College of Chinese Medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.
College of Medicine, China Medical University, Taichung, Taiwan.
J Altern Complement Med. 2021 Mar;27(S1):S60-S70. doi: 10.1089/acm.2020.0153. Epub 2020 Jul 31.
Patients with osteoarthritis (OA) are more likely to develop coronary heart disease (CHD) than the general population. Acupuncture is commonly used in OA patients; however, the therapeutic effect of acupuncture on the risk of CHD in patients with OA and the association between OA patients and their risk to develop CHD in Taiwan are unknown. We investigated the risk of CHD according to acupuncture use in OA patients and compared it with the general population. Records obtained from Taiwan's National Health Insurance Research Database identified 84,773 patients with OA, which were compared with 727,359 patients without OA diagnosis. Five thousand forty-six of those who met study inclusion criteria had 1:1 frequency matching and were categorized as OA-acupuncture cohort ( = 1682), OA nonacupuncture cohort ( = 1682), and non-OA cohort ( = 1682). Cox proportional hazards regression analysis determined the risk of CHD, which was defined as the study main outcome. Therapeutic effects of acupuncture and medical expenditure were also analyzed. OA nonacupuncture cohort had 3.04 higher risk to develop CHD compared with OA-acupuncture cohort (95% confidence interval [CI], 2.54-3.63, < 0.001) and non-OA cohort had 1.88 higher risk to develop CHD compared with OA-acupuncture cohort (95% CI, 1.52-2.32, < 0.001). In subgroup analyses, OA patients treated with both acupuncture and oral steroids were at significantly lower risk of CHD compared with those who used neither (adjusted hazard ratio 0.34; 95% CI, 0.22-0.53), and OA patients treated with acupuncture had the lowest medical expenditure in a follow-up time of 6 months, and 3 and 5 years. This is the first large-scale investigation in Taiwan that shows the association between OA and CHD and the beneficial effects of acupuncture in OA patients, and their associated risk to develop CHD. Our results may provide valuable information for health policy decision making. Further randomized controlled trials are needed to confirm these observational findings.
患者患有骨关节炎（OA）比一般人群更有可能发展为冠心病（CHD）。针灸在 OA 患者中很常用；然而，针灸对 OA 患者 CHD 风险的治疗效果以及台湾 OA 患者及其发展为 CHD 的风险之间的关联尚不清楚。我们调查了根据 OA 患者使用针灸的 CHD 风险，并将其与一般人群进行了比较。从台湾国家健康保险研究数据库中获得的记录确定了 84773 例 OA 患者，并与 727359 例无 OA 诊断的患者进行了比较。符合研究纳入标准的 5046 名患者进行了 1：1 频率匹配，并分为 OA-针灸队列（n=1682）、OA-非针灸队列（n=1682）和非-OA 队列（n=1682）。Cox 比例风险回归分析确定了 CHD 的风险，这是研究的主要结果。还分析了针灸的治疗效果和医疗支出。OA-非针灸队列发生 CHD 的风险比 OA-针灸队列高 3.04 倍（95%置信区间[CI]，2.54-3.63， <0.001），非-OA 队列发生 CHD 的风险比 OA-针灸队列高 1.88 倍（95% CI，1.52-2.32， <0.001）。在亚组分析中，与既不使用也不使用的 OA 患者相比，同时使用针灸和口服类固醇的 OA 患者患 CHD 的风险显著降低（调整后的危险比 0.34；95% CI，0.22-0.53），并且在 6 个月、3 年和 5 年的随访期间，接受针灸治疗的 OA 患者的医疗支出最低。这是台湾首次进行的大规模调查，显示了 OA 与 CHD 之间的关联以及针灸对 OA 患者的有益作用，以及他们患 CHD 的相关风险。我们的研究结果可能为卫生政策决策提供有价值的信息。需要进一步的随机对照试验来证实这些观察结果。
