title: Decreased risk of stroke in patients receiving traditional Chinese medicine for vertigo: A population-based cohort study.
abstract: BACKGROUND
  Patients with vertigo are reported to exhibit a higher risk of subsequent stroke. However, it remains unclear if Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of stroke for these patients. So the aim of the study was to investigate the effects of TCM on stroke risk among patients with vertigo.
  
  
  METHODS
  This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 112,458 newly diagnosed vertigo patients aged ≥20 years who received treatment between 1998 and 2007. Among these patients, 53,203 (47.31%) received TCM after vertigo onset (TCM users), and the remaining 59,201 patients were designated as a control group (non-TCM users). All enrollees received follow-up until the end of 2012 to measure stroke incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of stroke in recipients of TCM services.
  
  
  RESULTS
  During 15-year follow-up, 5532 TCM users and 12,295 non-TCM users developed stroke, representing an incidence rate of 13.10% and 25.71% per 1000 person-years. TCM users had a significantly reduced risk of stroke compared to non-TCM users (adjusted HR=0.64; 95% confidence interval CI=0.59-0.74). The predominant effect was observed for those receiving TCM for more than 180 days (adjusted HR=0.52; 95% CI=0.49-0.56). Commonly used TCM formulae, including Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Ling-Gui-Zhu-Gan-Tang, Bai Zhi (Angelica dahurica (Hoffm.) Benth. & Hook.f. ex Franch. & Sav., root), Ge Gen (Pueraria lobata (Willd.) Ohwi, root) and Hai Piao Xiao (Endoconcha Sepiae, Cuttlefish Bone) were significantly associated with lower risk of stroke.
  
  
  CONCLUSIONS
  Results of this population-based study support the effects of TCM on reducing stroke risk, and may provide a reference for stroke prevention strategies. The study results may also help to integrate TCM into clinical intervention programs that provide a favorable prognosis for vertigo patients.
authors.affiliation: Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Nursing, Tzu Chi College of Technology, 880 Chien-Kuo Road Section 2, Hualien 97004, Taiwan.
authors.forename: Tzung-Yi
authors.initials: TY
authors.lastname: Tsai
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan; Department of Public Health, College of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.affiliation: Rehabilitation Counseling Program, Portland State University, Portland, OR 97207-0751, USA.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Livneh
authors.affiliation: School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan.
authors.forename: I-Hsin
authors.initials: IH
authors.lastname: Lin
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan; School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan.
authors.forename: Ming-Chi
authors.initials: MC
authors.lastname: Lu
authors.affiliation: School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan; Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi 62247, Taiwan. Electronic address: yehcc0530@gmail.com.
authors.forename: Chia-Chou
authors.initials: CC
authors.lastname: Yeh
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D008517:Phytotherapy; D012306:Risk; D020521:Stroke / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology; D014717:Vertigo / Q000188:drug therapy*
keywords: Cohort study; Stroke; Traditional Chinese medicine; Vertigo