羟氯喹在红斑狼疮患者中的应用与主要不良心血管事件风险：一项丹麦全国队列研究。
Use of hydroxychloroquine and risk of major adverse cardiovascular events in patients with lupus erythematosus: A Danish nationwide cohort study.
机构信息
Department of Dermatology, Allergy and Venerology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
出版信息
J Am Acad Dermatol. 2021 Apr;84(4):930-937. doi: 10.1016/j.jaad.2020.12.013. Epub 2020 Dec 13.
BACKGROUND
Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).
OBJECTIVE
To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).
METHODS
Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997 and 2017). Cox regression models calculating the hazard ratio (HR) analyzing the risk of MACE were performed comparing time on and off hydroxychloroquine (including never users). The models were adjusted for age, sex, socioeconomic status, concomitant treatment, and cardiovascular risk factors.
RESULTS
Among 4587 patients with LE, 51% (n = 2343) were treated with hydroxychloroquine during the study period. An inverse association between use of hydroxychloroquine and MACE risk was observed among patients with SLE (adjusted HR, 0.65; 95% confidence interval, 0.46-0.90) and patients with CLE (adjusted HR, 0.71; 95% confidence interval, 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time control design.
LIMITATIONS
No information on disease activity/severity was available.
CONCLUSION
Our findings indicate an opportunity to reduce the risk of cardiovascular events in patients with LE through use of hydroxychloroquine.
背景
有限的数据表明羟氯喹可能会影响红斑狼疮患者的心血管疾病风险。
目的
研究羟氯喹治疗是否与皮肤红斑狼疮（CLE）或系统性红斑狼疮（SLE）患者的主要不良心血管事件（MACE）（心肌梗死、缺血性卒中和心血管相关死亡）有关。
方法
基于丹麦全国登记处，进行了一项观察性队列研究，纳入了首次诊断为 CLE 或 SLE 的患者（1997 年至 2017 年）。使用 Cox 回归模型计算风险比（HR），分析比较了羟氯喹治疗时间（包括从未使用者）与 MACE 风险。模型调整了年龄、性别、社会经济地位、合并治疗和心血管危险因素。
结果
在 4587 例 LE 患者中，51%（n=2343）在研究期间接受了羟氯喹治疗。在 SLE 患者（调整后的 HR，0.65；95%置信区间，0.46-0.90）和 CLE 患者（调整后的 HR，0.71；95%置信区间，0.42-1.19）中，羟氯喹的使用与 MACE 风险呈负相关。在包括病例时间对照设计的敏感性分析中也得到了一致的结果。
局限性
没有关于疾病活动/严重程度的信息。
结论
我们的研究结果表明，通过使用羟氯喹，有机会降低 LE 患者发生心血管事件的风险。
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