Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study
Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study
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DOI：
10.1136/annrheumdis-2014-205675
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发表时间：
2015-02-01
影响因子：
27.4
通讯作者：
Gelfand, Joel M.
中科院分区：
文献类型：
--
作者：
Ogdie, Alexis;Yu, YiDing;Gelfand, Joel M.
目的我们旨在量化银屑病关节炎（PsA）、类风湿关节炎（RA）和无已知PsA的银屑病患者与普通人群在调整传统心血管危险因素后发生主要不良心血管事件（MACE）的风险。方法1994 - 2010年在健康改善网络（THIN）进行了一项基于人群的纵向队列研究。英国的一个初级保健医疗记录数据库。纳入了18-89岁的PsA、RA或银屑病患者。为每例PsA患者选择最多10例在实践和索引日期匹配的未暴露对照。结局包括心血管死亡、心肌梗死、脑血管意外和复合结局（MACE）。使用考克斯比例风险模型计算校正传统风险因素后各结局的HR。先验，我们假设疾病状态和疾病修饰抗风湿药物（DMARD）use.Results患者PsA（N=8706），RA（N=41 752），银屑病（N=138 424）和未暴露的对照组（N=81 573）之间的相互作用。校正传统危险因素后，未开具DMARD处方的PsA患者发生MACE的风险较高（HR 1.24，95% CI 1.03 - 1.49），RA患者（无DMARD：HR 1.39，95% CI 1.28 - 1.50，DMARD：HR 1.58，95% CI 1.46 - 1.70），未开具DMARD处方的银屑病患者（HR 1.08，95% CI 1.02 ~ 1.15）和重度银屑病患者（DMARD使用者：HR 1.42，95% CI 1.17 ~ 1.73）。
Objectives We aimed to quantify the risk of major adverse cardiovascular events (MACE) among patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA) and psoriasis without known PsA compared with the general population after adjusting for traditional cardiovascular risk factors.Methods A population-based longitudinal cohort study from 1994 to 2010 was performed in The Health Improvement Network (THIN), a primary care medical record database in the UK. Patients aged 18-89 years of age with PsA, RA or psoriasis were included. Up to 10 unexposed controls matched on practice and index date were selected for each patient with PsA. Outcomes included cardiovascular death, myocardial infarction, cerebrovascular accidents and the composite outcome (MACE). Cox proportional hazards models were used to calculate the HRs for each outcome adjusted for traditional risk factors. A priori, we hypothesised an interaction between disease status and disease-modifying antirheumatic drug (DMARD) use.Results Patients with PsA (N=8706), RA (N=41 752), psoriasis (N=138 424) and unexposed controls (N=81 573) were identified. After adjustment for traditional risk factors, the risk of MACE was higher in patients with PsA not prescribed a DMARD (HR 1.24, 95% CI 1.03 to 1.49), patients with RA (No DMARD: HR 1.39, 95% CI 1.28 to 1.50, DMARD: HR 1.58, 95% CI 1.46 to 1.70), patients with psoriasis not prescribed a DMARD (HR 1.08, 95% CI 1.02 to 1.15) and patients with severe psoriasis (DMARD users: HR 1.42, 95% CI 1.17 to 1.73).Conclusions Cardiovascular risk should be addressed with all patients affected by psoriasis, PsA or RA.