MedWire News: Psoriasis may not be a clinical risk factor for ischemic heart disease (IHD) hospitalization, Dutch study findings suggest.
This latest finding seems to contradict a previous study reported by MedWire News that found an increased risk for myocardial infarction in patients with severe psoriasis and a recent consensus document advising assessment of cardiovascular risk in psoriasis patients.
The researchers, led by Tamar Nijsten from Erasmus University Medical Centre in Rotterdam, The Netherlands, note that “psoriasis patients initially seemed to have an increased risk for IHD, but after adjusting for metabolic drug use and healthcare consumption, this association seemed to be strongly affected by confounding.”
They therefore suggest that previous studies in which psoriasis was found to be an independent risk factor for cardiovascular events may have also been biased by such factors.
For their cohort study, the team assessed the hospital and pharmacy records for 2.5 million Dutch residents between 1997 and 2008.
They identified a total of 15,820 psoriasis patients and 27,577 individuals without psoriasis, who had an average age of 48 years.
Over a median follow-up time of about 6 years, 3.7% of psoriasis patients were hospitalized for IHD compared with 3.1% of controls, resulting in incidence rates of 611 IHDs per 100,000 person-years and 559 IHDs per 100,000 person-years, respectively.
The difference was non-significant, but after adjusting for age and gender, the hazard ratio for IHD was borderline significantly increased in patients with psoriasis compared with controls, at 1.10.
Psoriasis patients were significantly more likely to have filled prescriptions for lipid-lowering, antihypertensive, and antidiabetic drugs before study entry and to have been hospitalized for non-cardiovascular disease. After controlling for these factors, the risk for IHD in psoriasis patients decreased and remained comparable to that of controls, at a hazard ratio of 1.05.
Nijsten and colleagues also note that there was no difference in risk for IHD between psoriasis patients using topical versus systemic therapy, suggesting severity of psoriasis did not affect the findings.
Reporting in the Journal of Investigative Dermatology, the researchers suggest that psoriasis patients may have a different cardiovascular risk profile to that of the general population that puts them at greater risk for metabolic disorders, but not for IHD or myocardial infarction.
They add: “This may seem contradictory, but it has previously been shown that there is a weak or even no association between the metabolic syndrome and the occurrence of cardiovascular events.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
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