Risk Factors for Myocardial Infarction in Patients With Psoriasis
Risk Factors for Myocardial Infarction in Patients With Psoriasis
Background: Recent cross-sectional studies reported a higher prevalence of diabetes and other risk factors for cardiovascular disease in patients with psoriasis than in the general population.
Objectives: To estimate the cumulative incidences of risk factors for myocardial infarction and other vascular diseases after a first recorded diagnosis of psoriasis and the hazard ratio (HR) for these conditions in patients with psoriasis compared with the general population.
Methods: We used the General Practice Research Database to conduct a cohort study of 44 164 patients with a first-time diagnosis of psoriasis and 219 784 nonpsoriasis comparison subjects psoriasis-matched on age, sex and index date.
Results: HRs were increased among patients with psoriasis vs. the comparison cohort for incident diabetes [HR 1·33; 95% confidence interval (CI) 1·25-1·42], hypertension (HR 1·09; 95% CI 1·05-1·14), obesity (HR 1·18; 95% CI 1·14-1·23) and hyperlipidaemia (HR 1·17; 95% CI 1·11-1·23). Patients with psoriasis also had higher risks of incident myocardial infarction (HR 1·21; 95% CI 1·10-1·32), angina (HR 1·20; 95% CI 1·12-1·29), atherosclerosis (HR 1·28; 95% CI 1·10-1·48), peripheral vascular disease (HR 1·29; 95% CI 1·13-1·47) and stroke (HR 1·12; 95% CI 1·00-1·25).
Conclusions: Risk factors for cardiovascular disease as well as myocardial infarction and other vascular diseases occur with higher incidence in patients with psoriasis than in the general population. Further work is needed to investigate whether these associations involve causal factors related to psoriasis or its treatment.
Gelfand et al. recently reported the results of an observational study which suggested that psoriasis may confer an independent risk of myocardial infarction (MI). Moreover, the same investigators and others have published studies which found a higher prevalence of risk factors for ischaemic heart disease and other atherosclerotic vascular diseases among patients with psoriasis than among the general population. Potential biological mechanisms for these associations have been postulated which involve genetic differences, increased production of inflammatory mediators among patients with psoriasis, other environmental exposures possibly associated with psoriasis, and behavioural factors. Because prevalence studies, which are often cross-sectional, do not delineate the time sequence of the occurrence of the illnesses being evaluated, such studies are less useful for identifying possibly causal relationships than incidence studies, which focus on the time of onset of the diseases of interest. Moreover, prevalence estimates confound incidence and duration of illness, which may further obscure aetiological relationships.
In order to begin to understand whether causal relations between psoriasis and risk factors for MI are plausible, we conducted an observational study using the same database studied by Gelfand et al., namely the General Practice Research Database (GPRD). We restricted our attention to risk factors for MI that were diagnosed for the first time following a diagnosis of psoriasis, and we evaluated the time course of the incidence of these risk factors in patients with psoriasis compared with the general population. We also studied the incidence of MI and other cardiovascular diseases after a first diagnosis of psoriasis.
Background: Recent cross-sectional studies reported a higher prevalence of diabetes and other risk factors for cardiovascular disease in patients with psoriasis than in the general population.
Objectives: To estimate the cumulative incidences of risk factors for myocardial infarction and other vascular diseases after a first recorded diagnosis of psoriasis and the hazard ratio (HR) for these conditions in patients with psoriasis compared with the general population.
Methods: We used the General Practice Research Database to conduct a cohort study of 44 164 patients with a first-time diagnosis of psoriasis and 219 784 nonpsoriasis comparison subjects psoriasis-matched on age, sex and index date.
Results: HRs were increased among patients with psoriasis vs. the comparison cohort for incident diabetes [HR 1·33; 95% confidence interval (CI) 1·25-1·42], hypertension (HR 1·09; 95% CI 1·05-1·14), obesity (HR 1·18; 95% CI 1·14-1·23) and hyperlipidaemia (HR 1·17; 95% CI 1·11-1·23). Patients with psoriasis also had higher risks of incident myocardial infarction (HR 1·21; 95% CI 1·10-1·32), angina (HR 1·20; 95% CI 1·12-1·29), atherosclerosis (HR 1·28; 95% CI 1·10-1·48), peripheral vascular disease (HR 1·29; 95% CI 1·13-1·47) and stroke (HR 1·12; 95% CI 1·00-1·25).
Conclusions: Risk factors for cardiovascular disease as well as myocardial infarction and other vascular diseases occur with higher incidence in patients with psoriasis than in the general population. Further work is needed to investigate whether these associations involve causal factors related to psoriasis or its treatment.
Gelfand et al. recently reported the results of an observational study which suggested that psoriasis may confer an independent risk of myocardial infarction (MI). Moreover, the same investigators and others have published studies which found a higher prevalence of risk factors for ischaemic heart disease and other atherosclerotic vascular diseases among patients with psoriasis than among the general population. Potential biological mechanisms for these associations have been postulated which involve genetic differences, increased production of inflammatory mediators among patients with psoriasis, other environmental exposures possibly associated with psoriasis, and behavioural factors. Because prevalence studies, which are often cross-sectional, do not delineate the time sequence of the occurrence of the illnesses being evaluated, such studies are less useful for identifying possibly causal relationships than incidence studies, which focus on the time of onset of the diseases of interest. Moreover, prevalence estimates confound incidence and duration of illness, which may further obscure aetiological relationships.
In order to begin to understand whether causal relations between psoriasis and risk factors for MI are plausible, we conducted an observational study using the same database studied by Gelfand et al., namely the General Practice Research Database (GPRD). We restricted our attention to risk factors for MI that were diagnosed for the first time following a diagnosis of psoriasis, and we evaluated the time course of the incidence of these risk factors in patients with psoriasis compared with the general population. We also studied the incidence of MI and other cardiovascular diseases after a first diagnosis of psoriasis.