Prognosis following first-time myocardial infarction in patients with psoriasis: a Danish nationwide cohort study

Abstract

Objectives. The magnitude of cardiovascular risk associated with psoriasis has been debated and the prognostic impact of psoriasis following myocardial infarction (MI) is unknown. Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients with psoriasis following first-time MI.Design, setting and participants. Cohort study of the entire Danish population including all individuals who experienced first-time MI during the period [2002][2003][2004][2005][2006]. Multivariable Cox regression models were used to assess the post-MI prognostic impact of psoriasis.Main outcome measures. All-cause mortality and a composite cardiovascular end-point of recurrent MI, stroke and cardiovascular death.Results. A total of 462 patients with psoriasis and 48 935 controls (mean age 69.5 and 70.6 years, respectively) were identified with first-time MI during the study period. The mean follow-up was 19.5 months [standard deviation (SD) 16.5] for patients with psoriasis and 22 .0 months (SD 18.7) for those without psoriasis. Incidence rates (IRs) per 1000 patient-years for all-cause mortality were 119.4 [95% confidence interval (CI) 117.2-138.3] and 138.3 (95% CI 114.1-167.7) for patients without and with psoriasis, respectively, and the adjusted hazard ratio (HR) associated with psoriasis was 1.18 (95% CI 0.97-1.43). For the composite end-point, the IRs were 149.7 (95% CI 147.1-152.4) and 185.6 (95% CI 155.8-221.0) for patients without and with psoriasis, respectively, with an HR of 1.26 (95% CI 1.04-1.54) for patients with psoriasis.Conclusion. This first study of the impact of psoriasis on prognosis after first-time MI indicated a significantly impaired prognosis in patients with psoriasis. Further studies of this novel association are warranted.

Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity

“…No previous studies of post-MI prognosis in patients with IBD have been reported, but the association between IBD and worsened prognosis after MI is in line with findings in other chronic inflammatory diseases, including rheumatoid arthritis and psoriasis. 25,26 The observation of a relationship between adverse cardiovascular events and active stages of IBD further suggests that inflammation plays a central role in the association between IBD and atherothrombotic events. Indeed, the arterial and systemic immune-inflammatory processes implicated in atherosclerosis and atherothrombotic events bear many resemblances to the intestinal and systemic inflammation seen in active IBD.…”

Pregnancy Loss and Later Risk of Atherosclerotic Disease

“…The immune system and inflammatory mechanisms, including Th1-type inflammatory responses, appear to play a role in miscarriage, suggesting that pregnancy loss could resemble an autoimmune condition 16,17 ; several autoimmune conditions (inflammatory bowel disease, psoriasis, and rheumatoid arthritis) have recently been associated with an increased risk of atherosclerosis. [18][19][20] Atherosclerotic plaques on the endothelium contain active immune cells, including activated T cells and macrophages, along with signaling molecules promoting a Th1 response 21 ; endothelial dysfunction has been associated with previous miscarriages. 5 Consequently, inflammatory processes are good candidates for underlying, Figure. Incidence rate ratios (IRRs; y axis) with 95% confidence interval for each additional miscarriage (adjusted for calendar period and number of live births) by age in years (x axis) for myocardial infarction, cerebral infarction, and renovascular hypertension.…”

Effects of the Tumor Necrosis Factor-α Antagonist Adalimumab on Arterial Inflammation Assessed by Positron Emission Tomography in Patients With Psoriasis

“…Inflammatory diseases, such as psoriasis and rheumatoid arthritis, are now known to expose patients to an increased risk of myocardial infarction and stroke. [4][5][6][7] Psoriasis is a complex multi-systemic disease influenced by environmental and genetic factors. It is characterized by expansion of Th1, Th17, and Th22 cells resulting in significant inflammation at the skin and joint levels.…”

“…[4][5][6][7] Psoriasis treatments include topical corticosteroids, vitamin D analogs and phototherapy and also systemic anti-inflammatory agents, such as methotrexate, cyclosporin, or biological agents targeting tumor necrosis factor-α (TNF-α) or interleukin (IL)-12/IL-23. 8 These systemic agents all have a profound effect on skin and joint inflammation.…”