American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Attributable Risk Estimate of Severe Psoriasis on Major Cardiovascular Events

Patients with severe psoriasis have an additional 6.2% absolute risk of major adverse cardiac events compared to the general population. This finding could have important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis.

Abstract

Background
Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis.

Methods
We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N=3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N=14,330).

Results
Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events.

Conclusion
Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.

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— Nehal N. Mehta, MD, MSCE, FAHA, YiDing Yu, BA, Rebecca Pinnelas, BS, Parasuram Krishnamoorthy, MD, Daniel B. Shin, BA, Andrea B. Troxel, ScD, Joel M. Gelfand, MD, MSCE

This article originally appeared in the August 2011 issue of The American Journal of Medicine.

 

One Response to “Attributable Risk Estimate of Severe Psoriasis on Major Cardiovascular Events”

  1. Thanks for the comment. In our experience in Preventive Cardiology, these young patients with moderate to severe psoriasis all are found to be at the high end of a low risk Framingham score (e.g. 7-9%). Thus, by adding this AR of psoriasis of 6%, we see them fall into the intermediate risk category. Of these, about 5-10% will go on statins, however, all will get aggressive deit and lifestyl guidance from our dietician. The main purpose of this paper was to increase awareness to the providers as well as patients so that awareness of this increased risk of vascular disease is more quantifiable than just an “emerging risk factor” as ATP III states.

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