain. This study examined whether treated isolated diastolic hypertension (IDH) and treated isolated low DBP (ILDBP) were associated with MACEs in patients with hypertension.
Methods And Results: A total of 7582 patients with on-treatment systolic blood pressure <130 mm Hg from SPRINT (Systolic Blood Pressure Intervention Trial) were categorized on the basis of average DBP: <60 mm Hg (n=1031; treated ILDBP), 60 to 79 mm Hg (n=5432), ≥80 mm Hg (n=1119; treated IDH).
Article Synopsis
- The DELIVER trial studied the impact of dapagliflozin on patients with heart failure, focusing on differences between those in Asia and those elsewhere.
- It found that Asian participants had different health characteristics – being less likely to have conditions like diabetes and hypertension, yet they showed similar risks for worsening heart failure outcomes as those from outside Asia.
- The medication dapagliflozin effectively reduced the risk of cardiovascular death or worsening heart failure for both groups and was generally well tolerated, with similar rates of serious side effects and drug discontinuation across regions.
Background: Management of low-density lipoprotein cholesterol (LDL-C) in Asia remains suboptimal, with ∼50% of patients who are treated with lipid-lowering therapies (LLTs) unable to achieve their guideline-recommended LDL-C goals. Asian-representative studies of the use of inclisiran are needed.
Objectives: The authors sought to evaluate the efficacy and safety of inclisiran in Asian patients with atherosclerotic cardiovascular disease (ASCVD) or high risk of ASCVD, as an adjunct to diet and maximally tolerated statin dose, with or without additional LLTs.
Article Synopsis
- The VICTORIA study found that vericiguat reduced the risk of cardiovascular death or heart failure hospitalization compared to a placebo in patients with heart failure having reduced ejection fraction.
- The research evaluated how vericiguat impacted the frequency of hospitalizations for heart failure and subsequent mortality, using patient data to analyze various factors.
- Results showed a slight benefit of vericiguat in patients with lower levels of a specific biomarker (N-terminal pro-B-type natriuretic peptide), but overall, the differences in mortality rates were not significant between the vericiguat and placebo groups.
Hemodynamic parameters derived from pulse wave analysis have been shown to predict long-term outcomes in patients with heart failure (HF). Here we aimed to develop a deep-learning based algorithm that incorporates pressure waveforms for the identification and risk stratification of patients with HF. The first study, with a case-control study design to address data imbalance issue, included 431 subjects with HF exhibiting typical symptoms and 1545 control participants with no history of HF (non-HF).
View Article and Find Full Text PDFIntroduction: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have been linked to clinical outcomes in patients with coronary artery disease (CAD). However, the prognostic value of TIMP-1 in patients with CAD who underwent coronary artery bypass grafting (CABG) has not been elucidated. We aimed to investigate the correlations of TIMP-1 with high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the long-term prognosis of consecutive patients who underwent CABG.
View Article and Find Full Text PDFAsian perspective on the recently published practice guideline for acute coronary syndrome by ESC.
Eur Heart J Acute Cardiovasc Care
February 2024
Article Synopsis
- - Metabolic dysfunction-associated fatty liver disease (MAFLD) is a rising global health concern that is diagnosed through imaging, histology, or serum markers, alongside metabolic conditions like obesity and type 2 diabetes.
- - MAFLD not only affects the liver but is also linked to cardiovascular diseases (CVD), which significantly increase the health risks and mortality for affected individuals.
- - A recent position statement from Taiwan synthesizes research on MAFLD's prevalence, risk factors, and treatment options, emphasizing the need for collaboration between liver and heart specialists to better manage this interrelated health issue.
Symptom-limited exercise capacity is associated with long-term survival.
Medicine (Baltimore)
September 2023
The prognostic value of exercise capacity has been demonstrated in subjects with established cardiovascular diseases. We aim to evaluate the independence of exercise capacity measured by treadmill exercise test (TET) in predicting long-term outcomes among various comorbidities. This study was conducted from January 2003 to December 2012 in a tertiary medical center in Taiwan.
View Article and Find Full Text PDFThe prevalence of heart failure is increasing, causing a tremendous burden on health care systems around the world. Although mortality rate of heart failure has been significantly reduced by several effective agents in the past 3 decades, yet it remains high in observational studies. More recently, several new classes of drugs emerged with significant efficacy in reducing mortality and hospitalization in chronic heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).
View Article and Find Full Text PDFContext: Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant endocrine therapy, aiming for better bone protection and/or improving survival.
Objective: To summarize the clinical effects of antiresorptive agents in patients with early breast cancer receiving endocrine therapy.
Methods: We systematically reviewed and synthesized the clinical benefits and harms of antiresorptive agents in patients with early breast cancer receiving endocrine therapy by calculating the risk ratios (RRs).
Background: Many patients require revascularization after index acute coronary syndrome (ACS). Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In ODYSSEY OUTCOMES, alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a) levels.
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