ATLANTA — Patients with psoriasis had a significantly increased risk for developing atrial fibrillation or need for coronary artery revascularization in a review of the entire Danish population during 1997-2006.
The report is the first to find a link between psoriasis and these two types of cardiovascular disease events, Dr. Ole Ahlehoff reported in two posters at the annual meeting of the American College of Cardiology.
The analysis also showed that patients with psoriasis had a significantly increased risk for ischemic stroke and, in those with severe psoriasis, for all-cause death.
The link between psoriasis and these events occurs “presumably because of inflammation” mediated by T helper cells, said Dr. Ahlehoff of the cardiology department at Copenhagen University Hospital Gentofte.
“We need to consider psoriasis patients as a group at increased risk” for cardiovascular disease events, he said in an interview. “The vast majority of patients with psoriasis probably meet criteria for [needing] weight loss and increased activity.” At the least, patients with psoriasis should reach blood pressure and lipid levels that meet goals for the general population, he said.
His study reviewed national registry records in Denmark during 1997-2006, which included roughly 4.5 million people aged 10 years or older. During the 10-year span, about 40,000 developed new-onset psoriasis, based on their filling at least two prescriptions for vitamin D, an agent used exclusively to treat psoriasis in Denmark. Dr. Ahlehoff estimated that about 80%-90% of the patients in this group had plaque psoriasis, with most of the rest having psoriatic arthritis. Among these 40,000, the researchers identified about 3,000 as having severe psoriasis, defined as patients hospitalized at least three times for psoriasis during the study period.
The analysis examined the incidence rate of all-cause death and several cardiovascular disease events during the study period in both the psoriasis patients and the rest of the Danish population, with an average follow-up of 5 years.
In an analysis that adjusted for a variety of clinical and demographic variables, including age, gender, calendar year, medications, comorbidities, and socioeconomic status, patients with severe psoriasis had a statistically significant 53% increased risk of all-cause death compared with the general population (see chart). Patients with severe psoriasis also had a statistically significant 88% increased risk for needing coronary artery revascularization, a significant 51% increased risk for developing atrial fibrillation, and a significant 58% increased risk for having an ischemic stroke. The increased stroke risk remained at that level when the analysis excluded patients with atrial fibrillation.
Patients with mild psoriasis also had significantly increased rates of coronary revascularization, atrial fibrillation, and ischemic stroke, although the magnitudes of the increased rates were not as high as in the severe patients.
The analysis also showed that the increased risk linked with psoriasis was magnified in patients who were younger than 50 at the time the study began. Younger adults with severe psoriasis had a twofold greater risk of atrial fibrillation, ischemic stroke, or need for coronary revascularization, compared with the general adult population.
Source Elsevier Global Medical News