Prevalence of cardiovascular risk factors in patients with psoriasis
Prevalence of cardiovascular risk factors in patients with psoriasis
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DOI：
10.1016/j.jaad.2006.08.040
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发表时间：
2006-11-01
影响因子：
13.8
通讯作者：
Gelfand, Joel M.
中科院分区：
文献类型：
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作者：
Neimann, Andrea L.;Shin, Daniel B.;Gelfand, Joel M.
背景：以往的研究表明，因银屑病住院的患者出现各种心血管合并症的频率增加。关于这种关联的基于人群的数据有限，并且很少有研究确定哪些因素与牛皮癣独立相关。我们试图确定轻度和重度牛皮癣患者的主要心血管危险因素的患病率是否高于非牛皮癣患者。方法：我们在英国使用全科医学研究数据库进行了一项基于人群的研究。如果患者接受牛皮癣代码和全身治疗，则将其归类为严重牛皮癣。如果患者曾经接受过牛皮癣代码，但没有接受过全身治疗，则定义为患有轻度牛皮癣。对照受试者从与牛皮癣患者相同的实践和开始日期中选择。如果患者收到糖尿病、高血压、高脂血症、肥胖或吸烟的编码，则将其归类为具有危险因素。使用条件逻辑回归进行分析，并考虑年龄、性别、人年和所有心血管危险因素进行调整。结果：127,706例轻度牛皮癣患者，3854例重度牛皮癣患者。重度银屑病、轻度银屑病和对照组的危险因素患病率分别为：糖尿病（7.1%、4.4%、3.3%）、高血压（20%、14.7%、11.9%）、高脂血症（6%、4.7%、3.3%）、肥胖（20.7%、15.8%、13.2%）和吸烟（30.1%、28%、21.3%）。轻度牛皮癣患者患糖尿病的调整后几率较高（比值比[OR]）。), 1.13;95%可信区间[CI]， 1.08-1.18])、高血压（OR, 1.03; 95% CI, 1.01-1.06）、高脂血症（OR, 1.16; 95% CI, 1.12-1.21）、肥胖（OR, 1.27; 95% CI, 1.24-1.31）和吸烟（OR, 1.31; 95% CI, 1.29-1.34）均高于对照组。严重牛皮癣患者发生糖尿病（OR, 1.62; 95% CL, 1.3-2.01）、肥胖（OR, 1.79; 95% CI, 1.55-2.05）和吸烟（OR, 1.31; 95% CI, 1.17-1.47）的调整后几率高于对照组。此外，糖尿病（OR, 1.39; 95% Cl, 1.22-1.58）和肥胖（OR, 1.47; 95% CI, 1.32-1.63）在重度牛皮癣患者中比在轻度牛皮癣患者中更为普遍。局限性：该研究是横断面的，因此无法确定相关性的方向性。结论：多种心血管危险因素与银屑病相关。心血管危险因素是代谢综合征的关键组成部分，与严重牛皮癣的相关性比与轻度牛皮癣的相关性更强。
Background: Previous studies suggest that patients hospitalized for psoriasis have an increased frequency of a variety of cardiovascular comorbidities. Limited population-based data exist on this association, and few studies have determined which factors are independently associated with psoriasis.Objective. We sought to determine whether the prevalence of the major cardiovascular risk factors was higher in mild and severe psoriasis than in patients without psoriasis.Methods: We conducted a population-based study in the United Kingdom using the General Practice Research Database. Patients were classified as having severe psoriasis if they received a code for psoriasis as well as systemic therapy. Patients were defined as having mild psoriasis if they ever received a psoriasis code but no systemic therapy. Control subjects were selected from the same practices and start dates as psoriasis patients. Patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, obesity, or smoking. Analyses were performed by using conditional logistic regression, and adjustments were made considering age, gender, person-years, and all cardiovascular risk factors.Results: We identified 127,706 patients with mild psoriasis and 3854 with severe psoriasis. Respective prevalence rates of risk factors in those with severe psoriasis, mild psoriasis, and in controls were as follows: diabetes (7.1%, 4.4%, 3.3%), hypertension (20%, 14.7%, 11.9%), hyperlipidemia (6%, 4.7%, 3.3%), obesity (20.7%, 15.8%, 13.2%), and smoking (30.1%, 28%, 21.3%). Patients with mild psoriasis had a higher adjusted odds of diabetes (odds ratio [OR.], 1.13; 95% confidence interval [CI], 1.08-1.18]), hypertension (OR, 1.03; 95% CI, 1.01-1.06), hyperlipidemia (OR, 1.16; 95% CI, 1.12-1.21), obesity (OR, 1.27; 95% CI, 1.24-1.31), and smoking (OR, 1.31; 95% CI, 1.29-1.34) than controls. Patients with severe psoriasis had a higher adjusted odds of diabetes (OR, 1.62; 95% CL 1.3-2.01), obesity (OR, 1.79; 95% CI, 1.55-2.05), and smoking (OR, 1.31; 95% CI, 1.17-1.47) than controls. Additionally, diabetes (OR, 1.39; 95% Cl, 1.22-1.58) and obesity (OR, 1.47; 95% CI, 1.32-1.63) were more prevalent in those with severe psoriasis than with mild psoriasis.Limitations: The study was cross-sectional and therefore the directionality of the associations could not be determined.Conclusion: Multiple cardiovascular risk factors are associated with psoriasis. Cardiovascular risk factors that are key components of the metabolic syndrome are more strongly associated with severe psoriasis than with mild psoriasis.