A trial fibrillation (AF) is the most common cardiac arrhythmia and it affects 2% to 3% of the global population.1 AF results in a 4-to 5-fold increased risk of thromboembolic stroke, which has a worse prognosis and higher recurrence rate than non-AF-related stroke.2 Warfarin is a commonly used anticoagulant to prevent possible thromboembolic events in patients with AF. Previous studies have shown that warfarin significantly reduces mortality and risk of embolic stroke, while at the same time it also doubles the risk of intracranial hemorrhage. 3,4 Furthermore, Asian patients are at a higher risk of intracranial hemorrhage while receiving warfarin than white patients (hazard ratio [HR], 4.06; 95% confidence interval, 2.47-6.65), even when the international normalized ratio is ideally maintained. 5Dabigatran is a competitive direct thrombin inhibitor approved around the world for the prevention of stroke and systemic embolism in nonvalvular AF patients based on the results of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial. 6 After dabigatran was approved, several postmarketing studies reported that severe bleeding is associated with dabigatran among elderly patients or patients with renal function impairment. Some studies using a Medicare cohort indicated that dabigatran 150 mg is associated with an increased risk of major gastrointestinal bleeding in patients with AF, 7-9 whereas other studies showed that the risk of gastrointestinal bleeding is similar between warfarin and dabigatran using the data of the Danish National Registries or commercially insured samples in the United States, respectively. 10,11 Of note, there are limited published data available for evaluating the thromboembolic and bleeding risks in patients with AF of Asian ethnicity taking Background and Purpose-Whether dabigatran is associated with different risks of cardiovascular, bleeding events, and mortality from warfarin in Asian patients with nonvalvular atrial fibrillation remains unclear. Methods-We used the Taiwan National Health Insurance Research Database to obtain 9940 and 9913 nonvalvular atrial fibrillation patients taking dabigatran and warfarin, respectively, from June 1, 2012, to December 31, 2013, as the dynamic cohort. Inverse probability of treatment weighting using propensity scores was used to balance covariates across 2 study groups. Patients were followed up until the first occurrence of any study outcome or end date of study. Results-During a median follow-up period of 0.67 years, there were 526 outcomes for dabigatran group. The hazard ratios (95% confidence intervals) comparing dabigatran with warfarin (reference) were as follows: ischemic stroke, 0.

BackgroundWhether dipeptidyl peptidase-4 inhibitor (DPP4i) is associated with a lower risk of new-onset atrial fibrillation (AF) in patients with diabetes remains unclear. This study aimed to evaluate the risk of AF associated with use of DPP4i among a longitudinal cohort of patients with diabetes.MethodsOver a 3-year period, 480,000 patients with diabetes were analyzed utilizing Taiwan’s National Health Insurance Research Database and 90,880 patients taking metformin as first-line therapy were enrolled. Patients were further divided into two groups: (1) DPP4i users: those taking DPP4i and (2) non-DPP4i users: those prescribed other hypoglycemic agents (HAs) as second-line drug. Study end point was defined by diagnosis of AF, addition of any third-line HA, or the end of the study period (December 31, 2013), whichever came first.ResultsA total of 16,017 DPP4i users and 74,863 non-DPP4i users were eligible for the study. For the DPP4i group, most patients were prescribed sitagliptin (n = 12,180; 76%). Among the non-DPP4i group, most patients took sulfonylurea (n = 60,606; 81%) as their second-line medication. DPP4i users were associated with a lower risk of new-onset AF compared with non-DPP4i users after propensity-score weighting (hazard ratio 0.65; P < 0.0001). Subgroup analysis showed that DPP4i user were associated with a lower risk of new-onset AF compared with non-DPP4i users in most subgroups. Multivariate analysis indicated that use of DPP4i was associated with lower risk of new-onset AF and age > 65 years, presence of hypertension, and ischemic heart disease were independent risk factors for new-onset AF.ConclusionsAmong patients with diabetes prescribed with metformin, the patients with DPP4i as second HA were associated with a lower risk of AF compared with the patients with other drugs as second HAs in real-world practice.Electronic supplementary materialThe online version of this article (10.1186/s12933-017-0640-5) contains supplementary material, which is available to authorized users.

Patients with primary mitral regurgitation (MR) may remain asymptomatic for many years. For unknown reasons, some shift from a compensated to a decompensated state and progress to fatal heart failure. To elucidate the genetic determinants of this process, we recruited 28 patients who underwent mitral valve surgery and stratified them into control, compensated MR, and decompensated MR groups. Tissue biopsies were obtained from the patients’ left ventricular (LV) lateral wall for a transcriptome-wide profiling of 64,769 probes to identify differentially expressed genes (DEGs). Using cutoff values at the 1% FDR significance level and sex- and age-adjusted regression models, we identified 12 significant DEGs (CTGF, MAP1B, SERPINE1, MYH9, MICAL2, MYO1D, CRY1, AQP7P3, HTRA1, PRSS23, IGFBP2, and FN1). The most significant gene was CTGF (adjusted R2 = 0.74, p = 1.80 × 10−8). We found that the majority of genes expressed in the more advanced decompensated MR group were pro-fibrotic genes associated with cardiac fibrosis. In particular, six pro-fibrotic genes (CTGF, SERPINE1, MYH9, HTRA1, PRSS23, and FN1) were overexpressed and enriched in pathways involved in ECM (extracellular matrix) protein remodeling. Therapeutic interventions that antagonize these six genes may slow the progression toward decompensated MR.