Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database
Open accessAbstract
AIMS: Psoriasis is a common chronic inflammatory T-helper cell-1/17 mediated skin disease. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI), and stroke. We conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular (CV) mortality. METHODS AND RESULTS: Severe psoriasis was defined as patients who received a psoriasis diagnosis and systemic therapy consistent with severe psoriasis (n = 3603). Up to four unexposed patients without psoriasis were selected from the same practices and start dates for each psoriasis patient (n = 14 330). For every death, the cause was determined by review of the electronic medical record. Severe psoriasis was an independent risk factor for CV mortality (HR 1.57; 95% CI 1.26, 1.96) when adjusting for age, sex, smoking, diabetes, hypertension, and hyperlipidaemia. Overall, severe psoriasis patients experienced one extra CV death per 283 patients per year, even when adjusting for major CV risk factors. The relative risk of CV mortality was modified by age. For example, the RR of CV death for a 40-year-old and 60-year-old with severe psoriasis was 2.69 (1.45, 4.99) and 1.92 (1.41, 2.62), respectively. The findings were robust to multiple sensitivity analyses. CONCLUSION: Patients with severe psoriasis have an increased risk of CV 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.
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Patients in whom psoriasis was classified as severe had a higher risk of myocardial infarction than patients with mild psoriasis, consistent with the hypothesis that greater immune activity in psoriasis is related to a higher risk of myocardial infarction and cardiovascular death.
“Patients in whom the psoriasis was classified as severe had a higher risk of myocardial infarction than patients with mild psoriasis, consistent with the hypothesis that greater immune activity in psoriasis is related to a higher risk of myocardial infarction and cardiovascular death.185,186”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [186]
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- Authors
- Mehta, N. N., Azfar, R. S., Shin, D. B., Neimann, A. L., Troxel, A. B., & Gelfand, J. M.
- Affiliations
- University of Pennsylvania (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Gelfand, J. M.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-12-27
- Volume
- 31
- Issue
- 8
- Pages
- 1000-1006
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC2894736
- OpenAlex
- W2095652983
- Cited by
- 706
- References
- 54
- Citations by year
- 2026: 18 · 2025: 35 · 2024: 34 · 2023: 29 · 2022: 46 · 2021: 35 · 2020: 45 · 2019: 46 · 2018: 43 · 2017: 54 · 2016: 42 · 2015: 45 · 2014: 45 · 2013: 63 · 2012: 70
- FWCI
- 17.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of Pennsylvania
- National Heart, Lung, and Blood Institute (K23HL097151, R01HL089744)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR051125, T32AR007465)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
- Health Sciences › Medicine › Rheumatology › Spondyloarthritis Studies and Treatments
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Keywords
- severe psoriasis, cardiovascular mortality, cardiovascular risk factors, atherosclerosis, myocardial infarction, stroke, chronic inflammation
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Dermatologic Agents, Female, United Kingdom, Humans, Male, Middle Aged, Psoriasis, Risk Factors, Incidence
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