ORCID Profile
0000-0001-7523-7166
Current Organisations
College of Medicine, National Taiwan University
,
National Taiwan University Hospital
,
National Taiwan University College of Public Health
,
National Taiwan University
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Publications
Translational Research for Improving the Care of Familial Hypercholesterolemia: The “Ten Countries Study” and Beyond
Publisher: Japan Atherosclerosis Society
Date: 2016
DOI: 10.5551/JAT.35949
Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: Rationale and design of the global EAS Familial Hypercholesterola
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.ATHEROSCLEROSISSUP.2016.10.001
Abstract: The potential for global collaborations to better inform public health policy regarding major non-communicable diseases has been successfully demonstrated by several large-scale international consortia. However, the true public health impact of familial hypercholesterolaemia (FH), a common genetic disorder associated with premature cardiovascular disease, is yet to be reliably ascertained using similar approaches. The European Atherosclerosis Society FH Studies Collaboration (EAS FHSC) is a new initiative of international stakeholders which will help establish a global FH registry to generate large-scale, robust data on the burden of FH worldwide. The EAS FHSC will maximise the potential exploitation of currently available and future FH data (retrospective and prospective) by bringing together regional/national/international data sources with access to in iduals with a clinical and/or genetic diagnosis of heterozygous or homozygous FH. A novel bespoke electronic platform and FH Data Warehouse will be developed to allow secure data sharing, validation, cleaning, pooling, harmonisation and analysis irrespective of the source or format. Standard statistical procedures will allow us to investigate cross-sectional associations, patterns of real-world practice, trends over time, and analyse risk and outcomes (e.g. cardiovascular outcomes, all-cause death), accounting for potential confounders and subgroup effects. The EAS FHSC represents an excellent opportunity to integrate in idual efforts across the world to tackle the global burden of FH. The information garnered from the registry will help reduce gaps in knowledge, inform best practices, assist in clinical trials design, support clinical guidelines and policies development, and ultimately improve the care of FH patients.
The association between postpartum depression and air pollution during pregnancy and postpartum period: a national population study in Taiwan
Publisher: IOP Publishing
Date: 26-07-2021
Abstract: Epidemiological evidence shows the association between air pollutants and several mental health outcomes, including depression, sleep disturbance, dementia, childhood neurodevelopment and suicide. Pregnant women are believed to be more susceptible and vulnerable to environmental pollutants, and postpartum depression (PPD) is a prevalent debilitating mental disorder. However, data on the effects of exposure to air pollution during pregnancy and postpartum period on the risk of PPD remain limited. This study aimed to evaluate the association between exposure to ambient air pollution during pregnancy and postpartum period and the incidence of PPD. The Taiwan Birth Cohort Study recruited representative 12% of all newborn in 2005 and their mothers by two-stage stratified s ling, including 21 248 mother–infant pairs. The occurrence of PPD was assessed by a self-reported questionnaire. Exposure to air pollutants during pregnancy and postpartum period was estimated using hybrid kriging/land-use regression (LUR) and integrated LUR-machine learning model based on data from the air monitoring stations. Logistic regression was then conducted to determine adjusted odds ratios (aORs) of PPD in relation to air pollutants. A total of 21 188 women were included in the final analysis, among whom 3,648 (17.2%) developed PPD within 6 months postpartum. The occurrence of PPD was significantly related to exposure to ambient concentrations of nitrogen dioxide (NO 2 ) during first trimester after adjustment [aOR: 1.081 per interquartile range (10.67 ppb), 95% confidence interval: 1.003, 1.165], but not to particulate matter ⩽2.5 µ m in diameter or carbon monoxide. Exposure to ambient NO 2 during early pregnancy was significantly related to the occurrence of PPD among the women investigated in this population-based study.
Health literacy in familial hypercholesterolemia: A cross-national study
Publisher: Oxford University Press (OUP)
Date: 29-03-2018
Abstract: High rates of inadequate health literacy are associated with maladaptive health outcomes in chronic disease including increased mortality and morbidity rates, poor treatment adherence and poor health. Adequate health literacy may be an important factor in the effective treatment and management of familial hypercholesterolemia, and may also be implicated in genetic screening for familial hypercholesterolemia among index cases. The present study examined the prevalence and predictors of health literacy in familial hypercholesterolemia patients attending clinics in seven countries. Cross-sectional survey. Consecutive FH patients attending clinics in Australia, Brazil, China, Hong Kong, Malaysia, Taiwan and the UK completed measures of demographic variables (age, gender, household income and highest education level) and a brief three-item health literacy scale. Rates of inadequate health literacy were lowest in the UK (7.0%), Australia (10.0%), Hong Kong (15.7%) and Taiwan (18.0%) s les, with higher rates in the Brazil (22.0%), Malaysia (25.0%) and China (37.0%) s les. Income was an independent predictor of health literacy levels, accounting for effects of age. Health literacy was also independently related to China national group membership. Findings indicate non-trivial levels of inadequate health literacy in s les of familial hypercholesterolemia patients. Consistent with previous research in chronic illness, inadequate health literacy is related to income as an index of health disparities. Chinese familial hypercholesterolemia patients are more likely to have high rates of inadequate health literacy independent of income. Current findings highlight the imperative of education interventions targeting familial hypercholesterolemia patients with inadequate health literacy.
