Psoriasis and the Risk of Major Cardiovascular Events: Cohort Study Using the Clinical Practice Research Datalink

Abstract

The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarction, acute coronary syndrome, unstable angina, and stroke) is unclear. A cohort study with 48,523 patients with psoriasis and 208,187 controls was conducted. During a median follow-up of 5.2 years, 1,257 patients with psoriasis (2.59%) had a major CV event, compared with 4,784 controls (2.30%). In the multivariable analysis, inflammatory arthritis hazard ratio (HR) 1.36 (1.18-1.58), diabetes HR 1.18 (1.06-1.31), chronic kidney disease HR 1.18 (1.07-1.31), hypertension HR 1.37 (1.29-1.45), transient ischemic attack HR 2.74 (2.41-3.12), atrial fibrillation HR 1.54 (1.36-1.73), valvular heart disease HR 1.23 (1.05-1.44), thromboembolism 1.32 (1.17-1.49), congestive heart failure HR 1.57 (1.39-1.78), depression HR 1.16 (1.01-1.34), current smoker HR 2.18 (2.03-2.33), age (year) HR 1.07 (1.07-1.07), and male gender HR 1.83 (1.69-1.98) were statistically significant for the risk of major CV events. The age- and gender-adjusted HRs of a major CV event for psoriasis were 1.10 (1.04-1.17) and for severe psoriasis 1.40 (1.07-1.84), whereas the fully adjusted HRs were attenuated to 1.02 (0.95-1.08) and 1.28 (0.96-1.69). In conclusion, neither psoriasis nor severe psoriasis were associated with the short-to-medium term (over 3-5 years) risk of major CV events after adjusting for known cardiovascular disease risk factors.

Cardiovascular risk factors predicting cardiac events are different in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis

“…Case definitions may also vary from study to study, for instance, previous studies using electronic health records have stratified patients using phototherapy and differing DMARDs as surrogate markers for disease severity which may not accurately classify the level of disease activity [25][26][27]. Patients must assess the benefits and risks to starting treatments, in particular, systemic and biologic therapies which may cause adverse effects.…”

“…Two inception cohorts using the Clinical Practice Research Datalink have provided opposing results; Parisi et al [25] found no increased risk of major cardiovascular events while Degran et al [26] reported an increased risk for severe psoriasis patients.…”

Comorbidities in psoriasis: The recognition of psoriasis as a systemic disease and current management

“…Besides, there are also controversial results from other studies. Certain studies found equal cardiovascular risk with general population 47 . However, current guideline by the European Cardiology Association and international psoriasis organizations recognize the psoriasis as a condition increasing cardiovascular risk and suggests that patients should be managed also in this respect [48][49][50][51][52] .…”

Management of Psoriasis

“…Ancak son yıllarda, obezite, metabolik sendrom, nonalkolik yağlı karaciğer hastalığı ve kardiyovasküler hastalık (KVH) riskinin de artmış olduğu ve bunun hastalık şiddetiyle ilişkili olduğunu destekleyen veriler mevcuttur (13)(14)(15)(16)(17)(18)(19)(20).…”

“…Bu varsayımı doğrulamaya yönelik, çok sayıda, farklı yöntemlerle gerçekleştirilmiş araştırma vardır. Araştırmalardan elde edilen veriler çelişkili olup, bazılarında psoriatik inflamasyonun bağımsız bir risk faktörü oluşturarak KVH riskini arttırdığı, kalp krizine bağlı ölümün özellikle genç sedef hastalarında daha fazla olduğu ve yaşam beklentisinin, şiddetli sedefli bireylerde daha kısa (erkeklerde 4,4, kadınlarda 3,5 yıl) olduğu saptanmıştır (13)(14)(15)(30)(31)(32). Bazı çalışmalarda ise tüm risk faktörleri eşleştirilerek analiz yapıldığında kardiyovasküler riskin toplumla eş olduğu görülmüştür (33)…”