The Risk of Myocardial Infarction in Patients with Psoriasis

银屑病患者发生心肌梗死的风险

• 批准号: 7580371
• 负责人: JOEL M GELFAND
• 金额: $ 78.74万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7580371
• 关键词: Adult; Affect; American; Atherosclerosis; Autoimmune Diseases; Blood; Blood Pressure; Body Surface Area; Body mass index; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Cholesterol; Chronic Disease; Cohort Studies; Confounding Factors (Epidemiology); Cross-Sectional Studies; Data; Databases; Development; Diabetes Mellitus; Diagnosis; Disease; Event; Functional disorder; Hemoglobin concentration result; High Prevalence; Hyperlipidemia; Hypertension; Immune system; Inflammation; Inflammatory; Ischemic Stroke; Knowledge; Laboratories; Lead; Link; Measurement; Measures; Medical Records; Methods; Modeling; Myocardial Infarction; Outcome; Pathogenesis; Pathology; Pathway interactions; Patients; Play; Population; Prevalence; Psoriasis; Public Health; Publishing; Reporting; Research Personnel; Rheumatoid Arthritis; Risk; Risk Factors; Role; Series; Severities; Skin; Skin Plaques; Smoking; Stroke; System; T-Lymphocyte; Testing; Th1 Cells; Thick; Tumor Necrosis Factor-alpha; United Kingdom; arthropathies; base; cardiovascular risk factor; cost; cytokine; health related quality of life; high risk; improved; innovation; mortality; population based; prospective; public health relevance

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.

描述（由申请人提供）：牛皮癣是最常见的T辅助细胞类型1（TH-1）自身免疫性疾病，影响了2％以上的成人人群。与其他主要慢性疾病相似，牛皮癣与健康相关的生活质量的显着降低有关。牛皮癣的特征是厚实，红色，鳞状的皮肤斑块，可以局部或广泛地局部，并且在某些患者中是炎症性关节炎。 30多年来，研究人员提出牛皮癣可能与心肌梗塞的风险增加有关，但是，没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，即牛皮癣可能是开发MI的独立危险因素。越来越多的证据将TH-1炎症途径与动脉粥样硬化的发展联系起来，并最终将心肌梗塞与心肌梗死联系起来，这表明牛皮癣的病理生理学可能赋予心肌梗塞的独立风险。实际上，其他TH-1疾病，例如类风湿关节炎，已被证明是心肌梗塞的独立危险因素。我们建议进行一系列基于人群的队列研究，以确定牛皮癣患者的心血管危险因素的患病率是否更高，对心血管危险因素的控制较差以及与没有牛皮癣患者相比，心肌梗死，中风和心血管死亡率的风险增加。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对炎症性疾病与心肌梗死之间的关系的理解具有重要意义，并将对超过700万美国牛皮癣患者的护理产生重要的公共健康影响。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在动脉粥样硬化和心脏病发作等作用的其他情况下。在此应用中，我们旨在针对牛皮癣严重程度不同的患者进行大型基于人群的队列研究，以确定这种慢性疾病对心肌梗塞，中风和心血管死亡的风险的影响。该应用程序具有创新性，因为我们将使用英国的验证良好的医疗记录数据库系统来研究我们的假设，这显着提高了研究的效率并提高了发现的有效性。此外，据我们所知，这将是对牛皮癣患者中风风险的首次分析研究，也是第一个研究牛皮癣皮肤严重程度如何影响MI风险的研究。