title: Increased risk of acute coronary syndrome among patients with urinary stone disease: a nationwide population-based cohort study.
abstract: OBJECTIVE
  Urinary stones (US) are associated with systemic metabolic and endocrine disorders that share risk factors typically associated with acute coronary syndrome (ACS).
  
  
  METHODS
  For this investigation, 30,142 patients with US were set as the research group, and 121,768 randomly selected patients were set as the comparison group through frequency matching by age, sex, and index year. Each patient was individually tracked to identify those who developed ACS during the follow-up period. Cox proportional hazards regression and the Kaplan-Meier method were adopted to calculate the hazard ratios of ACS risk and plot the survival curve.
  
  
  RESULTS
  Overall, 275 (13.4 per 10,000 person-y) and 736 events (9.1 per 10,000 person-y) were observed among patients in the research and comparison cohorts, respectively. The patients with US had a substantially lower ACS-free survival rate compared with that of the patients in the comparison cohort (P<.001). After adjusting for potential risk factors, the patients with US were observed to have a 1.22-fold higher risk of ACS compared with patients in the comparison cohort (95% confidence interval = 1.05-1.40, P<.001), particularly among younger patients.
  
  
  CONCLUSIONS
  The results indicate that US is associated with increased risk of developing ACS, particularly among young (≤ 49 years) and male adults. Future studies should examine the possible mechanisms of US-related ACS morbidity by conducting multicenter recruitment and measurements of laboratory data.
authors.affiliation: Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan.
authors.forename: Shun-Fa
authors.initials: SF
authors.lastname: Hung
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.affiliation: Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
authors.affiliation: College of Medicine, China Medical University, Taichung, Taiwan; Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D014527:Uric Acid; D014545:Urinary Calculi / Q000150:complications / Q000453:epidemiology* / Q000473:pathology
chemical_list: D014527:Uric Acid