title: Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database.
abstract: OBJECTIVE
  Psoriasis is a common chronic inflammatory T-helper cell-1/17 mediated skin disease. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI), and stroke. We conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular (CV) mortality.
  
  
  RESULTS
  Severe psoriasis was defined as patients who received a psoriasis diagnosis and systemic therapy consistent with severe psoriasis (n = 3603). Up to four unexposed patients without psoriasis were selected from the same practices and start dates for each psoriasis patient (n = 14 330). For every death, the cause was determined by review of the electronic medical record. Severe psoriasis was an independent risk factor for CV mortality (HR 1.57; 95% CI 1.26, 1.96) when adjusting for age, sex, smoking, diabetes, hypertension, and hyperlipidaemia. Overall, severe psoriasis patients experienced one extra CV death per 283 patients per year, even when adjusting for major CV risk factors. The relative risk of CV mortality was modified by age. For example, the RR of CV death for a 40-year-old and 60-year-old with severe psoriasis was 2.69 (1.45, 4.99) and 1.92 (1.41, 2.62), respectively. The findings were robust to multiple sensitivity analyses.
  
  
  CONCLUSIONS
  Patients with severe psoriasis have an increased risk of CV mortality that is independent of traditional CV risk factors. Additional studies are needed to determine the mechanism of this association and the impact that control of psoriasis has on CV risk.
authors.affiliation: Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
authors.forename: Rahat S
authors.initials: RS
authors.lastname: Azfar
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Shin
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Neimann
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003879:Dermatologic Agents