Reply
Journal
Hepatology
Journal Volume
61
Journal Issue
5
Pages
1763-1764
Date Issued
2015
Author(s)
Abstract
We appreciate the valuable comments made by Dr. T.J.S. Cross. Although the patient‐reported questionnaire is not totally accurate, it remains a useful tool in community‐based, large‐scale study of multiple screening sites. As mentioned in our article, some residual confounding might come from the disease duration and medications used.1 There have been a few analyses using claims for a database reporting the association of each class of antidiabetic agents and hepatocellular carcinoma (HCC) risks.2 However, the research estimating the association of a class of antidiabetic agents with deaths from HCC is still lacking. We could not get liver tissues of all participants in this community‐based nation‐wide cohort to eliminate the presence of occult hepatitis B virus (HBV) infection. Furthermore, the direct contribution of occult HBV infection to HCC‐related death has not yet been established in those without physician‐diagnosed viral hepatitis.
There were 2,686 deaths during the follow‐up of all participants, including 235 from HCC and 549 cardiovascular deaths. Among our diabetics, there were 40 HCC‐related deaths and 73 cardiovascular deaths. Even if a participant had been dead with concurrent HCC and cardiovascular disease, only one primary cause of death would be coded in death certificates of Taiwan. Besides, our subjects with HCC‐related deaths were younger than those with cardiovascular deaths (66.1 vs. 70.7 years). Therefore, little research could verify the real impact of competing risks, especially if the diagnosis of HCC had never been made until death. We prefer that other unclear mechanisms should be elucidated for the observed protective effect of dyslipidemia. Finally, we agreed deeply that prevention of diabetes is crucial both to prevent HCC mortality and cardiovascular death.
There were 2,686 deaths during the follow‐up of all participants, including 235 from HCC and 549 cardiovascular deaths. Among our diabetics, there were 40 HCC‐related deaths and 73 cardiovascular deaths. Even if a participant had been dead with concurrent HCC and cardiovascular disease, only one primary cause of death would be coded in death certificates of Taiwan. Besides, our subjects with HCC‐related deaths were younger than those with cardiovascular deaths (66.1 vs. 70.7 years). Therefore, little research could verify the real impact of competing risks, especially if the diagnosis of HCC had never been made until death. We prefer that other unclear mechanisms should be elucidated for the observed protective effect of dyslipidemia. Finally, we agreed deeply that prevention of diabetes is crucial both to prevent HCC mortality and cardiovascular death.
SDGs
Other Subjects
antidiabetic agent; cancer diagnosis; cancer mortality; cancer risk; cardiovascular mortality; cause of death; death certificate; diabetes mellitus; disease duration; dyslipidemia; follow up; hepatitis B; human; Letter; liver cell carcinoma; priority journal; questionnaire; diabetes mellitus; Dyslipidemias; female; liver cell carcinoma; liver tumor; male; mortality; Carcinoma, Hepatocellular; Diabetes Complications; Dyslipidemias; Female; Humans; Liver Neoplasms; Male
Publisher
John Wiley and Sons Inc.
Type
letter