title: The risk of stroke in patients with psoriasis.
abstract: Psoriasis is a chronic Th-1 and Th-17 inflammatory disease. Chronic inflammation has also been associated with atherosclerosis and thrombosis. The purpose of this study was to determine the risk of stroke in patients with psoriasis. We conducted a population-based cohort study of patients seen by general practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002. Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0-1.1) and severe (1.43, 95% CI 1.1-1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively. Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
authors.affiliation: Department of Dermatology, University of Pennsylvania School of Medicine, Pennsylvania, PA 19104, USA. Joel.Gelfand@uphs.upenn.edu
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.forename: Erica D
authors.initials: ED
authors.lastname: Dommasch
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Shin
authors.forename: Rahat S
authors.initials: RS
authors.lastname: Azfar
authors.forename: Shanu K
authors.initials: SK
authors.lastname: Kurd
authors.forename: Xingmei
authors.initials: X
authors.lastname: Wang
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology