Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database
Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database
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DOI：
10.1093/eurheartj/ehp567
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发表时间：
2010-04-01
影响因子：
39.3
通讯作者：
Gelfand, Joel M.
中科院分区：
文献类型：
--
作者：
Mehta, Nehal N.;Azfar, Rahat S.;Gelfand, Joel M.
目的银屑病是一种常见的慢性炎症性T辅助细胞-1/17介导的皮肤病。最近的研究表明，银屑病，特别是严重的银屑病，可能是动脉粥样硬化、心肌梗死(MI)和中风的独立危险因素。我们利用全科医学研究数据库进行了一项队列研究，以确定严重银屑病患者心血管(CV)死亡的风险是否增加。方法和结果重度银屑病定义为接受银屑病诊断和系统治疗与严重银屑病一致的患者(n=3603)。每个银屑病患者从相同的治疗方法和开始日期中选择最多4名非银屑病患者(n=14330)。对于每一例死亡，死因都是通过审查电子病历确定的。在调整了年龄、性别、吸烟、糖尿病、高血压和高脂血症后，严重银屑病是CV死亡率的独立危险因素(HR 1.57；95%CI 1.26，1.96)。总体而言，即使调整了主要的心血管危险因素，重度牛皮癣患者每年每283名患者中也有一例额外的心血管死亡。心血管死亡的相对风险随年龄变化而变化。例如，40岁和60岁重度银屑病患者CV死亡的相对危险度分别为2.69(1.45，4.99)和1.92(1.41，2.62)。结论重症银屑病患者脑血管病死亡的风险增加，且独立于传统的脑血管病危险因素。还需要更多的研究来确定这种关联的机制以及控制牛皮癣对心血管风险的影响。
Aims Psoriasis is a common chronic inflammatory T-helper cell-1/17 mediated skin disease. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI), and stroke. We conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular (CV) mortality.Methods and results Severe psoriasis was defined as patients who received a psoriasis diagnosis and systemic therapy consistent with severe psoriasis (n = 3603). Up to four unxposed patients without psoriasis were selected from the same practices and start dates for each psoriasis patient (n = 14 330). For every death, the cause was determined by review of the electronic medical record. Severe psoriasis was an independent risk factor for CV mortality (HR 1.57; 95% Cl 1.26, 1.96) when adjusting for age, sex, smoking, diabetes, hypertension, and hyperlipidaemia. Overall, severe psoriasis patients experienced one extra CV death per 283 patients per year, even when adjusting for major CV risk factors. The relative risk of CV mortality was modified by age. For example, the RR of CV death for a 40-year-old and 60-year-old with severe psoriasis was 2.69 (1.45, 4.99) and 1.92 (1.41, 2.62), respectively. The findings were robust to multiple sensitivity analyses.Conclusion Patients with severe psoriasis have an increased risk of CV mortality that is independent of traditional CV risk factors. Additional studies are needed to determine the mechanism of this association and the impact that control of psoriasis has on CV risk.