Adults with psoriasis, especially younger patients with severe psoriasis, appear to be at increased risk for a heart attack, according to a study in the October 11 issue of JAMA.
Psoriasis is a common, chronic, disease that affects about 2 percent to 3 percent of the adult population. It is associated with markers of systemic inflammation, such as increased C-reactive protein levels, which have been linked to the development of atherosclerosis and myocardial infarction (MI; heart attack), according to background information in the article. Several hospital-based studies have indicated that psoriasis is associated with a higher prevalence of cardiovascular diseases, including heart attack, but these studies did not control for major cardiovascular risk factors.
Joel M. Gelfand, M.D., M.S.C.E., and colleagues from the University of Pennsylvania, Philadelphia, 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, which included a total of 556,995 control patients, and patients with mild (n = 127,139) and severe psoriasis (n = 3,837), compared outcomes among patients with and without a diagnosis of psoriasis. The patients, living in the United Kingdom, were 20 to 90 years of age. 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. Up to five controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis.
The researchers found 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), with patients who were younger and had severe psoriasis having the highest rate. For example, a 30-year-old patient with mild psoriasis had a 29 percent greater risk of having a heart attack than a patient without psoriasis; a 30-year-old patient with severe psoriasis had about three times the risk. A 60-year-old patient with severe psoriasis had a 36 percent increased risk for heart attack.
"The magnitude of association between severe psoriasis and MI in those patients younger than 50 years is similar to the magnitude of association for other major cardiac risk factors," the authors write.
"Our findings are novel and therefore it is important that additional studies be performed to confirm these results and determine their therapeutic implications. In particular, it is important to determine the impact of clinical markers of psoriasis activity, such as body surface area, as well as biomarkers of systemic inflammation (e.g., C-reactive protein) on the risk of MI in patients with psoriasis. In the meantime, as part of good medical care, patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors," the researchers conclude.