Traditional Chinese Medical Care and Incidence of Stroke in Elderly Patients Treated with Antidiabetic Medications

Abstract

Objectives: Experimental research has shown that herbal and traditional Chinese medicines (TCM) may serve as complements to Western medicine treatments in the control of blood glucose and cardiovascular complications, but population-based studies are limited. We investigated the association between TCM use and subsequent risk of stroke in older patients with diabetes. Study design: The database used in this cohort study contained longitudinal medical claims for one million subjects randomly selected among beneficiaries of a universal health care program in Taiwan. We identified a cohort of patients with diabetes aged 65 years and older who initiated anti-diabetic medications from 2000 to 2012. Patients who had at least two TCM outpatient visits after their initiation of anti-diabetic medications were considered TCM users. Main outcome measures: The incidence of stroke was measured until 2013. Cox regression models with TCM use as a time-dependent variable were used to calculate the adjusted hazard ratios (HRs) comparing TCM use with no use. Results: Over the 13-year period, 17,015 patients were identified; 4912 (28.9%) of them were TCM users. The incidence of stroke during the follow-up (per 1000 person-years) was 22.8 in TCM users and 25.7 in non-users. TCM users had an adjusted HR of 0.93 for the incidence of ischemic stroke (95% confidence interval [CI] 0.83, 1.04) and of 0.89 for developing hemorrhagic stroke (95% CI 0.66, 1.19), compared with non-users. Conclusions: In this study, in older patients receiving Western medicine treatments for diabetes, TCM use was not associated with an increased risk of developing ischemic stroke and hemorrhagic stroke.

Buyang huanwu decoction combined with probiotics or prebiotics for functional recovery from stroke

“…In particular, alternative medicine, such as sports, rehabilitation, traditional Chinese medicine, acupuncture, and moxibustion have been widely used and accepted in clinical treatment because of their less side effects and convenience customizing according to the patient [4] . Unlike the use of antiplatelet drugs, such as clopidogrel and aspirin, the early and reasonable use of alternative medicine, such as traditional Chinese medicine and acupuncture, does not increase the risk of bleeding [27,28] . Similarly, prebiotics, probiotics, and synbiotics [14] have gradually become the new drugs for the prevention and treatment of stroke through the microbiota-gut-brain axis, and have shown potential in research [29,30] …”

“…[4] Unlike the use of antiplatelet drugs, such as clopidogrel and aspirin, the early and reasonable use of alternative medicine, such as traditional Chinese medicine and acupuncture, does not increase the risk of bleeding. [27,28] Similarly, prebiotics, probiotics, and synbiotics [14] have gradually become the new drugs for the prevention and treatment of stroke through the microbiota-gut-brain axis, and have shown potential in research. [29,30] The recovery of stroke is a multicellular process, including, but not limited to, neuronal cells involved and cells involved in the inflammatory response or a large number of immune cells.…”

Association of Antihyperglycemic Therapy with Risk of Atrial Fibrillation and Stroke in Diabetic Patients

“…Stroke episodes in AF patients frequently have a thromboembolic nature; hence, the question arises as to whether a specific risk for AF in one or the other of the antidiabetic drugs would reflect an accordingly modified risk for cerebral thromboembolism, and thus stroke. Unfortunately, the major clinical trials have not yet distinguished between the ischemic or hemorrhagic nature of stroke episodes, and least of all, between the atherothrombotic or thromboembolic etiology of ischemic strokes [9,10]. In the absence of dedicated studies using electrocardiogram (ECG) technologies to monitor the heart rhythm, a high number of asymptomatic AF and/or paroxysmal, recurrent episodes of AF may go unrecognized; this may underlie the inconstant associations between diabetes and incidences of AF or stroke seen in clinical studies, especially those not reporting AF as a specific outcome [11].…”