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 link between psoriasis and these events occurs "presumably because of inflammation" mediated by T helper cells, said Dr. Ahlehoff, a research fellow at Copenhagen University Hospital Gentofte.
"Our study of nationwide data from an unselected cohort firmly establishes psoriasis as a clinically relevant risk factor for cardiovascular disease." His report added a new dimension to existing evidence because it "provides data from an independent cohort on a national scale that avoids selection bias," he said.
"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. The main point of our study is that physicians caring for patients with psoriasis should be more aware of possible cardiovascular disease risk" and "make sure that lifestyle changes occur, and that they screen for hypertension and lipidemia." At the least, patients with psoriasis should reach blood pressure and lipid levels that meet goals for the general population, he said.
"I personally feel that we're reaching the point where we need to reconsider how to manage patients with psoriasis" by giving greater consideration to "earlier risk factor intervention," such as statin therapy, Dr. Ahlehoff added. He admitted that this type of approach cannot be based on results from a single epidemiologic study, such as his presentation, but he noted that his findings are part of "mounting evidence" from several studies that psoriasis is a disease equivalent for cardiovascular disease, comparable to diabetes or rheumatoid arthritis. He also noted that other study results documented that statin treatment improves patients' psoriatic symptoms, further bolstering a link between the inflammatory processes involved in psoriasis and cardiovascular disease.
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 with a primary diagnosis of 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 variable, 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.
Dr. Ahlehoff said that he and his associates had no disclosures.