An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific regio
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-017817
Abstract: To determine physicians’ knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region. A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment. Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark. An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions. 1078 physicians completed the questionnaire from the Asia-Pacific region only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines this was significantly worse than physicians from the UK (35% vs 61%, p .001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management. The study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and extensive work in FH education and awareness programmes are imperative to improve the care of FH in the region.
Effects of medication, treatment, and behavioral beliefs on intentions to take medication in patients with familial hypercholesterolemia
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.ATHEROSCLEROSIS.2018.06.010
Abstract: Although familial hypercholesterolemia (FH) can be effectively managed using cholesterol-lowering medication, patients often fall short of complete treatment adherence. Identifying the psychological factors associated with self-regulation of FH medication is important to inform interventions to maximize adherence. The aim of the present study was to test an integrated psychological model in predicting FH patients' intentions to take medication. FH patients attending clinics in seven countries were invited to participate in a cross-sectional survey study. Consenting patients (N = 551) completed self-report measures of generalized beliefs about medication overuse and harms, beliefs in treatment effectiveness, specific beliefs about taking medication (attitudes, subjective norms, perceived behavioral control), and intentions to take medication. Participants also completed measures of demographic variables (age, gender, education level, income, cardiovascular disease status). Data were analysed using path analysis controlling for country and demographic variables. Attitudes (β = .331, p<0.001), subjective norms (β = .121, p=0.009), and beliefs about medication overuse (β = -.160, p<0.001) were significant predictors of intentions to take medication. Treatment beliefs predicted intentions indirectly (β = .088, p<0.001) through attitudes and subjective norms. There was also an indirect effect of beliefs about medication overuse on intentions (β = -.045, p=0.056), but the effect was small compared with the direct effect. The findings indicate the importance among FH patients of specific beliefs about taking medication and generalized beliefs about medication overuse and treatment in predicting medication intentions. When managing patients, clinicians should emphasize the efficacy of taking cholesterol-lowering drugs and the importance of treatment outcomes, and allay concerns about medication overuse.
Prescription patterns of anti‐diabetic medications and clinical outcomes in Asian patients with heart failure and diabetes mellitus
Publisher: Wiley
Date: 29-04-2019
DOI: 10.1002/EJHF.1467
Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.ATHEROSCLEROSIS.2018.08.051
Abstract: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.
Predicting intention to participate in self-management behaviors in patients with Familial Hypercholesterolemia: A cross-national study
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.SOCSCIMED.2019.112591
Abstract: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management. BEHAVIORS: physical activity, healthy eating, and taking cholesterol lowering medication. The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries. Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total N = 726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors. Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across s les and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across s les and behaviors. Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across s les and behaviors highlights the imperative of identifying s le- and behavior-specific correlates of FH self-management behaviors.
The selective peroxisome proliferator-activated receptor alpha modulator (SPPARMα) paradigm: conceptual framework and therapeutic potential
Publisher: Springer Science and Business Media LLC
Date: 04-06-2019
Familial hypercholesterolaemia: A global call to arms
Publisher: Elsevier BV
Date: 11-2015
Comparative aspects of the care of familial hypercholesterolemia in the “Ten Countries Study”
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JACL.2019.01.009
Abstract: There is a lack of information on the health care of familial hypercholesterolemia (FH). The objective of this study was to compare the health care of FH in countries of the Asia-Pacific region and Southern Hemisphere. A series of questionnaires were completed by key opinion leaders from selected specialist centers in 12 countries concerning aspects of the care of FH, including screening, diagnosis, risk assessment, treatment, teaching/training, and research the United Kingdom (UK) was used as the international benchmark. The estimated percentage of patients diagnosed with the condition was low (overall <3%) in all countries, compared with ∼15% in the UK. Underdetection of FH was associated with government expenditure on health care (ϰ = 0.667, P < .05). Opportunistic and systematic screening methods, and the Dutch Lipid Clinic Network criteria were most commonly used to detect FH genetic testing was infrequently used. Noninvasive imaging of coronary calcium and/or carotid plaques was underutilized in risk assessment. Patients with FH were generally not adequately treated, with <30% of patients achieving guideline recommended low-density lipoprotein cholesterol targets on conventional therapies. Treatment gaps included suboptimal availability and use of lipoprotein apheresis and proprotein convertase subtilsin-kexin type 9 inhibitors. A deficit of FH registries, training programs, and publications were identified in less economically developed countries. The demonstration of cost-effectiveness for cascade screening, genetic testing, and specialized treatments were significantly associated with the availability of subsidies from the health care system (ϰ = 0.571-0.800, P < .05). We identified important gaps across the continuum of care for FH, particularly in less economically developed countries. Wider implementation of primary and pediatric care, telehealth services, patient support groups, education/training programs, research activities, and health technology assessments are needed to improve the care of patients with FH in these countries.
Residual vascular risk in diabetes – Will the SPPARM alpha concept hold the key?
Publisher: Elsevier BV
Date: 07-2019
Related Organisations
College Of Medicine, National Taiwan University
Location: Taiwan, Province of China
National Cheng Kung University Hospital
Location: Taiwan, Province of China
Ministry Of Transport Civil Aviation Authority
Location: Taiwan, Province of China
National Taiwan University Hospital
Location: Taiwan, Province of China
National Taiwan University College Of Public Health
Location: Taiwan, Province of China
Related Funding Activities
No related grants have been discovered for TA-CHEN SU.