特发性炎性肌病诊断后的动脉粥样硬化性心血管疾病：来自 TrinetX 注册中心回顾性队列的分析。
Atherosclerotic cardiovascular disease following a diagnosis of idiopathic inflammatory myopathy: analysis from a retrospective cohort in the TriNetX registry.
机构信息
Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
Clin Rheumatol. 2024 Oct;43(10):3175-3182. doi: 10.1007/s10067-024-07109-w. Epub 2024 Aug 24.
OBJECTIVE
Idiopathic inflammatory myopathies (IIM) confer an increased risk of morbidity from atherosclerotic cardiovascular disease (ASCVD). While ASCVD risk has been studied in other countries, these results may not be applicable to patients with dermatomyositis (DM) and polymyositis (PM) in the United States. This retrospective analysis of a cohort of patients identified by ICD code from TriNetX investigated the incidence of ASCVD after International Classification of Disease (ICD) codes of DM, PM, dermatopolymyositis (DPM) or juvenile dermatomyositis (JDM).
METHOD
Patients were identified by entry of two ICD codes separated by at least 6 months, according to their first diagnosis code; ASCVD was defined as first ICD code for myocardial infarction, ischemic stroke, transient ischemic attack, or peripheral arterial disease. Cox proportional hazards regression modeled time from first IIM ICD code to ASCVD event.
RESULTS
A total of 35,554 patients were identified with the mean age at first IIM code of 54 and 26.1% were male. The most common comorbidity for all groups except JDM was hyperlipidemia (39.9%) though 79.2% of patients were on no cholesterol lowering medication. ASCVD occurred in 30.4% of patients with PM, 24.3% of patients with DM and 0.9% of patients with JDM. Patients with PM had a median time to event of 9.7 years (95% Confidence interval (CI) 9.1, 10.7) and 14.3 years (95% CI 12.6, 14.8) for DM. This study demonstrates that ASCVD is a comorbidity occurring after a median of 12.5 years (95% CI 11.9, 13.6) in patients with IIM.
CONCLUSIONS
ASCVD appears to be a long-term complication for IIM patients occurring in nearly a quarter of US patients without prior ASCVD with at least two ICD codes for IIM, with a median time to event of 12.5 years. There appears to be a practice gap in the recognition and treatment of hyperlipidemia in these patients. Key Points • Hyperlipidemia was a common comorbidity identified in patients with IIM though most patients were not on cholesterol lowering medication. • Development of ASCVD appears to be a long-term complication for patients with IIM in the United States.
目的
特发性炎性肌病（IIM）会增加动脉粥样硬化性心血管疾病（ASCVD）的发病风险。尽管其他国家已经研究了 ASCVD 的风险，但这些结果可能不适用于美国的皮肌炎（DM）和多发性肌炎（PM）患者。本研究通过 TriNetX 以国际疾病分类（ICD）代码识别的患者队列进行回顾性分析，研究了 DM、PM、皮肌炎（DPM）或幼年皮肌炎（JDM）的 ICD 代码后 ASCVD 的发生率。
方法
根据首次诊断代码，患者通过至少相隔 6 个月的两次 ICD 代码进入进行识别；ASCVD 定义为首次 ICD 代码为心肌梗死、缺血性卒、短暂性脑缺血发作或外周动脉疾病。使用 Cox 比例风险回归模型对首次 IIM ICD 代码至 ASCVD 事件的时间进行建模。
结果
共确定了 35554 名患者，首次 IIM 代码的平均年龄为 54 岁，26.1%为男性。除 JDM 外，所有组最常见的合并症是高脂血症（39.9%），尽管 79.2%的患者没有服用降胆固醇药物。PM 患者中 ASCVD 的发生率为 30.4%，DM 患者为 24.3%，JDM 患者为 0.9%。PM 患者的中位事件时间为 9.7 年（95%置信区间（CI）9.1，10.7）和 14.3 年（95%CI 12.6，14.8）DM。本研究表明，ASCVD 是一种在患有 IIM 的患者中发生的合并症，中位数时间为 12.5 年（95%CI 11.9，13.6）。
结论
ASCVD 似乎是 IIM 患者的一种长期并发症，近四分之一的美国患者没有 ASCVD 的既往病史，且至少有两个 IIM 的 ICD 代码，中位事件时间为 12.5 年。在这些患者中，似乎存在对高脂血症的认识和治疗方面的差距。
关键点
高脂血症是 IIM 患者的常见合并症，但大多数患者未服用降胆固醇药物。
ASCVD 的发生似乎是美国 IIM 患者的一种长期并发症。
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