银屑病、代谢综合征和心血管危险因素。一项基于人群的研究。
Psoriasis, metabolic syndrome and cardiovascular risk factors. A population-based study.
机构信息
Institut de Recerca Biomèdica de Lleida (IRB Lleida), Lleida, Spain.
Dermatology Department, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.
出版信息
J Eur Acad Dermatol Venereol. 2019 Jan;33(1):128-135. doi: 10.1111/jdv.15159. Epub 2018 Jul 17.
BACKGROUND
Psoriasis is a very prevalent systemic chronic inflammatory disease. Major cardiovascular events are the main cause of mortality in these patients which suggests an association between psoriasis and traditional cardiovascular risk factors.
OBJECTIVE
To identify classic cardiovascular risk factors and metabolic syndrome (MS) in patients with psoriasis, their possible association with its severity and compare it with the non-psoriatic population.
METHODS
This is an observational and cross-sectional population study in Lleida (Spain) from a joint hospital/primary care database.
RESULTS
The database comprised 398 701 individuals. There were 6868 cases registered as psoriasis (1.7%), and 499 of them (7.3%) were classified as moderate-severe psoriasis. Patients with psoriasis had a higher prevalence of traditional cardiovascular risk factors than non-psoriatic population: diabetes mellitus 2 (13.9% vs 7.4%, OR 2.01), dyslipidaemia (28.8% vs 17.4%, OR 1.92), arterial hypertension (31.2% vs 19.0%, OR 1.93), obesity (33.7% vs 28.1%, OR 1.30), altered fasting basal glycaemia (21.4% vs 15.1%, OR 1.54), low cholesterol HDL (38.1% vs 32.3%, OR 1.29), hypertriglyceridaemia (45.7% vs 35.2%, OR 1.55) and high waist circumference (75.7% vs 72.3%, OR 1.19). MS was more prevalent in psoriatic patients (28.3% vs 15.1%, OR 2.21), and cardiovascular risk factors were similar between psoriasis severity groups. Psoriatic patients had a higher prevalence of ischaemic heart disease (3.3% vs 1.8%, OR 1.87) and vascular cerebral accidents (1.8% vs 1.2%, OR 1.55). A model for MS showed a significant nonlinear relationship with age and sex and significant differences between patients with and without psoriasis.
CONCLUSION
We found statistically significant differences in relation to the prevalence of cardiovascular risk factors, MS and major cardiovascular events in psoriatic patients. However, differences were not seen between psoriasis severity groups. Our work reinforces the need for a multidisciplinary approach and close monitoring of cardiovascular risk factors in these patients to prevent a cardiovascular event.
背景
银屑病是一种非常普遍的系统性慢性炎症性疾病。主要心血管事件是这些患者死亡的主要原因，这表明银屑病与传统心血管危险因素之间存在关联。
目的
确定银屑病患者的经典心血管危险因素和代谢综合征（MS），及其与疾病严重程度的可能关联，并与非银屑病人群进行比较。
方法
这是一项在西班牙莱里达（Lleida）进行的基于医院/初级保健数据库的观察性、横断面人群研究。
结果
数据库共包含 398701 人。登记了 6868 例银屑病（1.7%）病例，其中 499 例（7.3%）为中重度银屑病。与非银屑病人群相比，银屑病患者具有更高的传统心血管危险因素患病率：糖尿病 2 型（13.9% vs 7.4%，OR 2.01）、血脂异常（28.8% vs 17.4%，OR 1.92）、动脉高血压（31.2% vs 19.0%，OR 1.93）、肥胖（33.7% vs 28.1%，OR 1.30）、空腹基础血糖升高（21.4% vs 15.1%，OR 1.54）、胆固醇高密度脂蛋白（HDL）降低（38.1% vs 32.3%，OR 1.29）、高甘油三酯血症（45.7% vs 35.2%，OR 1.55）和高腰围（75.7% vs 72.3%，OR 1.19）。银屑病患者的 MS 更为常见（28.3% vs 15.1%，OR 2.21），且不同疾病严重程度组的心血管危险因素相似。银屑病患者缺血性心脏病（3.3% vs 1.8%，OR 1.87）和脑血管意外（1.8% vs 1.2%，OR 1.55）的患病率更高。MS 的模型显示出与年龄和性别之间的显著非线性关系，以及有和无银屑病患者之间的显著差异。
结论
我们发现银屑病患者的心血管危险因素、MS 和主要心血管事件的患病率存在统计学显著差异。然而，不同疾病严重程度组之间没有差异。我们的工作加强了对这些患者进行多学科管理和密切监测心血管危险因素的必要性，以预防心血管事件的发生。
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