title: Attributable risk estimate of severe psoriasis on major cardiovascular events.
abstract: BACKGROUND
  Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis.
  
  
  METHODS
  We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N=3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N=14,330).
  
  
  RESULTS
  Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events.
  
  
  CONCLUSIONS
  Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.
authors.affiliation: Preventive Cardiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA. Nehal.Mehta@uphs.upenn.edu
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
authors.forename: YiDing
authors.initials: Y
authors.lastname: Yu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pinnelas
authors.forename: Parasuram
authors.initials: P
authors.lastname: Krishnamoorthy
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Shin
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 / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000150:complications; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications* / Q000453:epidemiology; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology