摘要
背景:银屑病是最常见的1型辅助性T细胞(TH1)免疫性疾病,有证据显示TH1疾病与心肌梗死(MI)相关。据悉,银屑病与心血管疾病相关,但这仅在未校正主要心血管危险因素的医院研究中被探讨过。
Context:Psoriasis is the most common T-helper cell type 1(TH1)immunological disease.Evidence has linked TH1 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
