New Users of Herbal Medicine Containing Aristolochic Acids and the Risk of Dementia in the Elderly: A Nationwide, Population-Based Study in Taiwan

Abstract

Yueh-Er Chiou,1,2 Wu-Chien Chien,3– 5,* Chi-Hsiang Chung,3,4,6 Hsin-An Chang,7,8 Yu-Chen Kao,7,9 Pei-Kwei Tsay,10,* Nian-Sheng Tzeng7,8,* 1Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; 3Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 4School of Public Health, National Defense Medical Center, Taipei, Taiwan; 5Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; 6Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; 7Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; 8Student Counseling Center, National Defense Medical Center, Taipei, Taiwan; 9Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan; 10Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Tao-Yuan 333, Taiwan*These authors contributed equally to this workCorrespondence: Pei-Kwei TsayDepartment of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Tao-Yuan 333, TaiwanTel [phone] # 5068 (PKT)Email [email protected] TzengJoint Program for Geriatric Psychiatry and Psychosomatic Medicine, Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan, Republic of ChinaTel [phone], Ext 17484Fax [phone]Email [email protected]: Herbal medicine containing aristolochic acids (HMCAA) was used for inflammatory and infectious diseases. This study aimed to investigate the association between the usage of HMCAA and the risk of dementia.Methods: A total of 199 new users of HMCAA were enrolled, along with 597 controls without the usage of HMCAA, at a ratio of 1:3 – matched by age, sex, and comorbidity, between 2000 and 2003 – from the National Health Research Institutes Database (NHRID) of Taiwan, which contains two million randomly sampled subjects, in this cohort study. We used Fine and Gray’s survival analysis (competing with mortality) to compare the risk of developing dementia during a 15-year follow-up period (2000– 2015).Results: In general, HMCAA was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 0.861, 95% confidence interval [CI] = 0.484– 1.532, p = 0.611) for the HMCAA-cohort, although differential risk was observed among the groups at risk. The patients with usage of HMCAA aged ≧ 85 years were associated with a higher risk in dementia (adjusted SHR: 6.243, 95% CI=1.258– 21.084, p = 0.001), in comparison to those aged 50– 54 years. Furthermore, the patients with usage of HMCAA that had cerebrovascular accidents were associated with an increased risk of dementia.Conclusion: The usage of HMCAA was associated with the risk of developing dementia in the patients aged ≧ 85 years.Keywords: herbal medicine containing aristolochic acids, traditional Chinese herbal medicines, dementia

Keywords

• herbal medicine containing aristolochic acids
• traditional chinese herbal medicines
• dementia