Chen Chun-Hsiung, Chen Hung-An, Liao Hsien-Tzung, Chen Chen-Hung
Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, and School of Medicine, Tzu Chi University, Hualien, Taiwan.
Chi Mei Medical Center, Taiwan.
Clin Exp Rheumatol. 2023 Nov;41(11):2230-2238. doi: 10.55563/clinexprheumatol/y7psev. Epub 2023 May 24.
To investigate the association of hydroxychloroquine (HCQ) with the risk of cardiovascular disease (CVD) events in patients with traditional risk factors, hypertension (HTN) or diabetes mellitus (DM).
We conducted a retrospective cohort study from 1 January, 2010 to 30 September, 2022. There was a total of 1007585 patients from a hospital-based population. In this cohort, 146862 patients had newly diagnosed HTN or DM. Among these patients, 1903 patients had HCQ exposure and 136396 patients had no HCQ exposure after exclusion of previous CVD events or invasive cardiovascular procedures. The risk of developing CVD events, a composite of acute myocardial infarction (AMI) and ischaemic stroke was evaluated.
The patients with HCQ exposure had reduced risk of CVD events [HR (hazard ratio)=0.67 95%CI: 0.55-0.83], AMI (HR=0.61, 95%CI: 0.41-0.90) and ischaemic stroke (HR=0.74, 95%CI:0.59-0.93), when compared with non-HCQ exposure, after adjusting for age, sex, rheumatic diseases, comorbidities and medications. Specifically, reduced risk for CVD events (HR=0.67, 95%CI: 0.54-0.83), including AMI (HR=0.67, 95%CI: 0.44-1.00) and ischaemic stroke (HR=0.71, 95%CI: 0.55-0.90) were observed in older patients (age ≥50 yrs) with HCQ exposure, and reduced risk for AMI also observed in younger patients (age <50 yrs) (HR=0.28, 95%CI: 0.08-0.97). Reduced risk for CVD events (HR=0.63, 95%CI: 0.48-0.82) and ischaemic stroke (HR=0.63, 95%CI: 0.47-0.85) were observed particularly in female patients with HCQ exposure. Reduced risk for AMI was observed particularly in male patients with HCQ exposure (HR=0.44, 95%CI: 0.22-0.87).
HCQ has protective effect on CVD events, including both AMI and ischaemic stroke in the patients with traditional risk factors. The protective effect of HCQ on CVD events is prominent in older patients.
探讨羟氯喹（HCQ）与具有传统危险因素（高血压（HTN）或糖尿病（DM））的患者发生心血管疾病（CVD）事件风险之间的关联。
我们进行了一项回顾性队列研究，时间跨度为2010年1月1日至2022年9月30日。研究对象为来自某医院人群的1007585例患者。在该队列中，146862例患者新诊断为HTN或DM。在这些患者中，排除既往CVD事件或侵入性心血管手术史后，1903例患者有HCQ暴露史，136396例患者无HCQ暴露史。评估发生CVD事件（急性心肌梗死（AMI）和缺血性中风的复合事件）的风险。
与未暴露于HCQ的患者相比，在调整年龄、性别、风湿性疾病、合并症和用药情况后，暴露于HCQ的患者发生CVD事件的风险降低[风险比（HR）=0.67，95%置信区间（CI）：0.55 - 0.83]，AMI（HR = 0.61，95%CI：0.41 - 0.90）和缺血性中风（HR = 0.74，95%CI：0.59 - 0.93）的风险降低。具体而言，在年龄≥50岁的暴露于HCQ的老年患者中，观察到发生CVD事件（HR = 0.67，95%CI：0.54 - 0.83）的风险降低，包括AMI（HR = 0.67，95%CI：0.44 - 1.00）和缺血性中风（HR = 0.71，95%CI：0.55 - 0.90），在年龄＜50岁的暴露于HCQ的年轻患者中也观察到AMI风险降低（HR = 0.28, 95%CI：0.08 - 0.97）。在暴露于HCQ的女性患者中，尤其观察到CVD事件（HR = 0.63，95%CI：0.48 - 0.82）和缺血性中风（HR = 0.63，95%CI：0.47 - 0.85）的风险降低。在暴露于HCQ的男性患者中，尤其观察到AMI风险降低（HR = 0.44，95%CI：0.22 - 0.87）。
HCQ对具有传统危险因素的患者发生CVD事件（包括AMI和缺血性中风）具有保护作用。HCQ对CVD事件的保护作用在老年患者中尤为突出。
