Abstract 12190: The Risk of Myocardial Infarction in Patients with Psoriasis: Results from a Large Population-Based Cohort Study
Background: Psoriasis is a chronic inflammatory skin disease affecting 2-3% of adults. Epidemiological studies report an association between psoriasis and cardiovascular disease (CVD). Objective: To determine the independent association of psoriasis with first acute myocardial infarction (AMI).
Methods: The study cohort was constructed from The Health Improvement Network (THIN), a UK database containing medical, therapeutic, and laboratory data for ∼7.5 million unselected patients from 464 primary care practices. Inclusion criteria were adults 18-90 without prior AMI or stroke. Patients with psoriasis (N= 132,682) had at least 1 diagnostic code for psoriasis; ‘severe psoriasis’ consisted of patients using systemic or phototherapies. Up to 5 controls were selected for each psoriasis patient. Survival was assessed using Kaplan Meier estimates and Cox proportional hazard models.
Results: We compared patients with mild psoriasis (n=125,317, median age 44 (IQR 32-59), 47.8% male) and severe psoriasis (n=7,365, age 48 (37-60), 48.1% male) to controls (n=650,766, age 37 (27-52), 47.2% male). Incidence of AMI for psoriasis and controls was 234 (95% CI 222-245) and 163 (158-168) per 100,000, respectively. Adjusted for CVD risk factors and age interaction, both mild psoriasis (p=0.003) and severe psoriasis (p=0.005) were associated with excess risk of first AMI. A psoriasis and age interaction indicated increasing relative risk of AMI with younger age (e.g., for severe psoriasis, adjusted HR for a 45 year-old male was 2.38 (1.47-3.85) vs. 1.58 (1.22-2.04) for a 65 year-old male.)
Conclusion: In this large UK population cohort, psoriasis was associated with increased risk of first AMI independent of traditional risk factors, with risk seen in severe psoriasis similar in magnitude to diabetes. Research is needed to understand the mechanism of this association, determine psoriasis impact on risk stratification and assess potential interventions to reduce CVD risk.
- © 2011 by American Heart Association, Inc.