Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K.

Abuabara, Katrina; Azfar, Rahat S.; Shin, Daniel B.; Neimann, Andrea L.; Troxel, Andrea B.; Gelfand, Joel M.

doi:10.1111/j.1365-2133.2010.09941.x

Cited by 395 publications

(379 citation statements)

References 54 publications

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“…In addition, approximately 31% of the PsA patients reported having an infection that required treatment with an antibiotic. A recent study from the UK demonstrated that infection was an important cause of death among patients with severe psoriasis (35). Whether this is related to the inflammatory process or to immunosuppression from medications is unclear.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Husted¹,

Thavaneswaran²,

Chandran³

et al. 2011

Arthritis Care & Research

226

177

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Objective. To determine whether the presence of psoriatic arthritis (PsA) is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. Methods. Six hundred eleven patients with PsA were recruited from the University of Toronto Psoriatic Arthritis Clinic and 449 psoriasis without arthritis patients were recruited from the University of Toronto Psoriasis Cohort. The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both PsA and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios (ORs), comparing the odds of ever having a given comorbid disease in PsA patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. Results. The prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus, and at least 1 cardiovascular event in PsA patients was 37.1%, 30.0%, 20.7%, 12.0%, and 8.2%, respectively. This was significantly higher than in psoriasis without arthritis patients, with unadjusted ORs ranging from 1.54 to 2.59. In the multivariate analyses, hypertension remained significantly elevated (adjusted OR 2.17). PsA was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted ORs 2.83, 4.76, 21.53, and 7.74, respectively). Infections treated with antibiotics and depression/anxiety were relatively common in PsA, with a prevalence of 30.5% and 20.7%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. Conclusion. The results suggest that inflammatory joint disease may play a role in both cardiovascular and noncardiovascular morbidity in PsA.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Husted¹,

Thavaneswaran²,

Chandran³

et al. 2011

Arthritis Care & Research

226

177

View full text Add to dashboard Cite

show abstract

“…Three studies [40][41][42] showed an increased cancer-related mortality in psoriasis inpatients 41,42 or in patients with severe psoriasis. 40 These populations are highly selected and it is difficult to extrapolate the results to the entire psoriasis patient population. There is no robust evidence to state that cancer mortality is higher in psoriasis patients than in the general population.…”

Section: Cancersmentioning

confidence: 99%

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

Richard

Barnetche²,

Horreau

et al. 2013

Acad Dermatol Venereol

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The relationship between psoriasis, chronic inflammation, cardiovascular risk and risk of cancer has long been debated.In addition, it has been suggested that alcohol consumption may be a risk factor for psoriasis onset and severity.The aim of this study was to develop evidence-based recommendations on the risk of comorbidities and its management for daily clinical use, focusing on cardiovascular risk, risk of cancer and alcohol use in psoriasis.A scientific committee identified and selected through the Delphi method clinically relevant questions about cardiovascular risk, risk of cancer and alcohol use in psoriasis. To address these questions, a systematic literature search was performed in Medline, Embase and the Cochrane Library databases. Systematic literature reviews including meta-analysis whenever possible were performed. Subsequently, an Expert board meeting involving 39 dermatologists took place to analyse the evidence and to elaborate recommendations on the selected questions. Recommendations were graded according to the Oxford level of evidence grading system. The degree of agreement of these recommendations was assessed on a 10-point scale, as well as their potential impact on daily clinical practice.A total of 3242 articles were identified through the systematic literature searches, among which 110 were included in the systematic reviews. Overall, 12 recommendations were elaborated regarding comorbidities management in psoriasis patients. A moderate increased risk of cardiovascular diseases (CVD), mainly myocardial infarction (MI) [meta-analysis of cohort studies: OR = 1.25 (95% CI 1.03-1.52) and of cross-sectional studies: OR = 1.57 (95% CI 1.08-2.27)], and coronary artery disease (CAD) [meta-analysis of cross-sectional: OR = 1.19 (95% CI 1.14-1.24), of cohort studies: OR = 1.20 (95% CI 1.13-1.27) and of case-control studies: OR = 1.84 (95% CI 1.09-3.09)] was acknowledged. This increased cardiovascular risk requires appropriate prevention measures. There was a lack of substantial evidence that conventional systemic treatment has any effect on cardiovascular risk although methotrexate might be cardioprotective. An increased risk of solid cancer potentially associated with smoking and alcohol use was identified. The role of systemic treatment on cancer risk could not be assessed thoroughly due to limited long-term follow-up data. A higher risk of non-melanoma skin cancers especially squamous cell carcinoma was shown, mainly due to previous exposure to oral 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. No firm conclusion could be drawn regarding alcohol and psoriasis due to high variability in alcohol usage assessment in studies. Clinical experience suggests higher alcohol consumption among psoriasis patients compared to the general population. The mean expert participants' level of agreement on these recommendations varied from 6.8 to 9.4. These 12 recommendations are evidence based and supported by a panel of expert dermatologists. The next step is now to dis...

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“…The absolute and excess risk of death was highest for cardiovascular disease (61.9 and 3.5 deaths per 1000 patient-years, respectively). Severe psoriasis is associated with an increased risk of death from a variety of causes, with cardiovascular death being the most common aetiology (Abuabara et al, 2010).…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…The authors also compared CV risks in patients with severe psoriasis with the risks in patients with diabetes mellitus and found comparable increases in major adverse CV events and CV deaths in these groups, demonstrating the clinical importance of the risk of CV disease attributable to psoriasis. Other recent studies have investigated the clinical significance of CV risk in patients with severe psoriasis, demonstrating that these patients have about a 6-year reduction in life expectancy and that excess risk of CV death is the largest contributor to this premature mortality (Abuabara et al, 2010;Gelfand et al, 2011) …”

Section: Cardiovascular Diseasementioning

confidence: 99%

Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many Comorbities – Clinical Remission with a Leishmania Amastigotes Vaccine, a Serendipity Finding

O'Daly¹

2012

Psoriasis - A Systemic Disease

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Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K.

Abstract: Background-Severe psoriasis is associated with excess mortality and increased risk of cardiovascular death. Population-based data evaluating cause-specific mortality in patients with psoriasis are limited.

Cited by 395 publications

References 54 publications

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

Psoriasis, a Systemic Disease Beyond the Skin, as Evidenced by Psoriatic Arthritis and Many Comorbities – Clinical Remission with a Leishmania Amastigotes Vaccine, a Serendipity Finding

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