Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case-control analysis
Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case-control analysis
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DOI：
10.1111/j.1365-2133.2008.09020.x
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发表时间：
2009-05-01
影响因子：
10.3
通讯作者：
Meier, C. R.
中科院分区：
文献类型：
--
作者：
Brauchli, Y. B.;Jick, S. S.;Meier, C. R.
全身炎症可能会增加银屑病患者患心血管疾病的风险，但有关早期银屑病患者这一风险的数据很少。为了评估和比较银屑病患者初始队列和无银屑病人群发生心肌梗死（MI）、中风或短暂性脑缺血发作（TIA）的风险。我们在英国全科医学研究数据库中进行了一项初始队列研究，并进行了嵌套病例对照分析。研究人群包括 1994-2005 年首次记录诊断为银屑病的 36 702 名患者，与无银屑病患者进行 1:1 匹配。我们评估了粗发病率 (IR) 并应用条件逻辑回归来获得比值比 (OR)，置信区间 (CI) 为 95%。总体而言，患有或不患有银屑病的患者中，MI (n = 449)、卒中 (n = 535) 和 TIA (n = 402) 的 IR 相似。然而，与无银屑病患者相比，年龄 < 60 岁银屑病患者发生 MI 的调整 OR 为 1.66 (95% CI 1.03-2.66)，而年龄 >= 60 岁患者的 OR 为 0.99 (95% CI 0.77-1.26)。对于每年接受 2 次口服银屑病治疗的所有年龄段患者，发生 MI 的调整后 OR 分别为 2.48 (95% CI 0.69-8.91) 和 1.39 (95% CI 0.43-4.53)，中风和 TIA 的结果类似。总体而言，早期银屑病患者发生心血管结局的风险并未显着升高。然而，在亚组分析中，年龄 < 60 岁的银屑病患者（主要是病情严重）的 MI 风险增加（但绝对值较低）。
Systemic inflammation may increase the risk for cardiovascular diseases in patients with psoriasis, but data on this risk in patients with early psoriasis are scarce.To assess and compare the risk of developing incident myocardial infarction (MI), stroke or transient ischaemic attack (TIA) between an inception cohort of patients with psoriasis and a psoriasis-free population.We conducted an inception cohort study with a nested case-control analysis within the U.K.-based General Practice Research Database. The study population encompassed 36 702 patients with a first-time recorded diagnosis of psoriasis 1994-2005, matched 1 : 1 to psoriasis-free patients. We assessed crude incidence rates (IRs) and applied conditional logistic regression to obtain odds ratios (ORs) with 95% confidence intervals (CIs).Overall, the IRs of MI (n = 449), stroke (n = 535) and TIA (n = 402) were similar among patients with or without psoriasis. However, the adjusted OR of developing MI for patients with psoriasis aged < 60 years was 1.66 (95% CI 1.03-2.66) compared with patients without psoriasis, while the OR for patients aged >= 60 years was 0.99 (95% CI 0.77-1.26). The adjusted ORs of developing MI for patients of all ages with 2 prescriptions/year for oral psoriasis treatment were 2.48 (95% CI 0.69-8.91) and 1.39 (95% CI 0.43-4.53), with a similar finding for stroke and TIA.The risk of developing a cardiovascular outcome was not materially elevated for patients with early psoriasis overall. In subanalyses, however, there was a suggestion of an increased (but low absolute) MI risk for patients with psoriasis aged < 60 years, mainly with severe disease.