Psoriasis and the Risk for Major Cardiovascular Events

Summary and Comment |
June 5, 2015

Psoriasis and the Risk for Major Cardiovascular Events

  1. Jeffrey P. Callen, MD

Psoriasis is associated with other cardiovascular disease risk factors, but researchers concluded the disease itself does not increase risk.

  1. Jeffrey P. Callen, MD

In 2006, researchers suggested that psoriasis was a risk factor for myocardial infarction and other atherosclerotic disease. Subsequent investigators questioned whether psoriasis was an independent risk factor or merely associated via such comorbidities as obesity, hyperlipidemia, smoking, diabetes, and hypertension.

These authors used a large database to study 48,523 patients with psoriasis and 208,157 matched controls, who were followed until they had a first major cardiovascular (CV) event (myocardial infarction, stroke, unstable angina, or acute coronary syndrome), transferred out of the practice, or died, or until the study ended (average follow-up, 5.2 years).

Over the study period, 1257 psoriasis patients (2.59%) and 4784 controls (2.30%) had major CV events. In multivariant analysis, factors significantly associated with having such an event, listed from highest to lowest hazard ratio (range, 2.74–1.07), included transient ischemic attack, current smoker, male gender, congestive heart failure, atrial fibrillation, hypertension, inflammatory arthritis, valvular heart disease, diabetes, chronic kidney disease, depression, and age. HRs for psoriasis were 1.10 (1.04–1.17) and for severe psoriasis 1.40 (1.07–1.84); when fully adjusted, these HRs fell to 1.02 (0.95–1.08) and 1.28 (0.96–1.69), respectively. The authors conclude that no increased risk for major CV disease was associated with psoriasis over the relatively short time frame (3–5 years).

Comment

Study limitations include lack of a confirmatory dermatologist-rendered psoriasis diagnosis, the possibility that some interventions for severe psoriasis may modulate CV disease risk (e.g., methotrexate or tumor necrosis factor-α antagonist therapy), and the relatively short follow-up period (CV disease may take years of uncontrolled inflammation to develop).

Bottom line: Psoriasis is associated with obesity, the metabolic syndrome, and smoking, all of which are risk factors for development of CV disease. These are opportunities for intervention (e.g., weight loss, smoking cessation, lipid-lowering agents, diabetes control) that we should discuss with our patients. Such interventions might well result in improved health outcomes.

Editor Disclosures at Time of Publication

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board XOMA; Eli Lilly Equity Various trust accounts Editorial boards JAMA Dermatology; UpToDate; Journal of Rheumatology; Psoriasis Forum; Journal of Drugs in Dermatology; eMedicine Leadership positions in professional societies Association of Professors of Dermatology (President-Elect)

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Reader Comments (1)

Bogomir Dimitrijevic, PhD Other Healthcare Professional, Oncology, Institute for sciences VINCA

Thank you

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