The Risk of Myocardial Infarction in Patients with Psoriasis

描述（由申请人提供）：银屑病是最常见的T辅助细胞1型（Th-1）自身免疫性疾病，影响超过2%的成年人群。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。银屑病的特征是厚的、红色的、鳞状的皮肤斑块，其可以是局部的或广泛的，并且在一些患者中是炎性关节病。30多年来，研究人员认为银屑病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。我们已经开发了令人信服的初步数据，银屑病可能是一个独立的风险因素，发展心肌梗死。越来越多的证据表明Th-1炎症通路与动脉粥样硬化的发展和最终的心肌梗死有关，这表明银屑病的病理生理学可能赋予心肌梗死的独立风险。事实上，其他Th-1疾病，如类风湿性关节炎，已被证明是心肌梗死的独立危险因素。我们建议进行一系列以人群为基础的队列研究，以确定银屑病患者与非银屑病患者相比，是否有更高的心血管危险因素患病率，心血管危险因素控制较差，心肌梗死，中风和心血管死亡率增加的风险。研究银屑病、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，并对美国700多万银屑病患者的护理具有潜在的重要公共卫生意义。

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.