Risk of myocardial infarction in patients with psoriasis.

CONTEXT Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors. OBJECTIVE To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors. DESIGN, SETTING, AND PATIENTS A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556,995 control patients and patients with mild (n = 127,139) and severe psoriasis (n = 3837) were identified. MAIN OUTCOME MEASURE Incident MI. RESULTS There were 11,194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively. CONCLUSIONS Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.

[1]  Daniel B. Shin,et al.  Prevalence of cardiovascular risk factors in patients with psoriasis. , 2022, Central European journal of public health.

[2]  S. Feldman,et al.  The skinny on psoriasis and obesity. , 2005, Archives of dermatology.

[3]  K. Leffondré,et al.  Relationship between smoking and the clinical severity of psoriasis. , 2005, Archives of dermatology.

[4]  Michael Hinckley,et al.  Impact of obesity and smoking on psoriasis presentation and management. , 2005, Archives of dermatology.

[5]  D. Margolis,et al.  Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. , 2005, Archives of dermatology.

[6]  R. Stern,et al.  Epidemiology of psoriatic arthritis in the population of the United States. , 2005, Journal of the American Academy of Dermatology.

[7]  L. Naldi,et al.  Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. , 2005, The Journal of investigative dermatology.

[8]  R. Frye,et al.  Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study , 2005, Arthritis research & therapy.

[9]  S. Gabriel,et al.  Cardiovascular death in rheumatoid arthritis: a population-based study. , 2005, Arthritis and rheumatism.

[10]  C. Griffiths,et al.  Psoriasis: epidemiology, clinical features, and quality of life , 2005, Annals of the rheumatic diseases.

[11]  A. Bowcock,et al.  Psoriasis pathophysiology: current concepts of pathogenesis , 2005, Annals of the rheumatic diseases.

[12]  S. Gabriel,et al.  Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. , 2005, Arthritis and rheumatism.

[13]  R. Kirsner,et al.  Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis. , 2005, Journal of the American Academy of Dermatology.

[14]  David J Margolis,et al.  Determinants of quality of life in patients with psoriasis: a study from the US population. , 2004, Journal of the American Academy of Dermatology.

[15]  Colleen Brensinger,et al.  Agreement between GPRD smoking data: a survey of general practitioners and a population‐based survey , 2004, Pharmacoepidemiology and drug safety.

[16]  F. Teixeira,et al.  The inflammatory response in mild and in severe psoriasis , 2004, The British journal of dermatology.

[17]  David J Margolis,et al.  Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. , 2004, The journal of investigative dermatology. Symposium proceedings.

[18]  G. Chodorowska,et al.  C‐reactive protein and α2‐macroglobulin plasma activity in medium–severe and severe psoriasis , 2004, Journal of the European Academy of Dermatology and Venereology : JEADV.

[19]  F. Granath,et al.  Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients , 2003, European Journal of Epidemiology.

[20]  D. Margolis,et al.  Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. , 2003, Archives of dermatology.

[21]  A. Alver,et al.  Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients. , 2003, Clinica chimica acta; international journal of clinical chemistry.

[22]  Corri Black,et al.  Validity of the General Practice Research Database , 2003, Pharmacotherapy.

[23]  M. Lebwohl,et al.  Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. , 2001, Journal of the American Academy of Dermatology.

[24]  S. Gabriel,et al.  The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. , 2000, The Journal of rheumatology.

[25]  E. Ford,et al.  Serum C-reactive protein and fibrinogen concentrations and self-reported angina pectoris and myocardial infarction: findings from National Health and Nutrition Examination Survey III. , 2000, Journal of clinical epidemiology.

[26]  D M Reboussin,et al.  Psoriasis causes as much disability as other major medical diseases. , 1999, Journal of the American Academy of Dermatology.

[27]  A. Gottlieb,et al.  Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. , 1998, Journal of the American Academy of Dermatology.

[28]  T. Walley,et al.  The UK General Practice Research Database , 1997, The Lancet.

[29]  A. Wahba-Yahav.  Disease concomitance in psoriasis. , 1996, Journal of the American Academy of Dermatology.

[30]  P. Hutchinson,et al.  Psoriasis in the community: prevalence, severity and patients' beliefs and attitudes towards the disease , 1996, The British journal of dermatology.

[31]  H. Jick,et al.  The Risk of Myocardial Infarction Associated with Antihypertensive Drug Treatment in Persons with Uncomplicated Essential Hypertension , 1996, Pharmacotherapy.

[32]  H Jick,et al.  Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. , 1991, BMJ.

[33]  E. Christophers,et al.  Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. , 1985, Journal of the American Academy of Dermatology.

[34]  N. Glorioso,et al.  High prevalence of cardiovascular diseases and enhanced activity of the renin-angiotensin system in psoriatic patients. , 1985, Acta cardiologica.

[35]  P. Calabresi,et al.  Complication of psoriasis. , 1973, JAMA.

[36]  P. Calabresi,et al.  Occlusive vascular disease in psoriatic patients. , 1973, The New England journal of medicine.