Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

Abstract

Objective. The magnitude of the cardiovascular risk from psoriasis and psoriatic arthritis is debated. We therefore investigated the psoriasis-related risk of adverse cardiovascular events and mortality.Design, setting and subjects. We conducted a cohort study of the entire Danish population aged ‡18 years followed from 1997 to 2006 by individual-level linkage of nationwide registers. Psoriasis was defined by prescription claims and classified as severe if patients received hospital-based treatment. Time-dependent Poisson regression models were applied to assess cardiovascular risk in patients with psoriasis and psoriatic arthritis.Main outcome measures. All-cause mortality, cardiovascular mortality and hospitalizations for myocardial infarction (MI), stroke and coronary revascularization were recorded.Results. A total of 34 371 patients with mild psoriasis and 2621 with severe psoriasis, including 607 with psoriatic arthritis, were identified and compared with 4 003 265 controls. The event rates and rate ratios (RRs) of all-cause mortality, cardiovascular death, MI, coronary revascularization, stroke and a composite of MI, stroke and cardiovascular death were increased in patients with psoriasis. The rate ratio increased with disease severity and decreased with age of onset. The overall RRs for the composite endpoint were 1.20 (95% confidence interval [CI] 1.14-1.25) and 1.58 (95% CI 1.36-1.82) for mild and severe psoriasis, respectively. The corresponding RRs for cardiovascular death were 1.14 (95% CI 1.06-1.22) and 1.57 (95% CI1.27-1.94). The risk was similar in patients with severe skin affection alone and those with psoriatic arthritis.Conclusions. Psoriasis is associated with increased risk of adverse cardiovascular events and all-cause mortality. Young age, severe skin affection and ⁄ or psoriatic arthritis carry the most risk. Patients with psoriasis may be candidates for early cardiovascular risk factor modification.

Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After Childbirth

“…It is a subject of debate whether obesity should be regarded an independent risk factor [19][20][21][22] or a marker of an unhealthy, inactive life style 23 and metabolic disturbances, such as impaired glucose metabolism and initial stages of dyslipidemia and hypertension. The latter emphasizes that although BMI might not improve prediction of cardiovascular disease risk independently, it is a major determinant of the intermediate cardiovascular risk factors.…”

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…Patients with rheumatoid arthritis (RA) and other chronic inflammatory disorders (eg, psoriasis and inflammatory bowel disease) suffer considerably increased cardiovascular morbidity and mortality when compared with the background population 1, 2, 3, 4, 5. In patients with RA, the excess cardiovascular disease risk appears to be comparable with that found in patients with type 2 diabetes mellitus 6, 7.…”

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

“…The RRs increased with disease severity and decreased with age of onset. The risk was similar in patients with severe skin affection alone and those with PsA (Ahlehoff et al, 2010). Patients with psoriasis have an increased prevalence of major cardiovascular (CV) risk factors and a clinically significant increased risk of myocardial infarction, stroke, and CV death that is independent of conventional risk factors (Gelfand et al, 2011).…”

“…Two recent studies have added to this previously summarized literature. First, Ahlehoff et al (2010), in a nationwide Danish study of 34,371 people with mild psoriasis and 2,621 with severe psoriasis, demonstrated independent risk ratios (RRs) for CV death of 1.14 and 1.57 respectively, with the greatest increase in young people ages 18-50, RR 2.98, with severe disease. 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.…”