Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
JAMA Dermatol. 2020 Jan 1;156(1):65-71. doi: 10.1001/jamadermatol.2019.3412.
Although hidradenitis suppurativa (HS) is associated with several cardiovascular risk mediators, information on the risk of myocardial infarction (MI) and cerebrovascular accident (CVA) in this population is sparse.
To compare risk of MI, CVA, and composite disease (MI or CVA) in patients with HS, stratified by use of biologic agents, with controls without HS.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort analysis was conducted between January 1, 1999, and April 1, 2019, using a demographically heterogeneous population-based sample of over 56 million unique patients. Individuals with HS (n = 49 862) and without HS (n = 1 421 223) were identified using electronic health records data.
The primary outcome was incidence of composite MI or CVA.
Of the 49 862 patients with HS, 37 981 were women (76.2%), 29 711 were white (59.6%), and mean (SD) age was 38.3 (13.3) years. Crude incidence rate of composite disease was 6.6 (95% CI, 6.3-7.0) per 1000 person-years in patients with HS compared with 6.8 (95% CI, 6.7-6.8) per 1000 person-years in controls. In patients with HS, crude incidence rates were 2.9 (95% CI, 2.6-3.1) per 1000 person-years for MI alone and 4.1 (95% CI, 3.9-4.4) per 1000 person-years for CVA alone compared with 3.2 (95% CI, 3.18-3.25) per 1000 person-years for MI alone in control patients and 4.1 (95% CI, 4.0-4.1) per 1000 person-years for CVA alone in control patients. In adjusted analysis, patients with HS had a 23% increased risk of composite disease (hazard ratio [HR], 1.23; 95% CI, 1.17-1.30; P < .001) and a similar increase in the risk of MI alone (HR, 1.21; 95% CI, 1.12-1.32; P < .001) and CVA alone (HR, 1.22; 95% CI, 1.14-1.31; P < .001) compared with control patients. The relative difference in composite MI or CVA risk between patients with HS and controls was highest among younger patients HR in subgroup aged 18-29 years: 1.67; 95% CI, 1.37-2.03).
Patients with HS appear to have an increased risk of MI and CVA. Early management of modifiable cardiovascular risk mediators may be warranted in patients with HS.
尽管化脓性汗腺炎（HS）与几种心血管风险介质有关，但有关该人群心肌梗死（MI）和脑血管意外（CVA）风险的信息仍然很少。
比较 HS 患者和无 HS 对照者使用生物制剂时 MI、CVA 和复合疾病（MI 或 CVA）的风险。
设计、设置和参与者：这是一项回顾性队列分析，于 1999 年 1 月 1 日至 2019 年 4 月 1 日期间在一个人口统计学上多样化的基于人群的超过 5600 万独特患者的样本中进行。使用电子健康记录数据确定 HS（n=49862）和无 HS（n=1421223）患者。
主要结局是复合 MI 或 CVA 的发生率。
在 49862 例 HS 患者中，37981 例为女性（76.2%），29711 例为白人（59.6%），平均（SD）年龄为 38.3（13.3）岁。与对照组相比，HS 患者复合疾病的粗发病率为 6.6（95%CI，6.3-7.0）/1000 人年，而对照组为 6.8（95%CI，6.7-6.8）/1000 人年。在 HS 患者中，MI 单独的粗发病率为 2.9（95%CI，2.6-3.1）/1000 人年，CVA 单独的粗发病率为 4.1（95%CI，3.9-4.4）/1000 人年，而对照组中 MI 单独的粗发病率为 3.2（95%CI，3.18-3.25）/1000 人年，CVA 单独的粗发病率为 4.1（95%CI，4.0-4.1）/1000 人年。在调整分析中，HS 患者发生复合疾病的风险增加 23%（风险比[HR]，1.23；95%CI，1.17-1.30；P<.001），MI 单独发生的风险和 CVA 单独发生的风险也分别增加了 21%（HR，1.21；95%CI，1.12-1.32；P<.001）和 22%（HR，1.22；95%CI，1.14-1.31；P<.001）。与对照组相比，HS 患者和对照组之间复合 MI 或 CVA 风险的相对差异在年轻患者中最高（年龄在 18-29 岁的亚组中 HR 为 1.67；95%CI，1.37-2.03）。
HS 患者似乎存在 MI 和 CVA 风险增加。可能需要对 HS 患者进行早期管理，以控制可改变的心血管风险因素。
