Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients

Abstract

We have conducted a historical cohort study to assess cardiovascular mortality among psoriasis patients. Using the Swedish Inpatient Registry, we selected 8991 patients hospitalized for psoriasis at dermatological wards. To represent an outpatient cohort, 19,757 members of the Swedish Psoriasis Association were selected. Mortality from cardiovascular diseases was compared with the general population. We found no increased cardiovascular mortality among outpatients with psoriasis (standardized mortality ratio, SMR 0.94; 95% confidence interval, CI: 0.89-0.99). The overall risk among inpatients admitted at least once was increased by 50% (SMR 1.52; 95% CI: 1.44-1.60). The excess risk increased with increasing number of hospital admissions (p for trend <0.001). Cardiovascular mortality was higher among those admitted at younger ages (p for trend <0.001; SMR 2.62, 95% CI: 1.91-3.49, for patients aged 20 to 39 years at first admission). Young age at first admission appeared to further increase the risk among those who were repeatedly admitted. We conclude that a diagnosis of psoriasis per se does not appear to increase the risk for cardiovascular mortality. Severe psoriasis, however, here measured as repeated admissions, and early age at first admission, is associated with increased risk for cardiovascular death.

Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis

“…However, these studies have focused on highly selected psoriasis patients, such as those hospitalized for their disease or with multiple comorbidities, including diabetes mellitus, obesity, hypertension and smoking. 5,6,[15][16][17][18][19] These studies describe findings of manifest atherosclerosis, but give limited information on early, subclinical changes in psoriasis (patients Data are mean ± SD. Table 3 Multiple linear regression analyses factors associated with carotid artery IMT, FMD and NTD in the entire group of the 86 study subjects Kimhi et al also found that patients with psoriatic arthritis had greater IMT than healthy controls.…”

Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature

“…Mallbris et al 83 2004 Using the Swedish Inpatient Registry, there appeared to be no increased cardiovascular mortality among outpatients with psoriasis. Overall risk among inpatients admitted at least once was increased by 50%.…”

“…81 They found no increase in CVD mortality. Severe psoriasis, defined by use of systemic medications, 82 hospitalization at an early age, or repeated hospitalization, 83 has been shown by two high quality cohort studies to increase the risk of death. These patients with severe disease have increased mortality, which persisted after adjustment for DM, HTN, BMI, and smoking and after exclusion of patients with inflammatory arthropathy.…”

National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening

“…5,6 In initial assessments the increased risk of myocardial infarction and vaso-occlusive disease was attributed to the increased prevalence of risk factors. These risk factors have been attributed to behaviors such as obesity and smoking which are thought to be provoked by the psychosocial burden of the disease.…”