(Philadelphia, PA) - Psoriasis is an independent
risk factor for myocardial infarction (MI; heart attack), and this
risk is greatest in young patients with severe psoriasis, according
to Joel M. Gelfand, MD, MSCE, Assistant Professor
of Dermatology, University of Pennsylvania School of Medicine,
and lead author of the study that appears in the October 11 issue
of The Journal of the American Medical Association (JAMA).
Psoriasis is a common, chronic immune-mediated disease that affects
about 2% to 3% of the population. The disease is associated with
markers of systemic inflammation, and the immunological abnormalities
that lead to the development of psoriasis suggest that these patients
may be at increased risk for other diseases associated with an inflammatory
“Several hospital-based studies have indicated that psoriasis
is associated with a higher prevalence of cardiovascular diseases,
including MI,” said Gelfand. “However, these studies
did not control for any associated risk factors for MI.”
Gelfand and colleagues conducted a perspective population-based
cohort study to determine the risk of heart attack in patients with
psoriasis when controlling for major cardiovascular risk factors.
The study data was collected from 1988-2002 by more than 500 general
practitioners in the United Kingdom who were unaware of the hypothesis
being tested. The data was collected as part of the patient’s
electronic medial record and maintained in the General Practice
The study population consisted of psoriasis patients aged 20-90.
Among these patients, 127,139 were defined as having mild psoriasis
and 3,831 patients were defined as having severe psoriasis. Adjustments
were made for hypertension, diabetes, history of heart attack, hyperlipidemia
(an excess of fats or lipids in the blood), age, sex, smoking, and
body mass index. Each patient was matched to up to five control
subjects who did not have psoriasis. These 556,995 control subjects
were seen in the same practice during similar time periods.
The study revealed that the incidence of heart attack was higher
in patients with severe psoriasis (5.13 MIs per 1,000 person-years)
and mild psoriasis (4.04 MIs per 1,000 person-years) compared with
control patients (3.58 MIs per 1,000 person-years). Younger patients
with severe psoriasis had the highest relative risk of heart attack.
For example, a 40-year-old patient with mild psoriasis had a 20
percent greater risk of having a heart attack than a patient without
psoriasis; a 40-year-old patient with severe psoriasis had more
than double the risk. A 60-year-old patient with severe psoriasis
had a 36 percent increased risk for heart attack. The authors write
that the magnitude of association between severe psoriasis and MI
in those less than 50 years of age is similar to the magnitude of
association for other major cardiac risk factors.
“Our findings are novel and therefore it is important that
additional studies be performed to confirm these results and determine
their therapeutic implications,” write the authors. They recommend
that in the meantime, as part of good medical care, patients with
psoriasis should be encouraged to aggressively address their modifiable
cardiovascular risk factors.
This study was supported by a grant from the National Institutes
of Health/National Institute of Arthritis and Musculoskeletal and
Skin Diseases and an unrestricted grant to the Trustees of the University
of Pennsylvania from Biogen Idec.
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