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Charles E. Crutchfield III, M.D.

Psoriasis Associated With Increased Risk For Heart Attack
Main Category: Dermatology News
Article Date: 15 Oct 2006 - 0:00am (PDT)

Adults with psoriasis, especially younger patients with severe psoriasis, appear to be at increased risk for a heart attack, according to a study in the October 11 issue of JAMA.

Psoriasis is a common, chronic, disease that affects about 2 percent to 3 percent of the adult population. It is associated with markers of systemic inflammation, such as increased C-reactive protein levels, which have been linked to the development of atherosclerosis and myocardial infarction (MI; heart attack), according to background information in the article. Several hospital-based studies have indicated that psoriasis is associated with a higher prevalence of cardiovascular diseases, including heart attack, but these studies did not control for major cardiovascular risk factors.

Joel M. Gelfand, M.D., M.S.C.E., and colleagues from the University of Pennsylvania, Philadelphia, 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, which included a total of 556,995 control patients, and patients with mild (n = 127,139) and severe psoriasis (n = 3,837), compared outcomes among patients with and without a diagnosis of psoriasis. The patients, living in the United Kingdom, were 20 to 90 years of age. 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. Up to five controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis.

The researchers found 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), with patients who were younger and had severe psoriasis having the highest rate. For example, a 30-year-old patient with mild psoriasis had a 29 percent greater risk of having a heart attack than a patient without psoriasis; a 30-year-old patient with severe psoriasis had about three times the risk. A 60-year-old patient with severe psoriasis had a 36 percent increased risk for heart attack.

“The magnitude of association between severe psoriasis and MI in those patients younger than 50 years is similar to the magnitude of association for other major cardiac risk factors,” the authors write.

“Our findings are novel and therefore it is important that additional studies be performed to confirm these results and determine their therapeutic implications. In particular, it is important to determine the impact of clinical markers of psoriasis activity, such as body surface area, as well as biomarkers of systemic inflammation (e.g., C-reactive protein) on the risk of MI in patients with psoriasis. In the meantime, as part of good medical care, patients with psoriasis should be encouraged to aggressively address their modifiable cardiovascular risk factors,” the researchers conclude.

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Psoriasis Linked to Higher Risk of Heart Attack

By Amanda Gardner
HealthDay Reporter

TUESDAY, Oct. 10 (HealthDay News) -- Psoriasis sufferers may face an increased risk of having a heart attack , a new study suggests.The risk appears to be most pronounced among younger patients with more severe forms of the disease, according to a paper appearing in the Oct. 11 issue of the Journal of the American Medical Association."This study is really quite important," said Liz Horn, director of research for the National Psoriasis Foundation. "There have been a few other studies, but this one is important because it uses such a large database. This is just one more very important study that gives more evidence."While more studies are needed to confirm the findings, "the potential is there for someone who has severe psoriasis who is in their 50s or 40s, of having a heart attack," said lead researcher Dr. Joel Gelfand, an assistant professor of dermatology at the University of Pennsylvania School of Medicine, in Philadelphia."The relative risk due to severe psoriasis is similar to the relative risk of having a heart attack from having diabetes," he said. "But the absolute risk [to any one person] is low. If you have severe psoriasis and are in your 40s, the risk of having a heart attack due to psoriasis is about one in 600 per year."Psoriasis is thought to be an autoimmune disorder, occurring when the body inexplicably begins overproducing skin cells. The extra cells pile up on the surface of the skin before they have a chance to mature, creating bright red patches that cause itching, burning and stinging. The disease affects 2 percent to 3 percent of the adult population.Some previous studies had shown an association between psoriasis and cardiovascular diseases but those studies could not rule out obesity, smoking and other risk factors as the true culprits.In this study, the authors examined medical records from a large sample of patients aged 20 to 90 in the United Kingdom. The sample included more than half a million controls (people without psoriasis), more than 125,000 patients with mild psoriasis and almost 4,000 with severe psoriasis.Heart attacks were more common in patients with severe psoriasis (five heart attacks per 1,000 person-years) and mild psoriasis (four heart attacks per 1,000 person-years) compared with the controls (about 3.6 heart attacks per 1,000 person-years).Individuals who were younger and had more severe disease had the highest relative risk, with a 30-year-old patient with mild disease having a 29 percent greater risk than a person without psoriasis. A 30-year-old patient with severe psoriasis had about triple the risk and a 60-year-old patient with severe disease had a 36 percent increased risk.It is thought that earlier-onset psoriasis (before age 40) is more severe than later-onset disease (after age 40). About three-quarters of patients will develop psoriasis before they turn 40."People with psoriasis have a bigger tendency to smoke, be obese, have high blood pressure and other things we know are risk factors for cardiovascular disease," Gelfand said. "The thing we've done, which hadn't been done before for psoriasis, was to control for these risk factors. We found that psoriasis still increases the risk of having a heart attack."The common denominator may be inflammation, the researchers said."Immune activity is important for establishing atherosclerosis or blockage of the arteries and promoting them to rupture into a heart attack," Gelfand explained. "The same immune cells involved in this are involved in psoriasis. Other diseases, like rheumatoid arthritis -- which share common immune factors -- [also] have an increased risk of heart disease. This is a scientific theory that has been evolving over the last decade or so but still needs additional studies to confirm."In the meantime, patients with psoriasis should not be alarmed but should see a physician and be screened for cardiovascular risk factors, Gelfand said. And, if you do have risk factors, you should treat them according to current guidelines. This includes stopping smoking and losing excess weight."There needs to start being a conversation between patients and physicians about the risk of cardiovascular disease and what psoriasis patients should be doing to decrease risks," Horn said."This is really important information," she said. "But it's still very early in understanding what all this means. I do think general health issues about cardiovascular disease and lifestyle modification is probably a good starting place.""This study is of great concern and it underscores why we believe the National Institutes of Health should be increasing research on psoriasis," Michael Paranzino, president of Psoriasis Cure Now, said in a staement. "Unlocking the apparent link between psoriasis and heart attack risk may help us improve treatments both for psoriasis and heart attack prevention. The 'heartbreak of psoriasis' is supposed to be a tired punch line, not a literal truth."

"This study suggests that estimates of the impact of psoriasis, both in terms of dollars spent and lives lost, may be undercounting the true burden of this disease," Paranzino added. "With NIH funding having doubled over the last decade but psoriasis funding down 20 percent, this study should serve as a wake-up call that increasing psoriasis research funding should become a national priority. One of the key questions that patients need answered is whether aggressive treatment of psoriasis can reduce this increased heart attack risk."

SOURCES: Joel M. Gelfand, M.D., assistant professor, dermatology, University of Pennsylvania School of Medicine, Philadelphia; Liz Horn, Ph.D., director, research, National Psoriasis Foundation, Portland, Ore.; Oct. 9, 2006, statement, Michael Paranzino, president of Psoriasis Cure Now; Oct. 11, 2006, Journal of the American Medical Association

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