title: Increased risk of coronary heart disease in patients with chronic osteomyelitis: a population-based study in a cohort of 23 million.
abstract: OBJECTIVE
  Chronic inflammatory disease may trigger vascular atherosclerosis. This study aimed to determine whether chronic osteomyelitis (COM) is linked to an increased risk of coronary heart disease (CHD).
  
  
  METHODS
  A national insurance claim dataset of more than 23 million enrolees was used to identify 15 054 patients with newly diagnosed COM and 60 216 randomly selected age-matched and gender-matched controls between 2001 and 2009 for comparing the risk and incidence of CHD. The study period was from the entry date to the first date of the following events: the diagnosis of CHD, death, withdrawal from the Taiwan National Health Insurance programme or the end of 2010. The analysis of the CHD risk was performed using Cox proportional hazards regression model.
  
  
  RESULTS
  During a follow-up period of 67 927 person-years, the overall incidence rate of CHD in COM cohort was 1.95 times higher than non-COM cohort (16.66 vs 8.52 per 1000 person-years). After controlling age, gender and four comorbidities (hypertension, diabetes, hyperlipidaemia and stroke), the risk remained significantly higher in the COM cohort than the control group (adjusted HR=1.65, 95% CI 1.54 to 1.78, p<0.001). In age-stratified analysis, the younger population had a stronger association between COM and CHD risk than the elderly (from HR=3.42, 95% CI 1.60 to 7.32 in age <35 to HR  1.39, 95% CI 1.15 to 1.68 in age ≥80).
  
  
  CONCLUSIONS
  This study demonstrates that COM is an independent risk factor for CHD, particularly in the younger population. Further studies are necessary to explore the underlying mechanisms linking COM and CHD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Lien-Cheng
authors.initials: LC
authors.lastname: Hsiao
authors.affiliation: Institute of Environmental Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Department of Biomedical Informatics, Asia University, Taichung, Taiwan.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Department of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors.forename: Kuan-Cheng
authors.initials: KC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010019:Osteomyelitis / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: Coronary Artery Disease