Psoriasis patients at risk for AF and stroke
MedWire News: Individuals with psoriasis are at increased risk for developing atrial fibrillation (AF) and ischemic stroke (IS) compared with those in the general population, show Danish study results.
"These novel results add to mounting evidence of the role of psoriasis as a clinically relevant cardiovascular risk factor and they call for increased awareness of cardiovascular risk factor management in this large group of patients," say Ole Ahlehoff and colleagues from Copenhagen University Hospital in Hellerup.
Recent evidence has linked inflammatory mechanisms to the pathogenesis of AF, which is associated with an increased risk for IS, and psoriasis is known to be a chronic inflammatory disorder, writes the team in the European Heart Journal.
To investigate possible associations between the three conditions, the researchers used 9 years of data from the entire Danish population, including 36,765 patients with mild psoriasis, 2793 with severe psoriasis, and 4,478,926 individuals without the condition, who acted as a comparison.
The cohort was stratified by age (<50 years, ≥50 years) and overall incidence rates of AF and IS were higher in psoriasis patients than in the reference population.
Specifically, patients with mild and severe psoriasis experienced an average 4.67 and 5.96 AF events per 1000 observational years, respectively, compared with 3.03 events in the reference group. The corresponding average rates of IS were 4.54 and 6.82 versus 3.06.
After adjustment for variables including concomitant medication, comorbidities, and gender, patients with mild psoriasis aged less than 50, or 50 years or more had a rate ratio for AF of 1.50 and 1.16, respectively, while the corresponding rate ratios for patients with severe forms of the skin condition were higher, at 2.98 and 1.29.
Disease severity affected patients' risk for IS, with rate ratios of 1.97 and 2.80 in patients aged less than 50 years with mild and severe psoriasis, respectively, and ratios of 1.13 and 1.34 in mild and severe psoriasis patients aged 50 years or more.
Sensitivity analysis that included excluding patients with prior myocardial infarction and censoring those at the time of a surgical procedure, or incident AF prior to IS gave comparable results.
The research team believes it is "notable that exclusion of patients with prior myocardial infarction did not cancel out the observed association, suggesting that the risk of AF in patients with psoriasis was not mainly driven by concomitant coronary artery disease."
In addition, risk estimates for IS were raised in all psoriasis patients and were not attenuated after censoring for those with incident AF, "suggesting that the IS risk exceeded the risk attributable to AF," write Ahlehoff and co-investigators.
Psoriasis is therefore likely to be an independent risk factor for IS, with inflammation likely to be underlying this association, they conclude.
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By Sarah Guy