https://orcid.org/0000-0002-6368-3676
Dear Editor,
We are grateful to the authors of the letter to the editor for providing inspiring comments on our published article in Postgraduate Medicine, and we are glad to address the issues raised by them [Citation1].
We only compared the risk of AMI (acute myocardial infarction) between the gallbladder stone patients with and without cholecystectomy to avoid misclassification of asymptomatic gallbladder stones into no gallbladder stones. The literature has validated the high accuracy of medical diagnoses in the National Health Insurance Research Database of Taiwan, including AMI, but we cannot find any reference to validate the accuracy of gallbladder stones or cholecystectomy to our knowledge [Citation2,Citation3]. We find high accuracy by analyzing 50 chart records for the diagnosis of gallbladder stones and the claims for cholecystectomy, respectively. The patients are randomly selected in Changhua Show-Chwan Memorial Hospital, a 500-bed community hospital in Taiwan, from the inpatient claims database between 2000 and 2010. The diagnosis of gallbladder stones is ascertained by ultrasound, and cholecystectomy is verified by operation note.
We admit that chronic kidney disease or end-stage renal disease should be a risk factor of AMI, although most of the risk factors shared by AMI and end-stage renal disease have been adjusted in our analysis [Citation4]. Endometriosis may be associated with AMI in the literature, but the ameliorating effect of cholecystectomy on AMI is consistent in our sensitivity analysis for men [Citation5]. Furthermore, based on our other studies, it is intriguing to find the ameliorating effect of cholecystectomy in patients with gallbladder stones on stroke, organic erectile dysfunction in men, and aortic dissection or aneurysm [Citation6].
Finally, we regret that we did not analyze the effect of the duration between the diagnosis of gallbladder stones and cholecystectomy on the risk of AMI. However, it should be noted that gallstones may have existed long before the diagnosis of gallbladder stones and, therefore, it is hard to ascertain the duration of chronic inflammation induced by gallstones [Citation7].
Sincerely Chen
CH, Lin CL, Kao CH.
Declaration of funding
No funding was received for the production of this manuscript.
Disclosure of any financial/other conflicts of interest
The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
References
- Chen CH, Lin CL, Kao CH. The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones. Postgrad Med. 2021;133(2):209–216.
- Wu CS, Lai MS, Gau SSF, et al. Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan. PLoS ONE. 2014;9(12):e112257.
- Cheng CL, Lee CH, Chen PS, et al. Validation of acute myocardial infarction cases in the National Health Insurance Research Database in Taiwan. J Epidemiol. 2014;24(6):500–507.
- Sun CY, Li CY, Sung JM. A comparison of the risk of acute myocardial infarction in patients receiving hemodialysis and peritoneal dialysis: a population-based, propensity score-matched cohort study. Atherosclerosis. 2020;307:130–138.
- Wei CH, Chang R, Wan YH, et al. Endometriosis and new-onset coronary artery disease in Taiwan. A nationwide population-based study. Front Med. 2021;8:619664.
- Chen CH, Lin CL, Kao CH. Risk of aortic dissection or aneurysm in patients with gallstone disease: a retrospective cohort study in Taiwan. BMJ Open. 2021;11:e049316.
- Zheng Y, Xu M, Li Y, et al. Gallstones and risk of coronary artery disease: prospective analysis of 270,000 men and women from 3 US cohorts and meta-analysis. Arterioscler Thromb Vasc Biol. 2016;36(9):1997–2003.