Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study

Ahlehoff, Ole; Gislason, Gunnar; Jørgensen, Christoffer Calov; Lindhardsen, Jesper; Charlot, Mette; Olesen, Jonas Bjerring; Abildstrøm, Steen Zabell; Skov, Lone; Torp‐Pedersen, Christian; Hansen, Peter Riis

doi:10.1093/eurheartj/ehr285

Cited by 201 publications

(192 citation statements)

References 41 publications

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“…[1][2][3] Inflammatory bowel disease (IBD) is characterized by intestinal inflammation and periodical flares with increased disease activity, and along with other chronic inflammatory diseases, IBD has been linked to an increased risk of cardiovascular disease, including myocardial infarction, stroke, and atrial fibrillation. [4][5][6][7][8][9] Research has provided evidence that inflammatory activation plays a role in the development and progression of HF, and the prothrombotic state associated with inflammation has been suggested as a causal link between IBD and atherothrombosis. [10][11][12][13][14][15][16][17] In addition, intestinal inflammation in IBD, especially during flares, may contribute to the development of HF by translocation of bacterial lipopolysaccharides from the bowel to the circulatory system that elicit production of proinflammatory mediators and tissue injury including myocardial damage.…”

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confidence: 99%

Inflammatory Bowel Disease Is Associated With an Increased Risk of Hospitalization for Heart Failure

Kristensen

Ahlehoff

Lindhardsen

et al. 2014

Circ: Heart Failure

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Background-Inflammatory bowel disease (IBD) has been linked to adverse cardiovascular events, but a relation to heart failure (HF) is uncertain. We investigated the IBD-associated risk of HF in a nationwide setting. Methods and Results-A total of 5 436 647 Danish citizens, with no history of IBD or HF, were included on January 1, 1997, and followed up until first hospitalization for HF, death, or December 31, 2011. Of these subjects, 23 681 developed IBD for which disease activity was determined continuously throughout the study. The risk of hospitalization for HF was estimated with a Poisson regression model adjusting for comorbidity and cardiovascular pharmacotherapy as timedependent covariates. During a mean follow-up of 11.8 years in the reference population and 6.4 years in the IBD group, hospitalization for HF occurred in 553 subjects with IBD and 171 405 in the reference population. Patients with IBD had a 37% increased risk of hospitalization for HF (incidence rate ratio, 1.37; 95% confidence interval, 1.26-1.49) compared with the reference population. IBD activity-specific analyses showed markedly increased risk of HF hospitalization during flares (incidence rate ratio, 2.54; 95% confidence interval, 2.13-3.04) and persistent activity (incidence rate ratio, 2.73; 95% confidence interval, 2.25-3.33) but not in IBD remission (incidence rate ratio, 1.04; 95% confidence interval, 0.94-1.16). Conclusions-In a nationwide cohort, IBD was associated with an increased risk of hospitalization for HF, and this risk was strongly correlated to periods of active disease. The mechanisms underlying this finding warrant further studies.(Circ Heart Fail. 2014;7:717-722.)

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Inflammatory Bowel Disease Is Associated With an Increased Risk of Hospitalization for Heart Failure

Kristensen

Ahlehoff

Lindhardsen

et al. 2014

Circ: Heart Failure

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“…Also, given the large sample size, the impact of such misclassification is likely to be small. 41 Furthermore, the registries used in the study lacked information on important clinical parameters such as smoking status. Therefore, as a proxy for smoking, we used information on diagnoses of smoking, tobacco use, chronic obstructive lung disease, lung cancer, and pharmacological treatment for smoking cessation.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

“…In this validation analysis, vitamin D derivatives were found to be the preferred first-line treatment for 73% of the patients with psoriasis. 41 Although the results cannot be generalized to the patients who were not captured by our criteria for mild psoriasis, these patients would have been misclassified as controls and hence bias our estimates toward the null hypothesis. Also, given the large sample size, the impact of such misclassification is likely to be small.…”

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confidence: 90%

Nationwide Study on the Risk of Abdominal Aortic Aneurysms in Patients With Psoriasis

