银屑病患者发生心肌梗死的风险

Risk of myocardial infarction in patients with psoriasis.

作者信息

Gelfand Joel M, Neimann Andrea L, Shin Daniel B, Wang Xingmei, Margolis David J, Troxel Andrea B

机构信息

Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA.

出版信息

JAMA. 2006 Oct 11;296(14):1735-41. doi: 10.1001/jama.296.14.1735.

DOI:10.1001/jama.296.14.1735

PMID:17032986

Abstract

CONTEXT

Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors.

OBJECTIVE

To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors.

DESIGN, SETTING, AND PATIENTS: A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556,995 control patients and patients with mild (n = 127,139) and severe psoriasis (n = 3837) were identified.

MAIN OUTCOME MEASURE

Incident MI.

RESULTS

There were 11,194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively.

CONCLUSIONS

Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.

摘要

背景

银屑病是最常见的1型辅助性T细胞（Th1）免疫疾病。有证据表明Th1疾病与心肌梗死（MI）有关。银屑病与心血管疾病相关，但仅在未对主要心血管危险因素进行控制的医院研究中得到调查。

目的

确定在一个基于人群的队列中，控制主要心血管危险因素时银屑病是否为心肌梗死的独立危险因素。

设计、地点和患者：在英国对20至90岁的银屑病患者进行的一项前瞻性、基于人群的队列研究，比较有和没有银屑病诊断的患者的结局。数据由全科医生作为患者病历的一部分收集，并于1987年至2002年存储在全科医疗研究数据库中，平均随访5.4年。对高血压、糖尿病、心肌梗死病史、高脂血症、年龄、性别、吸烟和体重指数进行了调整。银屑病患者若曾接受全身治疗则被分类为重度。从与银屑病患者相同的医疗机构和起始日期中随机选择多达5名无银屑病的对照。共识别出556,995名对照患者以及轻度（n = 127,139）和重度银屑病（n = 3837）患者。

主要结局指标

新发心肌梗死。

结果

对照人群中有11,194例心肌梗死（2.0%），轻度和重度银屑病组分别有2319例（1.8%）和112例（2.9%）心肌梗死。对照患者以及轻度和重度银屑病患者每1000人年的发病率分别为3.58（95%置信区间[CI]，3.52 - 3.65）、4.04（95%CI，3.88 - 4.21）和5.13（95%CI，4.22 - 6.17）。银屑病患者发生心肌梗死的校正相对风险（RR）随年龄而异。例如，对于一名30岁的轻度或重度银屑病患者，发生心肌梗死的校正RR分别为1.29（95%CI，1.14 - 1.46）和3.10（95%CI，1.98 - 4.86）。对于一名60岁的轻度或重度银屑病患者，发生心肌梗死的校正RR分别为1.08（95%CI，1.03 - 1.13）和1.36（95%CI，1.13 - 1.64）。