Abstract 1640: Patients With Severe Psoriasis and No History of Cardiovascular Disease Are at Increased Risk of Cardiovascular Mortality
Background: Psoriasis is a chronic inflammatory T helper cell-1/17 skin disease that affects 2– 4% of the adult population. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI) and stroke.
Methods: We conducted a cohort study using the General Practice Research Database to determine if patients with severe psoriasis have an increased risk of cardiovascular mortality. Severe psoriasis was defined as patients who received a psoriasis diagnosis and systemic therapy consistent with severe psoriasis (N=3,603). Patients were excluded if they had history of coronary artery disease, MI, stroke/transient ischemic attack (TIA), cerebrovascular disease or peripheral vascular disease (PVD). Up to 4 controls without psoriasis were selected from the same practices and start dates for each psoriasis patient (N=14,330). The electronic medical record of all patients who died (N=971), was independently reviewed by up to three physicians to determine the cause of death. Cardiovascular death (N=301) was defined as diagnoses consistent with stroke, MI, PVD, arrhythmia, or left ventricular thrombus entered on or very close to the entry of death.
Results: Agreement on cause of death among the reviewers was excellent (96%). Severe psoriasis was an independent risk factor for cardiovascular mortality (HR 1.66; 95% CI 1.2, 2.3) when adjusting for age, sex, smoking, BMI, diabetes, hypertension, and hyperlipidemia. Interestingly, there was a significant (p=0.09) interaction between psoriasis and age. For example, the RR of CV death for a 40 year old and 60 year old with severe psoriasis was 2.65 (1.42, 4.95) and 1.90 (1.39, 2.58), respectively. The adjusted excess risk of CV mortality in a 40 and 60 year old psoriasis patient was 5.78 deaths/10,000 person-years and 66 deaths/10,000 person-years respectively. The findings were robust to multiple sensitivity analyses.
Conclusions: Patients with severe psoriasis have an increased risk of cardiovascular 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.