Primary care-based screening for cardiovascular risk factors in patients with psoriasis.
Primary care-based screening for cardiovascular risk factors in patients with psoriasis.
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DOI：
10.1111/bjd.14557
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发表时间：
2016-08-01
期刊：
影响因子：
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通讯作者：
Griffiths, C E M
中科院分区：
文献类型：
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作者：
Rutter, M K;Kane, K;Griffiths, C E M
背景技术背景：评估银屑病患者心血管疾病（CVD）危险因素的研究受到选择偏倚、不适当的对照或依赖于临床原因收集的数据的限制。结论：在一项横断面研究中，调查初级保健中银屑病患者的CVD危险因素筛查是否增加了已知的CVD危险因素的患病率。结果：共纳入287例患者（平均年龄53岁，57%为女性，94%为白色英国人，22%为严重银屑病，33%为银屑病关节炎）。已知和筛查检测到（以前未知）风险因素的比例如下：高血压35%已知，13%筛查检测到;高胆固醇血症32%和37%;糖尿病6.6%和3.1%，慢性肾脏疾病1.1%和4.5%。在48%的患者中发现了至少一个筛查检测到的风险因素，在21%的患者中发现了两个或更多的风险因素。三分之一（37%）以前不知道处于高风险的患者被发现具有高（>10%）的10年CVD风险。在接受已知的心血管疾病危险因素治疗的参与者中，近一半的血压（46%）和胆固醇（46%）水平低于最佳水平。结论：基于初级保健的成年银屑病患者的心血管危险因素筛查确定了高比例的患者（i）高心血管疾病风险，（ii）与屏幕检测到的危险因素和（iii）与次优管理的已知危险因素。这些发现需要与报告一起考虑，这些报告检测到临床医生对已确定的风险因素的反应有限，然后才能推荐进行普遍的CVD筛查。
BACKGROUND: Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons.OBJECTIVES: To investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross-sectional study.METHODS: Patients listed as having psoriasis in primary care were recruited, screened and risk assessed by QRISK2.RESULTS: In total, 287 patients attended (mean age 53years, 57% women, 94% white British, 22% severe disease, 33% self-reported psoriatic arthritis). The proportion with known and screen-detected (previously unknown) risk factors was as follows: hypertension 35% known and 13% screen-detected; hypercholesterolaemia 32% and 37%; diabetes 6·6% and 3·1% and chronic kidney disease 1·1% and 4·5%. At least one screen-detected risk factor was found in 48% and two or more risk factors were found in 21% of patients. One in three patients (37%) not previously known to be at high risk were found to have a high (>10%) 10-year CVD risk. Among the participants receiving treatment for known CVD risk factors, nearly half had suboptimal levels for blood pressure (46%) and cholesterol (46%).CONCLUSIONS: Cardiovascular risk factor screening of primary care-based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen-detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended.