Chen Yi-Ju, Chang Yun-Ting, Shen Jui-Lung, Chen Tzu-Ting, Wang Chang-Bi, Chen Chuan-Mu, Wu Chun-Ying
National Yang-Ming University, Taipei, Taiwan.
Arthritis Rheum. 2012 Jun;64(6):1879-87. doi: 10.1002/art.34335. Epub 2011 Dec 12.
Psoriasis is associated with ischemic heart disease (IHD). Results of prior studies have suggested that methotrexate (MTX) may improve vascular disease in patients with psoriasis and rheumatoid arthritis. The aim of this study was to assess the risk of new-onset IHDs in psoriasis patients, comparing those taking MTX with those taking other nonbiologic antipsoriatic drugs.
In this retrospective cohort study, we utilized claims data from the National Health Insurance Research Database of Taiwan to identify 179,200 subjects who had received a diagnosis of psoriasis, with or without psoriatic arthritis, on at least 3 visits. The risk of hospitalization for new-onset IHD was compared between psoriasis patients taking MTX monotherapy (n = 6,578; MTX case cohort) and psoriasis patients taking other nonbiologic antipsoriatic drugs (n = 5,471; reference control cohort) between January 1996 and December 2008. Additional adjustments were made for cardiovascular risk factors, number of hospital visits, Charlson comorbidity score, and use of other antiinflammatory drugs.
The incidence rates of IHD were 666 cases per 100,000 person-years in the MTX case cohort and 830 cases per 100,000 person-years in the reference control cohort (unadjusted P = 0.027). Increasing age, male sex, presence of hypertension, presence of diabetes, Charlson comorbidity score, and use of phototherapies were independent risk factors for hospitalization related to a new IHD in the study cohorts. However, the multivariate-adjusted hazard ratio for IHD-related hospitalizations among patients receiving MTX, in comparison with those receiving other nonbiologic antipsoriatic drugs, was 0.97 (95% confidence interval 0.79-1.19), after adjustment for age, sex, comorbidity score, number of hospital visits, and other antiinflammatory treatments for psoriasis.
In patients with psoriasis with or without coexisting psoriatic arthritis, the adjusted risk of hospitalization for an IHD among individuals receiving MTX was comparable with that among individuals receiving other nonbiologic antipsoriatic drugs.
银屑病与缺血性心脏病（IHD）相关。既往研究结果提示，甲氨蝶呤（MTX）可能改善银屑病和类风湿关节炎患者的血管疾病。本研究旨在评估银屑病患者新发IHD的风险，比较服用MTX的患者与服用其他非生物性抗银屑病药物的患者。
在这项回顾性队列研究中，我们利用台湾国民健康保险研究数据库中的理赔数据，确定了179200名至少3次就诊时被诊断为银屑病（无论有无银屑病关节炎）的受试者。比较了1996年1月至2008年12月期间接受MTX单药治疗的银屑病患者（n = 6578；MTX病例队列）和服用其他非生物性抗银屑病药物的银屑病患者（n = 5471；对照队列）新发IHD的住院风险。对心血管危险因素、就诊次数、Charlson合并症评分和其他抗炎药物的使用进行了额外调整。
MTX病例队列中IHD的发病率为每10万人年666例，对照队列中为每10万人年830例（未调整P = 0.027）。年龄增加、男性、高血压、糖尿病、Charlson合并症评分和光疗的使用是研究队列中与新发IHD相关住院的独立危险因素。然而，在对年龄、性别、合并症评分、就诊次数和其他银屑病抗炎治疗进行调整后，接受MTX治疗的患者与接受其他非生物性抗银屑病药物治疗的患者相比，IHD相关住院的多变量调整风险比为0.97（95%置信区间0.79 - 1.19）。
在有或无银屑病关节炎的银屑病患者中，接受MTX治疗的个体因IHD住院的调整风险与接受其他非生物性抗银屑病药物治疗的个体相当。
