Risk of major adverse cardiovascular events among traditional Chinese medicine users: a cohort study with a subgroup analysis of male patients with sexual dysfunction

Riesgo de eventos cardiovasculares adversos mayores entre los usuarios de medicina tradicional china: un estudio de cohortes con un análisis de subgrupos en pacientes varones con disfunción sexual

Background: The association between traditional Chinese medicine (TCM) use and major adverse cardiovascular events (MACEs) in males with sexual dysfunction (SD) remains underexplored. Methods: This retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database (2001–2018), including 2 million randomly selected individuals. A propensity score-matched cohort of TCM users (n = 144,114) and non-TCM users (n = 144,114) was followed for an average of 9.49 years. The primary analysis examined the risk of MACEs in the overall matched cohort using Cox proportional hazards models and Kaplan-Meier methods. A secondary analysis focused on 4959 males with SD. Results: Among the overall matched cohort, the incidence of MACEs was higher in TCM users than in non-TCM users (9.93 vs. 9.08 per 1000 person-years; adjusted hazard ratio (aHR) 1.07, 95% confidence interval (CI) (1.04, 1.09), p < 0.001). The risk was notably higher among older TCM users (≥50 years) and those with pre-existing comorbidities. In the SD subgroup, TCM users exhibited a 1.23-fold increased risk of MACEs compared to non-TCM users (aHR 1.23, 95% CI (1.05, 1.43), p = 0.009). Further analysis by SD type showed that this increased risk was primarily observed in patients with organic SD (aHR 1.24, 95% CI (1.06, 1.45), p = 0.006). In contrast, no statistically significant difference was found among those with non-organic SD (aHR 0.58, 95% CI (0.19, 1.82), p = 0.353). Conclusions: TCM users with SD had a higher incidence of MACEs than non-TCM users, even after adjustment for confounders. While this association remained significant, residual confounding due to underlying comorbidities and differences in health-seeking behaviors remains a potential limitation. Further prospective studies are needed to investigate the long-term cardiovascular effects of TCM and optimize risk-based treatment strategies, particularly for high-risk SD patients with comorbidities.

Resumen

Antecedentes: La asociación entre el uso de la medicina tradicional china (MTC) y los eventos cardiovasculares adversos mayores (ECAM) en varones con disfunción sexual (DS) sigue siendo poco explorada. Métodos: Este estudio de cohorte retrospectivo analizó datos de la Base de Datos de Investigación del Seguro Nacional de Salud de Taiwán (2001–2018), que incluyó a 2 millones de individuos seleccionados aleatoriamente. Se identificó una cohorte emparejada por puntuación de propensión compuesta por usuarios de MTC (n = 144,114) y no usuarios de MTC (n = 144,114), con un seguimiento promedio de 9.49 años. El análisis primario examinó el riesgo de ECAM en la cohorte emparejada global mediante modelos de riesgos proporcionales de Cox y métodos de Kaplan-Meier. Un análisis secundario se centró en 4959 hombres con DS. Resultados: En la cohorte emparejada global, la incidencia de ECAM fue mayor en los usuarios de MTC que en los no usuarios (9.93 frente a 9.08 por cada 1000 personas-año; razón de riesgo ajustada (aHR) 1.07, intervalo de confianza del 95% (IC) (1.04–1.09), p < 0.001). El riesgo fue notablemente mayor entre los usuarios de MTC de edad avanzada (≥50 años) y aquellos con comorbilidades preexistentes. En el subgrupo de DS, los usuarios de MTC presentaron un riesgo 1.23 veces mayor de ECAM en comparación con los no usuarios de MTC (aHR 1.23, IC del 95% (1.05–1.43), p = 0.009). Un análisis adicional según el tipo de DS mostró que este mayor riesgo se observó principalmente en pacientes con DS orgánica (aHR 1.24, IC del 95% (1.06–1.45), p = 0.006), mientras que no se encontró una diferencia estadísticamente significativa entre aquellos con DS no orgánica (aHR 0.58, IC del 95% (0.19–1.82), p = 0.353). Conclusiones: Los usuarios de MTC con DS presentaron una mayor incidencia de ECAM en comparación con los no usuarios de MTC, incluso después del ajuste por factores de confusión. Si bien esta asociación se mantuvo significativa, la confusión residual derivada de comorbilidades subyacentes y diferencias en los comportamientos de búsqueda de atención médica sigue siendo una posible limitación. Se requieren estudios prospectivos adicionales para investigar los efectos cardiovasculares a largo plazo de la MTC y optimizar estrategias de tratamiento basadas en el riesgo, particularmente para pacientes con DS de alto riesgo y comorbilidades.

Chinese herbal drugs; Major adverse cardiac events; Physiological sexual dysfunction; Psychosexual dysfunctions; Traditional Chinese medicine

Palabras Clave

Medicina tradicional china; Eventos cardiovasculares adversos mayores; Disfunción sexual fisiológica; Disfunciones psicosexuales; Medicamentos herbales chinos

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