Khalid

Egeberg

Ahlehoff

et al. 2016

ATVB

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Objective-Abdominal aortic aneurysm (AAA) is a complex multifactorial disease associated with a high morbidity and mortality. Increased inflammation including T-helper 17 cell-mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a T-helper 17-driven chronic inflammatory disease and in view of potentially overlapping inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a nationwide cohort. Approach and Results-The study comprised all Danish residents aged ≥18 years followed up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AAA were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications, socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5 495 203 subjects were eligible for analysis. During the study period, we identified 59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis. The overall incidence rates of AAA were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The corresponding adjusted incidence rate ratios for AAA were increased in patients with psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.03-1.39) and 1.67 (confidence interval, 1.21-2.32) for subjects with mild and severe disease, respectively. Conclusions-In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AAA.The mechanisms and consequences of this novel finding require further investigation. Figure, and baseline characteristics for the study population are presented in Table 1. Risk of AAA in Patients With PsoriasisThe results showed a disease-severity-dependent association between psoriasis and AAA ( Sensitivity AnalysesCensoring of patients who developed atherosclerotic disease during the study and exclusion of patients with atherosclerotic disease before the study start did not alter the risk of AAA in psoriasis patients ( DiscussionIn this retrospective cohort study of the Danish population, we found an increased risk of AAA in patients with psoriasis, independent of traditional cardiovascular risk factors. Notably, the observed risk increased with increasing severity of psoriasis. The results were supported by the sensitivity analyses. To our knowledge, this is the first study to assess the risk of AAA in patients with psoriasis in a nationwide setting. These results may warrant the need for increased awareness on higher risk of AAA in patients with severe psoriasis. Psoriasis is a chronic immune-mediated inflammatory disease associated with cardiometabolic comorbidities. 13,14,17,18 Although it is well-established that psoriasis is an independent risk factor for atherosclerotic disease and persi...

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“…In patients with PASI scores >20, 69.3% had low risk of stroke, 19.8% had intermediate risk of stroke, and 10.9% had high risk of stroke. Ahlehoff et al [5] also have shown that patients with psoriasis were at increased risk of disease severity-dependent ischemic stroke, with RRs of 1.97 (95% CI, 1.66-2.34) and 2.80 (95% CI, 1.81-4.34) in patients aged <50 years with mild and severe psoriasis, and RRs of 1.13 (95% CI, 1.04-1.21) and 1.34 (95% CI, 1.04-1.71) in patients aged ≥50 years with mild and severe psoriasis, respectively.…”

Section: Strokementioning

confidence: 99%

“…Ahlehoff et al [5] have shown that psoriasis is associated with increased risk of AF, as patients with mild psoriasis had a higher risk of AF with adjusted rate ratios of 1.50 (95% CI, 1.21-1.86) and 1.16 (95% CI, 1.08-1.24) in patients aged <50 years and ≥50 years, respectively. Patients with severe psoriasis had a higher risk of AF, with rate ratios of 2.98 (95% CI, 1.80-4.34) in patients aged <50 years and 1.29 (95% CI, 1.01-1.65) in patients ≥50 years.…”

Section: Introductionmentioning

confidence: 99%

A Review of the Epidemiology of Cardiovascular Comorbidities in Psoriasis

Lee

2012

Curr Derm Rep

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Several epidemiologic studies suggest that there is an association between psoriasis and cardiovascular comorbidities, possibly due to overall systemic inflammation. Psoriasis is an independent risk factor for cardiovascular disease and mortality that is also associated with many of the traditional cardiovascular risk factors. This article summarizes important studies that demonstrate an association between psoriasis with smoking and alcohol intake, as well as increased risk of psoriasis patients for atrial fibrillation, atherosclerosis, coronary artery calcification, type 2 diabetes, dyslipidemia, hypertension, metabolic syndrome, obesity, peripheral vascular disease, myocardial infarction, stroke, and cardiac death.

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Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study

Abstract: Psoriasis is associated with increased risk of AF and ischaemic stroke. These novel results add to a growing body of evidence, suggesting that patients with psoriasis could be considered at increased cardiovascular risk.

Cited by 201 publications

References 41 publications

Inflammatory Bowel Disease Is Associated With an Increased Risk of Hospitalization for Heart Failure

Inflammatory Bowel Disease Is Associated With an Increased Risk of Hospitalization for Heart Failure

Nationwide Study on the Risk of Abdominal Aortic Aneurysms in Patients With Psoriasis

A Review of the Epidemiology of Cardiovascular Comorbidities in Psoriasis

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