Hung Yao-Min, Chang Wei-Pin, Wei James Cheng-Chung, Chou Pesus, Wang Paul Yung-Pou
From the Department of Emergency Medicine (Y-MH), Kaohsiung Veterans General Hospital, Kaohsiung; School of Health Care Administration (W-PC), Taipei Medical University, Taipei City, Taiwan; Department of Healthcare Management, Yuanpei University, HsinChu, Taiwan; Division of Allergy (JC-CW), Immunology and Rheumatology, Chung Shan Medical University Hospital; Institute of Medicine, Chung Shan Medical University; Graduate Institute of Integrated Medicine (JC-CW), China Medical University, Taichung, Taiwan; Institute of Public Health (Y-MH, PC), School of Medicine, National Yang Ming University, Taipei, Taiwan; and Division of Nephrology (Y-PW), Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA.
Medicine (Baltimore). 2016 May;95(18):e3596. doi: 10.1097/MD.0000000000003596.
There are limited studies describing the association between ankylosing spondylitis (AS) and cardiovascular disease (CVD) in patients over 40 years old. We aimed to focus on the incident AS patients in those aged 40 years or older and to investigate whether events of CVD occurred more than the general population.We conducted a nationwide cohort study between 2000 and 2005 using the Taiwan National Health Insurance Research Database. The risk of newly diagnosed CVD was compared between incident AS patients and matched age- and sex-matched subjects without AS. Events of CVDs were classified into 1 of 5 subcategories: hypertensive heart disease, coronary heart disease, congestive heart failure, cerebrovascular disease, or "other" CVD according to the ICD-9-CM codes. Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for demographic and comorbid medical disorders. Multivariate analyses were performed using Cox proportional hazards model.We compared 537 AS and 2685 non-AS patients and found that the cumulative incidence rate of CVD during follow-up period was higher in the AS cohort than the non-AS cohort. The crude HR of CVD for the AS group was 1.24 [95% confidence interval (95% CI), 1.05-1.46; P = 0.01] and the adjusted HR was 1.20 with 95% CI 1.02 to 1.42 (P = 0.03). When stratified by age, AS cohort at age 60 to 69 years exhibited a significantly higher HR for all CVD than the general population cohort (adjusted HR 1.48, 95% CI 1.06-2.08, P < 0.05). When stratified by gender, male AS group had a significantly higher HR for all CVD than the general population cohort with the adjusted HR 1.28 (95% CI 1.01-1.63, P < 0.05). There was no statistically significant difference for females.Patients with AS, especially age 60 to 69 years male patients, had a higher risk of CVDs than non-AS controls.
关于40岁以上强直性脊柱炎（AS）患者与心血管疾病（CVD）之间关联的研究有限。我们旨在关注40岁及以上的初发AS患者，并调查CVD事件的发生是否高于普通人群。我们利用台湾国民健康保险研究数据库在2000年至2005年期间进行了一项全国性队列研究。比较了初发AS患者与年龄和性别匹配的无AS受试者中新诊断CVD的风险。根据国际疾病分类第九版临床修订本（ICD - 9 - CM）编码，CVD事件被分为5个亚类之一：高血压性心脏病、冠心病、充血性心力衰竭、脑血管疾病或“其他”CVD。在调整人口统计学和合并症后计算累积发病率和风险比（HRs）。使用Cox比例风险模型进行多变量分析。我们比较了537例AS患者和2685例非AS患者，发现随访期间AS队列中CVD的累积发病率高于非AS队列。AS组CVD的粗HR为1.24 [95%置信区间（95%CI），1.05 - 1.46；P = 0.01]，调整后的HR为1.20，95%CI为1.02至1.42（P = 0.03）。按年龄分层时，60至69岁的AS队列所有CVD的HR显著高于普通人群队列（调整后的HR为1.48，95%CI为1.06 - 2.08，P < 0.05）。按性别分层时，男性AS组所有CVD的HR显著高于普通人群队列，调整后的HR为1.28（95%CI为1.01 - 1.63，P < 0.05）。女性之间无统计学显著差异。AS患者，尤其是60至69岁的男性患者，发生CVD的风险高于非AS对照。
