The Risk of Myocardial Infarction in Patients with Psoriasis

描述（由申请人提供）：牛皮癣是最常见的辅助性T细胞1型（Th-1）自身免疫性疾病，影响超过2%的成年人。与其他主要慢性疾病类似，牛皮癣与健康相关的生活质量显著下降有关。银屑病的特点是厚的、红色的、鳞状的皮肤斑块，可以是局部的或广泛的，在一些患者中有炎症性关节病。30多年来，研究人员一直认为牛皮癣可能与心肌梗死风险增加有关，然而，尚未有研究使用基于人群的方法和多变量分析来评估这种关联，以控制潜在的混杂变量。我们已经获得了令人信服的初步数据，表明银屑病可能是发生心肌梗死的独立危险因素。越来越多的证据表明，Th-1炎症途径与动脉粥样硬化的发展以及最终的心肌梗死有关，这表明银屑病的病理生理可能会导致心肌梗死的独立风险。事实上，其他Th-1疾病，如类风湿关节炎，已被证明是心肌梗死的独立危险因素。我们建议开展一系列以人群为基础的队列研究，以确定牛皮癣患者是否具有更高的心血管危险因素患病率、较差的心血管危险因素控制、心肌梗死、卒中和心血管死亡率的风险比无牛皮癣患者高。研究牛皮癣、心血管危险因素和心血管结局之间的关系将对我们理解炎症性疾病和心肌梗死之间的关系具有重要意义，并对700多万美国牛皮癣患者的护理具有潜在的重要公共卫生意义。公共卫生相关性：牛皮癣是最常见的Th-1自身免疫性疾病，影响超过700万美国人。与牛皮癣相关的炎症可能导致免疫系统发挥作用的其他疾病，如动脉粥样硬化和心脏病发作。在这项应用中，我们的目标是在不同程度银屑病严重程度的患者中进行一项基于人群的大型队列研究，以确定这种慢性疾病对心肌梗死、中风和心血管死亡风险的影响。该应用程序的创新之处在于，我们将使用英国一个经过良好验证的医疗记录数据库系统来调查我们的假设，这大大提高了研究的效率，提高了研究结果的有效性。此外，据我们所知，这将是第一个分析银屑病患者中风风险的研究，也是第一个研究银屑病皮肤严重程度如何影响心肌梗死风险的研究。

DESCRIPTION (provided by applicant): Psoriasis is the most common T helper cell type 1 (Th-1) autoimmune disease, affecting over 2% of the adult population. Similar to other major chronic illnesses, psoriasis is associated with significant decrements in health related quality of life. Psoriasis is characterized by thick, red, scaly skin plaques which can be localized or widespread and an inflammatory arthropathy in some patients. For over 30 years, investigators have suggested that psoriasis may be associated with an increased risk of myocardial infarction, however, there have been no studies evaluating this association using population-based methods and multivariable analysis to control for potential confounding variables. We have developed compelling preliminary data that psoriasis may be an independent risk factor for developing MI. Increasing evidence has linked Th-1 inflammatory pathways to the development of atherosclerosis and ultimately, myocardial infarction, suggesting that the pathophysiology of psoriasis may confer an independent risk for myocardial infarction. In fact, other Th-1 diseases, such as rheumatoid arthritis, have been shown to be independent risk factors for myocardial infarction. We propose to conduct a series of population-based cohort studies to determine if patients with psoriasis have a higher prevalence of cardiovascular risk factors, poorer control of cardiovascular risk factors, and an increased risk of myocardial infarction, stroke, and cardiovascular mortality compared to patients without psoriasis. Studying the relationship between psoriasis, cardiovascular risk factors, and cardiovascular outcomes will have important implications as to our understanding of the relationship between inflammatory diseases and myocardial infarction and will have potentially important public health implications for the care of the over 7 million US patients with psoriasis. PUBLIC HEALTH RELEVANCE: Psoriasis is the most common Th-1 autoimmune disease, affecting over 7 million Americans. The inflammation associated with psoriasis may lead to other conditions in which the immune system plays a role such as atherosclerosis and heart attack. In this application, we aim to perform a large population-based cohort study in patients with varying degrees of psoriasis severity to determine the impact this chronic disease has on the risk of myocardial infarction, stroke, and cardiovascular death. The application is innovative in that we will use a well-validated medical records database system in the United Kingdom to investigate our hypotheses which markedly increases the efficiency of the study and improves the validity of the findings. Furthermore, to our knowledge, this will be the first analytic study of the risk of stroke in patients with psoriasis, and the first study to examine how psoriasis skin severity impacts the risk of MI.