Penn researchers find psoriasis patients at increased risk for heart attack

Psoriasis is an independent risk factor for myocardial infarction (MI; heart attack), and this risk is greatest in young patients with severe psoriasis, according to Joel M. Gelfand, MD, MSCE, Assistant Professor of Dermatology, University of Pennsylvania School of Medicine, and lead author of the study that appears in the October 11 issue of The Journal of the American Medical Association (JAMA).

Psoriasis is a common, chronic immune-mediated disease that affects about 2% to 3% of the population. The disease is associated with markers of systemic inflammation, and the immunological abnormalities that lead to the development of psoriasis suggest that these patients may be at increased risk for other diseases associated with an inflammatory state.

“Several hospital-based studies have indicated that psoriasis is associated with a higher prevalence of cardiovascular diseases, including MI,” said Gelfand. “However, these studies did not control for any associated risk factors for MI.”

Gelfand and colleagues conducted a perspective population-based cohort study to determine the risk of heart attack in patients with psoriasis when controlling for major cardiovascular risk factors. The study data was collected from 1988-2002 by more than 500 general practitioners in the United Kingdom who were unaware of the hypothesis being tested.

The data was collected as part of the patient's electronic medial record and maintained in the General Practice Research Database.

The study population consisted of psoriasis patients aged 20-90. Among these patients, 127,139 were defined as having mild psoriasis and 3,831 patients were defined as having severe psoriasis. Adjustments were made for hypertension, diabetes, history of heart attack, hyperlipidemia (an excess of fats or lipids in the blood), age, sex, smoking, and body mass index. Each patient was matched to up to five control subjects who did not have psoriasis. These 556,995 control subjects were seen in the same practice during similar time periods.

The study revealed that the incidence of heart attack was higher in patients with severe psoriasis (5.13 MIs per 1,000 person-years) and mild psoriasis (4.04 MIs per 1,000 person-years) compared with control patients (3.58 MIs per 1,000 person-years). Younger patients with severe psoriasis had the highest relative risk of heart attack. For example, a 40-year-old patient with mild psoriasis had a 20 percent greater risk of having a heart attack than a patient without psoriasis; a 40-year-old patient with severe psoriasis had more than double the risk. A 60-year-old patient with severe psoriasis had a 36 percent increased risk for heart attack. The authors write that the magnitude of association between severe psoriasis and MI in those less than 50 years of age is similar to the magnitude of association for other major cardiac risk factors.

“Our findings are novel and therefore it is important that additional studies be performed to confirm these results and determine their therapeutic implications,” write the authors. They recommend that in the meantime, as part of good medical care, patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors.