Risk of myocardial infarction in patients with psoriasis
Risk of myocardial infarction in patients with psoriasis
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DOI：
10.1001/jama.296.14.1735
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发表时间：
2006-10-11
影响因子：
120.7
通讯作者：
Troxel, Andrea B.
中科院分区：
文献类型：
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作者：
Gelfand, Joel M.;Neimann, Andrea L.;Troxel, Andrea B.
上下文牛皮癣是最常见的T-辅助细胞1型（T（H）1）免疫疾病。证据已将T（H）1疾病与心肌梗塞（MI）联系起来。牛皮癣与心血管疾病有关，但仅在无法控制主要心血管危险因素的医院研究中进行了研究。目标是确定在控制主要的主要牛皮癣的基于人群的同类牛皮癣中是否是MI的独立风险因素心血管危险因素。设计，环境和患者在英国的牛皮癣患者20至90岁的英国一项前瞻性，基于人群的队列研究，比较有和没有牛皮癣的患者的结局。全科医生作为患者病历的一部分收集了数据，并在1987年至2002年之间存储在一般实践研究数据库中，平均随访时间为5。4年。对高血压，糖尿病，心肌梗塞史，高脂血症，年龄，性别，吸烟和体重指数进行了调整。如果牛皮癣患者接受全身疗法，则将其分类为严重。从相同的实践中随机选择了多达5种没有牛皮癣的对照，并与牛皮癣患者开始日期。总共确定了55695例对照患者和轻度（n = 127 139）和严重的牛皮癣（n = 3837）的患者。梅恩结局措施事件MI。反应在对照人群中有114个MIS（2.0％），2319 （1.8％）和112（2.9％）分别在轻度和严重的牛皮癣组中。对照患者和轻度和重度牛皮癣患者每1000人年的发病率为3.58（95％置信区间[CI]，3.52-3.65），4.04（95％CI，3.88-4.21）和5.13（95％CI ，分别为4.22-6.17）。牛皮癣患者的MI调整后相对风险（RR）的增加，随着年龄的增长而变化。例如，对于30岁的轻度或重度牛皮癣患者，具有MI的调整后RR分别为1.29（95％CI，1.14-1.46）和3.10（95％CI，1.98-4.86）。对于一个60岁的轻度或重度牛皮癣患者，具有MI的调整后RR为1.08（95％CI，1.03-1.13）和1.36（95％CI，1.13-1.64），分别为Conclusions牛皮癣，可能会提供MI的独立风险。在严重牛皮癣的年轻患者中，RR最大。
Context Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors.Objective To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors.Design, Setting, and Patients A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556 995 control patients and patients with mild (n = 127 139) and severe psoriasis (n = 3837) were identified.Main Outcome Measure Incident MI.Results There were 11 194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively.Conclusions Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.