患有化脓性汗腺炎患者的主要不良心血管事件和全因死亡率风险。
Risk of Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Hidradenitis Suppurativa.
机构信息
Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark2Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark3Danish Heart Foundation, Copenhagen, Denmark4National Institute of Public Health, University of Southern Denmark, Copenhagen.
出版信息
JAMA Dermatol. 2016 Apr;152(4):429-34. doi: 10.1001/jamadermatol.2015.6264.
IMPORTANCE
Hidradenitis suppurativa (HS) is a common inflammatory skin disease. The disease has been associated with cardiovascular (CV) risk factors, but the risk of CV disease in patients with HS is unknown.
OBJECTIVE
To investigate CV risk in patients with HS.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study was conducted from January 1, 1997, to December 31, 2011, using individual-level linkage of nationwide administrative registers. In a study population of 35 368 Danish individuals, 5964 patients aged 18 years or older with a hospital-based diagnosis of HS (cases) were matched 1:5 on age, sex, and calendar time with 29 404 individuals serving as controls.
MAIN OUTCOMES AND MEASURES
Outcomes were myocardial infarction (MI), stroke, CV-associated death, major adverse CV events (MACEs), and all-cause mortality. Incidence rate ratios (IRRs) were estimated by Poisson regression.
RESULTS
The 5964 patients with HS had a mean (SD) age of 37.7 (11.7) years; 4346 (72.9%) were women. In this sample, a total of 62 (42 749.0 person-years) MIs, 74 (42 647.8 person-years) ischemic strokes, 63 (42 941.7 person-years) CV-associated deaths, 169 (42 463.5 person-years) MACEs, and 231 (42 941.7 person-years) all-cause deaths occurred during follow-up. Adjusted (age, sex, socioeconomic status, smoking, comorbidity, and medication) IRRs (95% CIs) were 1.57 (1.14-2.17) for MI, 1.33 (1.01-1.76) for ischemic stroke, 1.95 (1.42-2.67) for CV-associated death, 1.53 (1.27-1.86) for MACEs, and 1.35 (1.15-1.59) for all-cause mortality. When patients with severe psoriasis were used as controls, the adjusted IRRs in patients with HS were 1.00 (0.74-1.35) for MI, 0.93 (0.71-1.22) for ischemic stroke, 1.58 (1.17-2.12) for CV-associated death, 1.08 (0.90-1.29) for MACEs, and 1.09 (0.94-1.28) for all-cause mortality.
CONCLUSIONS AND RELEVANCE
Hidradenitis suppurativa was associated with a significantly increased risk of adverse CV outcomes and all-cause mortality independent of measured confounders. The risk of CV-associated death was higher in patients with HS compared with the risk in those with severe psoriasis. The results call for increased awareness of this association and for studies of its clinical consequences.
重要性：化脓性汗腺炎（HS）是一种常见的炎症性皮肤病。该疾病与心血管（CV）危险因素相关，但 HS 患者患 CV 疾病的风险尚不清楚。
目的：调查 HS 患者的 CV 风险。
设计、环境和参与者：本研究为基于人群的队列研究，使用全国性行政登记册的个体水平关联，于 1997 年 1 月 1 日至 2011 年 12 月 31 日进行。在一个 35368 名丹麦人的研究人群中，根据医院诊断，年龄在 18 岁及以上的 5964 例 HS 患者（病例）按年龄、性别和时间与 29404 名对照进行 1:5 匹配。
主要结局和测量：结局包括心肌梗死（MI）、中风、CV 相关死亡、主要不良 CV 事件（MACEs）和全因死亡率。使用泊松回归估计发病率比（IRR）。
结果：5964 例 HS 患者的平均（SD）年龄为 37.7（11.7）岁，4346 例（72.9%）为女性。在该样本中，共发生 62 例（42749.0 人年）MI、74 例（42647.8 人年）缺血性中风、63 例（42941.7 人年）CV 相关死亡、169 例（42463.5 人年）MACEs 和 231 例（42941.7 人年）全因死亡。调整（年龄、性别、社会经济状况、吸烟、合并症和药物治疗）后的 IRR（95%CI）分别为 MI 1.57（1.14-2.17）、缺血性中风 1.33（1.01-1.76）、CV 相关死亡 1.95（1.42-2.67）、MACEs 1.53（1.27-1.86）和全因死亡率 1.35（1.15-1.59）。当使用严重银屑病患者作为对照时，HS 患者的调整后 IRR 为 MI 1.00（0.74-1.35）、缺血性中风 0.93（0.71-1.22）、CV 相关死亡 1.58（1.17-2.12）、MACEs 1.08（0.90-1.29）和全因死亡率 1.09（0.94-1.28）。
结论和相关性：化脓性汗腺炎与不良 CV 结局和全因死亡率显著增加相关，独立于已测量的混杂因素。与严重银屑病患者相比，HS 患者的 CV 相关死亡风险更高。这些结果表明需要提高对这种关联的认识，并研究其临床后果。
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