Prospective evaluation of cardiovascular risk and mortality in patients with psoriasis: An American population‐based study

Abstract

The association between psoriasis and cardiovascular disease (CVD) has long been discussed and continually refined. However, there is currently a lack of prospective studies on the cardiovascular risk attributed to psoriasis in the United States general population. Representative adult participants were selected from the National Health and Nutrition Examination Survey (NHANES). Risks of cardiovascular symptoms and diseases prevalence were evaluated between participants with and without psoriasis. The hazards for all‐cause mortality and CVD mortality were stratified by psoriasis status. Mediation analysis was then conducted to identify potential mediators between psoriasis and cardiac death. Overall, 19 741 participants were included in the current study, 542 (2.7%) had psoriasis and 19 199 (97.3%) did not have psoriasis. After adjusting for known CVD risk factors, odds for hypertension (OR = 1.37, 95% CI: 1.13–1.66, p = 0.001), hypercholesterolemia (OR = 1.37, 95% CI: 1.13–1.64, p < 0.001) and angina pectoris (OR = 1.74, 95% CI: 1.11–2.60, p = 0.011) were higher in psoriasis patients. Compared with participants without psoriasis, moderate/severe but not mild patients showed significantly higher CVD mortality (HR = 2.55, 95% CI: 1.27–5.15, p = 0.009). This result was supported by subgroup analyses. Mediation analysis further suggested that the direct effect of moderate/severe psoriasis on CVD mortality accounted for 81.4% (65.8%–97.1%). Besides, the indirect effect might derive from disturbance of serum albumin, urea nitrogen and uric acid. Moderate‐to‐severe psoriasis is an independent risk factor for cardiovascular disease, making it necessary to regularly conduct cardiovascular disease‐related examinations for patients with higher severity of psoriasis in clinical settings.

Effectiveness and Safety of Biological Therapies in Very Severe Plaque Psoriasis: A Real-Life Retrospective Study

“…Extensive real-world evidence indicates that higher psoriasis severity is linked to lower HRQoL and increased impairments in work productivity [9,10]. This is also explained by the higher prevalence of comorbidities compared to the general population; severe psoriasis is associated with a significant increased risk of myocardial infarction, coronary artery disease, stroke, and cardiovascular mortality, as well as metabolic syndrome, type 2 diabetes mellitus, inflammatory bowel diseases, depression, anxiety, and suicidal ideation [2][3][4][5][6][7].…”

“…Although, in most cases, the disease manifests on the skin, it is also associated with important comorbidities, including psoriatic arthritis, metabolic syndrome, cardiovascular diseases, inflammatory bowel diseases, type 2 diabetes mellitus, depression, and cancer [2,[4][5][6][7]. The Psoriasis Area and Severity Index (PASI) is a tool used to evaluate and categorize the severity of psoriatic lesions and their response to treatment; it divides the body into four regions, the head, trunk, upper extremities, and lower extremities, and each of these areas is individually examined to determine the percentage of involvement, resulting in a numerical score ranging from 0 (no involvement) to 6 (90% to 100% involvement).…”

The impact of serum uric acid on psoriasis: NHANES 2005–2014 and Mendelian randomization

“…Additionally, a study pointed out that in psoriasis patients in Hong Kong, there was no correlation between uric acid levels and the extent, or severity of skin lesions, blood lipid profiles, and kidney function ( Lai et al, 2018 ). However, it is crucial to note that these studies are subject to variations in patient populations and the presence of multiple comorbidities, which currently generate a debate around the relationship ( Kan et al, 2024 ). Therefore, comprehensive research with large sample sizes is required to thoroughly investigate the impact of uric acid levels on psoriasis.…”