Gulliver Wayne P, Randell Shane, Gulliver Susanne, Connors Sean, Bachelez Hervé, MacDonald Don, Gladney Neil, Morrissey Andrea, Fleming Patrick
Newlab Clinical Research, St John's, NL, Canada
Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada.
J Cutan Med Surg. 2016 Nov;20(6):536-541. doi: 10.1177/1203475416650430. Epub 2016 May 10.
Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome.
We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI).
Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056).
Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.
银屑病是一种慢性免疫介导的炎症性疾病，影响约2%至3%的人口，在北美和欧洲约有1700万人受其影响，全球约有1.7亿人患病。虽然银屑病可发生于任何年龄，但大多数病例在40岁之前发病。一些大型研究指出发病年龄呈双峰模式，第一个高峰出现在约30岁，第二个高峰出现在55至60岁左右，但大多数患者发病年龄较轻（15 - 30岁）。银屑病与多种合并症、生活质量下降及寿命缩短相关。两项近期的系统评价和一项荟萃分析得出结论，银屑病患者发生主要不良心血管事件的风险增加。多项研究证实，银屑病患者中发现的许多合并症也是心血管疾病、中风、糖尿病、高血压、高脂血症、肥胖和代谢综合征的重要危险因素。
我们进行了一项回顾性队列研究，使用加拿大纽芬兰和拉布拉多省一家皮肤科诊所的病历以及中重度银屑病患者的管理数据库。我们研究了临床预测因素（银屑病发病年龄、年龄、性别、生物制剂使用情况）在预测心肌梗死（MI）发生中的作用。
逻辑回归显示，发病年龄（比值比[OR]，8.85；P = 0.005）、年龄增长（OR，1.07；P < 0.0001）和男性（OR，3.64；P = 0.018）是发生MI的显著危险因素。生物制剂治疗及其治疗持续时间均不是发生MI的统计学显著危险因素。我们的研究发现，在接受生物制剂治疗的银屑病患者中，MI降低78%有不显著的趋势（相对风险，0.18；95%置信区间，0.24 - 1.34；P = 0.056）。
我们的研究表明，接受生物制剂治疗的中重度银屑病患者发生MI有降低的趋势。银屑病发病年龄早（<25岁）的患者发生MI的可能性几乎高9倍。临床医生应考虑对银屑病患者采取适当的心血管风险降低策略。
