title: Psoriasis and risk of nonfatal cardiovascular disease in U.S. women: a cohort study.
abstract: BACKGROUND
  Psoriasis has been linked to cardiovascular comorbidities in cross-sectional studies, but evidence regarding the association between psoriasis and incident cardiovascular disease (CVD) is limited.
  
  
  OBJECTIVE
  To make a prospective evaluation of the association between psoriasis and risk of incident nonfatal CVD.
  
  
  METHODS
  Participants (n = 96, 008) were included from the Nurses' Health Study II, and followed for 18 years. Information on physician-diagnosed psoriasis was obtained by self-report and diagnosis was confirmed by supplementary questionnaires. We included 2463 individuals with self-reported psoriasis and a subsample of 1242 with validated psoriasis. The main outcome was incident nonfatal CVD events [nonfatal myocardial infarction (MI) and nonfatal stroke], ascertained by biennial questionnaires and confirmed.
  
  
  RESULTS
  During 1 709 069 person-years of follow-up, 713 incident nonfatal CVD events were confirmed. Psoriasis was associated with a significantly increased multivariate-adjusted hazard ratio (HR) of nonfatal CVD, 1·55 [95% confidence interval (CI): 1·04-2·31]. HRs for nonfatal MI and stroke were 1·70 (95% CI: 1·01-2·84) and 1·45 (95% CI: 0·80-2·65), respectively. The association remained consistent in a sensitivity analysis of confirmed psoriasis (HR: 2·06, 95% CI: 1·31-3·26). For individuals with concomitant psoriatic arthritis, the risk of nonfatal CVD was even higher (HR: 3·47; 95% CI: 1·85-6·51). Women diagnosed with psoriasis at < 40 years of age or with duration of psoriasis ≥ 9 years had substantial elevations in CVD risk: HR: 3·26 (95% CI: 1·21-8·75) and 3·09 (95% CI: 1·15-8·29), respectively.
  
  
  CONCLUSIONS
  Psoriasis is an independent predictor for nonfatal CVD among women, with particularly high risk for those with longer duration of psoriasis and concomitant psoriatic arthritis.
authors.affiliation: Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: W-Q
authors.initials: WQ
authors.lastname: Li
authors.forename: J-L
authors.initials: JL
authors.lastname: Han
authors.forename: J E
authors.initials: JE
authors.lastname: Manson
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.forename: K M
authors.initials: KM
authors.lastname: Rexrode
authors.forename: G C
authors.initials: GC
authors.lastname: Curhan
authors.forename: A A
authors.initials: AA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D011565:Psoriasis / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology