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Psoriasis linked to adverse events and AF

Mild and severe psoriasis are associated with an increased risk of myocardial infarction and stroke, while severe psoriasis is also associated with an increased risk of cardiovascular mortality, according to a study1 published recently in the Journal of the American Heart Association.

Authors searched the MEDLINE, EMBASE, and Cochrane Central Register databases for relevant studies in English between January 1, 1980, and January 1, 2012. Extraction was by three independent reviewers. Summary incidence, risk ratios (RRs), and confidence intervals (CIs) were calculated using fixed‐effects and random‐effects modeling. Meta‐regression was also performed to identify sources of between‐study variation. Nine studies were included, representing a total of 201,239 patients with mild and 17,415 patients with severe psoriasis.

The level of covariate adjustment varied among studies, leading to the possibility of residual confounding. Using the available adjusted effect sizes, mild psoriasis remained associated with a significantly increased risk of myocardial infarction (RR, 1.29; 95% CI, 1.02 to 1.63) and stroke (RR, 1.12; 95% CI, 1.08 to 1.16). Severe psoriasis was associated with a significantly increased risk of cardiovascular mortality (RR, 1.39; 95% CI, 1.11 to 1.74), myocardial infarction (RR, 1.70; 95% CI, 1.32 to 2.18), and stroke (RR, 1.56 95% CI, 1.32 to 1.84). Based on these risk ratios and the background population event rates, psoriasis is associated with an estimated excess of 11,500 (95% CI, 1,169 to 24,407) major adverse cardiovascular events each year.

psoriasis pic

Dr Ehrin J Armstrong (University of California, USA)

Speaking to BJC Arrhythmia Watch on the study’s results, co-author Dr Ehrin J Armstrong (Division of Cardiovascular Medicine, University of California, Sacramento, USA) said: “The mechanisms underlying this association remain uncertain, but the increased systemic inflammation associated with psoriasis may predispose to re-entry and arrhythmia development. We are currently studying this question in a separate cohort of patients that will include detailed ECG analysis of patients with vs. without psoriasis”.

“There is some preliminary evidence that psoriasis is associated with an increased risk of atrial fibrillation. One of the only published studies on this topic involved a Danish nationwide cohort and found that both mild and severe psoriasis were associated with increased atrial fibrillation and ischaemic stroke,” he added.

References

1. Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: a systematic review and meta‐analysis of observational studies. J Am Heart Assoc 2013;2:e000062. http://dx.doi.org/10.1161/​JAHA.113.000062

Published on: April 26, 2013

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