Psoriasis and the Risk of Major Cardiovascular Events: Cohort Study Using the Clinical Practice Research Datalink.
The association between psoriasis and risk of major cardiovascular (CV) events (myocardial infarction, acute coronary syndrome, unstable angina, and stroke) is unclear. A cohort study with 48,523 patients with psoriasis and 208,187 controls was conducted. During a median follow-up of 5.2 years, 1,257 patients with psoriasis (2.59%) had a major CV event, compared with 4,784 controls (2.30%). In the multivariable analysis, inflammatory arthritis hazard ratio (HR) 1.36 (1.18-1.58), diabetes HR 1.18 (1.06-1.31), chronic kidney disease HR 1.18 (1.07-1.31), hypertension HR 1.37 (1.29-1.45), transient ischemic attack HR 2.74 (2.41-3.12), atrial fibrillation HR 1.54 (1.36-1.73), valvular heart disease HR 1.23 (1.05-1.44), thromboembolism 1.32 (1.17-1.49), congestive heart failure HR 1.57 (1.39-1.78), depression HR 1.16 (1.01-1.34), current smoker HR 2.18 (2.03-2.33), age (year) HR 1.07 (1.07-1.07), and male gender HR 1.83 (1.69-1.98) were statistically significant for the risk of major CV events. The age- and gender-adjusted HRs of a major CV event for psoriasis were 1.10 (1.04-1.17) and for severe psoriasis 1.40 (1.07-1.84), whereas the fully adjusted HRs were attenuated to 1.02 (0.95-1.08) and 1.28 (0.96-1.69). In conclusion, neither psoriasis nor severe psoriasis were associated with the short-to-medium term (over 3-5 years) risk of major CV events after adjusting for known cardiovascular disease risk factors.
Centre for Pharmacoepidemiology & Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK.
Rosa
R
Parisi
Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Endocrinology and Diabetes Research Group, Institute of Human Development, University of Manchester, Manchester, UK.
Martin K
MK
Rutter
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
Mark
M
Lunt
The Dermatology Research Centre, Salford Royal Hospital, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
Helen S
HS
Young
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Deborah P M
DPM
Symmons
The Dermatology Research Centre, Salford Royal Hospital, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
Christopher E M
CEM
Griffiths
Centre for Pharmacoepidemiology & Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK. Electronic address: darren.ashcroft@manchester.ac.uk.
Darren M
DM
Ashcroft
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016019:Survival Analysis; D055815:Young Adult