Duration of mild or moderate psoriasis had an influence on the risk of major acute coronary events (MACE) over time, a cohort and population study together showed.
Based on imaging study results and observational registry data, investigators found that for each additional year of disease duration, there was a 1% increase in the risk of cardiovascular disease (CVD) events — “an effect size similar to that of smoking,” reported Alexander Egeberg, MD, PhD, University of Copenhagen, and colleagues in the Journal of the American Academy of Dermatology.
Moreover, the longer the duration of disease, the greater the risk of each of the components of the composite outcome of myocardial infarction (MI), ischemic stroke, and death from cardiovascular causes, they added.
“We have provided novel and convincing evidence to suggest a detrimental effect of psoriasis duration on CVD beyond traditional CV risk factors, even in patients with low CV risk scores,” investigators stated. “Providers should consider inquiring about the duration of psoriasis when assessing CV risk stratification.”
It has been previously reported that CV risk factors are common in patients with inflammatory diseases including rheumatoid arthritis, psoriatic arthritis, and psoriasis and that the patients require monitoring for underlying risk factors and treatment as indicated.
The longitudinal cohort involved 190 young patients in a National Institutes of Health investigation. The participants had a low risk for CVD based on traditional CV risk scores, and all had 18F-PET/CT imaging to quantify vascular inflammation.
The data showed that duration of psoriasis was associated with increased vascular inflammation and persisted after adjustment for traditional CV risk factors (P=0.002).
Every standard deviation increase in disease duration increased the target-to-background ratio by 2.5%, which translated into an absolute increase of about 10% in future adverse events, the researchers reported.
The population cohort consisted of all Danish citizens 18 or older. Investigators found 87,161 of 4,321,954 people had psoriasis. The maximum duration of the disease in those with psoriasis in this population was 31.1 years.
During a mean follow-up of 4.7 years, 152,122 individuals in the general population experienced MACE for an incidence rate of 7.56 per 1,000 person-years. Among patients with psoriasis in the same cohort, the incidence rate of MACE per 1,000 person-years was 10.94.
In multivariable analysis, the risk of MACE increased by 1% per additional year of psoriasis duration, the authors reported.
For each MACE component, multivariable HRs associated with disease duration were:
• MI (HR 1.006, 95% CI, 1.001-1.012)
• Ischemic stroke (HR 1.011, 95% CI, 1.007-1.016)
• CV death (HR 1.011, 95% CI, 1.007-1.015)
Study limitations included lack of information about body mass index or physical activity, both of which could influence the risk of CVD events in patients with and without psoriasis.
Alan Menter, MD, of Baylor University Medical Center in Dallas, told MedPage Today that psoriasis arrived late to the systemic-disease arena, unlike Crohn’s disease and rheumatoid arthritis, which have been there for many years.
“But I think it’s finally been realized that we have to evaluate our patients very carefully with our cardiology colleagues,” said Menter. “I believe that all dermatologists who see psoriasis patients should now be taking a brief history of heart disease, particularly in patients with more moderate to severe psoriasis, because in addition to heart issues, we also have obesity issues, along with metabolic issues such as hypertension and liver disease, all of which are increased in our patients with psoriasis as well.”
Menter has worked closely with the senior author of the current study, Nehal Mehta, MD, of the University of Pennsylvania in Philadelphia, to identify cardiovascular issues in the psoriasis population. In one recent study, investigators found that the prevalence of moderate-to-severe coronary calcification was similar between patients with psoriasis and those with type 2 diabetes, and approximately five times greater than healthy controls.Full Article