Division of Cardiovascular Medicine, University of California, DavisSacramento, CA 95816, USA.
J Am Heart Assoc. 2013 Apr 4;2(2):e000062. doi: 10.1161/JAHA.113.000062.
Psoriasis is a chronic inflammatory disease that may be associated with increased risk of cardiovascular events, including cardiovascular mortality, myocardial infarction, and stroke.
We searched the MEDLINE, EMBASE, and Cochrane Central Register databases for relevant studies in English between January 1, 1980, and January 1, 2012. Extraction was by 3 independent reviewers. Summary incidence, risk ratios (RRs), and confidence intervals (CIs) were calculated using fixed-effects and random-effects modeling. Meta-regression was also performed to identify sources of between-study variation. Nine studies were included, representing a total of 201 239 patients with mild and 17 415 patients with severe psoriasis. The level of covariate adjustment varied among studies, leading to the possibility of residual confounding. Using the available adjusted effect sizes, mild psoriasis remained associated with a significantly increased risk of myocardial infarction (RR, 1.29; 95% CI, 1.02 to 1.63) and stroke (RR, 1.12; 95% CI, 1.08 to 1.16). Severe psoriasis was associated with a significantly increased risk of cardiovascular mortality (RR, 1.39; 95% CI, 1.11 to 1.74), myocardial infarction (RR, 1.70; 95% CI, 1.32 to 2.18), and stroke (RR, 1.56 95% CI, 1.32 to 1.84). Based on these risk ratios and the background population event rates, psoriasis is associated with an estimated excess of 11 500 (95% CI, 1169 to 24 407) major adverse cardiovascular events each year.
Mild and severe psoriasis are associated with an increased risk of myocardial infarction and stroke. Severe psoriasis is also associated with an increased risk of cardiovascular mortality. Future studies should include more complete covariate adjustment and characterization of psoriasis severity.
银屑病是一种慢性炎症性疾病，可能与心血管事件风险增加有关，包括心血管死亡率、心肌梗死和中风。
我们在 MEDLINE、EMBASE 和 Cochrane 中央注册数据库中检索了 1980 年 1 月 1 日至 2012 年 1 月 1 日期间的英文相关研究。提取由 3 位独立评审员进行。使用固定效应和随机效应模型计算汇总发病率、风险比 (RR) 和置信区间 (CI)。还进行了荟萃回归以确定研究间差异的来源。纳入了 9 项研究，共代表 201 239 例轻度银屑病患者和 17 415 例重度银屑病患者。研究之间的协变量调整水平不同，可能存在残余混杂。使用可用的调整后效应大小，轻度银屑病与心肌梗死 (RR，1.29；95%CI，1.02 至 1.63) 和中风 (RR，1.12；95%CI，1.08 至 1.16) 的风险显著增加相关。重度银屑病与心血管死亡率 (RR，1.39；95%CI，1.11 至 1.74)、心肌梗死 (RR，1.70；95%CI，1.32 至 2.18) 和中风 (RR，1.56；95%CI，1.32 至 1.84) 的风险显著增加相关。基于这些风险比和背景人群的事件发生率，估计每年银屑病会导致超过 11 500 例 (95%CI，1169 至 24 407 例) 主要不良心血管事件。
轻度和重度银屑病与心肌梗死和中风的风险增加有关。重度银屑病也与心血管死亡率的风险增加有关。未来的研究应包括更完整的协变量调整和更准确的银屑病严重程度描述。
