美国一项代表性全国性研究中的银屑病严重程度与心脏代谢风险因素

Psoriasis Severity and Cardiometabolic Risk Factors in a Representative US National Study.

作者信息

Lin I-Chun, Heck Julia E, Chen Liwei, Feldman Steven R

机构信息

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA.

出版信息

Am J Clin Dermatol. 2021 Sep;22(5):719-730. doi: 10.1007/s40257-021-00600-z. Epub 2021 Apr 28.

DOI:10.1007/s40257-021-00600-z

PMID:33913115

Abstract

BACKGROUND

Psoriasis is associated with metabolic syndrome; however, the relationship of psoriasis severity with individual cardiometabolic risk factors is not clear. There is a reporting gap between the cardiometabolic risks among patients with psoriasis and what has been reported in the literature using US samples.

OBJECTIVES

The objective of this study was to examine the disease burden of psoriasis and assess the associations of psoriasis severity and cardiometabolic risk factors in a nationally representative sample.

METHODS

We conducted a cross-sectional study using the weighted pooled data from the National Ambulatory Medical Care Survey (NAMCS) 2007 through 2016. The NAMCS data were collected from US office-based physicians. Each physician was randomly assigned a specific week to report a sample of their cases. Patients were categorized as severe psoriasis if they were prescribed at least one systemic therapy. We used logistic regression models adjusting for potential confounders to estimate the associations of psoriasis severity with individual cardiometabolic factors.

RESULTS

There were about 3.3 million office-based psoriasis visits per year with a mean age of 50 years, a female-to-male ratio of 1:1, and severe disease in 23%. We observed greater values of blood pressure, lipid profiles, and higher body mass index among patients with psoriasis, compared with patients without psoriasis. A higher proportion of the psoriasis patient group were overweight and obese (73.6% vs 62.9% in the non-psoriasis patient group). Compared to mild case groups, severe case groups tended to have a higher proportion of overweight/obese with a body mass index ≥ 25 kg/m (77% vs 73%). Obesity was weakly associated with psoriasis severity (adjusted odds ratio = 1.37, 95% confidence interval 0.98-1.91 for mild disease and adjusted odds ratio = 1.42, 95% confidence interval 0.80-2.52 for severe cases).

CONCLUSIONS

Cardiometabolic factors are related health issues in psoriasis, and obesity is associated with greater psoriasis severity.

摘要

背景

银屑病与代谢综合征相关；然而，银屑病严重程度与个体心血管代谢危险因素之间的关系尚不清楚。银屑病患者的心血管代谢风险与美国样本在文献中的报道存在差距。

目的

本研究的目的是在全国代表性样本中检查银屑病的疾病负担，并评估银屑病严重程度与心血管代谢危险因素之间的关联。

方法

我们使用2007年至2016年国家门诊医疗调查（NAMCS）的加权汇总数据进行了一项横断面研究。NAMCS数据是从美国的门诊医生处收集的。每位医生被随机分配特定的一周来报告其病例样本。如果患者至少接受了一种全身治疗，则被归类为重度银屑病患者。我们使用逻辑回归模型对潜在混杂因素进行调整，以估计银屑病严重程度与个体心血管代谢因素之间的关联。

结果

每年约有330万次门诊银屑病就诊，平均年龄50岁，男女比例为1:1，23%为重症患者。与无银屑病患者相比，我们观察到银屑病患者的血压、血脂水平更高，体重指数更高。银屑病患者组中超重和肥胖的比例更高（73.6%对非银屑病患者组中的62.9%）。与轻度病例组相比，重度病例组超重/肥胖且体重指数≥25kg/m²的比例往往更高（77%对73%）。肥胖与银屑病严重程度呈弱相关（轻度疾病的调整优势比=1.37，95%置信区间0.98-1.91；重度病例的调整优势比=1.42，95%置信区间0.80-2.52）。