People with psoriasis and psoriatic arthritis are at a greater risk for cardiovascular events than the general population, but the risk varies depending on treatment and disease severity, according to the results of a recent study.
Although cardiovascular disease is already a well-known comorbidity of psoriatic disease, this study is one of the first that uses a control group to analyze the risk for patients with psoriasis, psoriatic arthritis or rheumatoid arthritis, said Dr. Alexis Ogdie, the lead author of the study and a rheumatologist at the University of Pennsylvania.
“It is also one of the largest studies to examine these risks in psoriatic arthritis,” said Ogdie, who was awarded a $50,000 National Psoriasis Foundation Discovery Grant in 2012.
Using patient records from The Health Improvement Network (THIN), a large United Kingdom medical database, researchers compared the risk of major cardiovascular events, including heart attack, stroke and death from cardiovascular disease, in 138,424 people with psoriasis, 8,706 people with psoriatic arthritis and 41,752 people with rheumatoid arthritis.
The study also involved a control group of 82,258 people without any of these diseases.
More severity equals more risk
Researchers divided patients into two groups: those taking a kind of drug called disease-modifying anti-rheumatic drugs (DMARDs) and those not taking DMARDs. DMARDS included systemic drugs and biologics, and for people with psoriasis, phototherapy.
After adjusting for other risk factors for cardiovascular disease, such as high blood pressure and diabetes, patients with psoriatic disease and rheumatoid arthritis were found to have a higher risk for cardiovascular events than the general population.
People with psoriatic arthritis, whether or not they used DMARDs, had a significantly higher risk for heart attacks. Those with PsA are 36 percent more likely to have a heart attack than the general population. Psoriatic arthritis patients not on DMARDs were also significantly more likely to have a stroke, with a 33 percent higher risk.Researchers considered people with psoriasis taking DMARDs as having more severe disease, and this group also had a significantly higher risk of stroke, with a 45 percent higher risk than the general population. People with severe psoriasis also had a significantly increased risk of death due to cardiovascular disease, with a 54 percent increased risk. Increased disease severity could be linked to greater overall inflammation.
Heart attack risk for people with mild psoriasis, though elevated, was not considered significant.
Do treatments have an impact?
The reason for examining risk associated with DMARD use was twofold, explained Ogdie. The use of these drugs could indicate that a patient has more severe disease, she said. However, she said, it might also be possible that DMARD use could reduce cardiovascular risk, because these drugs reduce overall inflammation. It can be difficult to examine the impact of treatment on cardiovascular risk in retrospective studies such as this, Ogdie said. “Ideally, prospective studies will address the question of whether DMARDs improve cardiovascular risk.”
A Penn Medicine team lead by Dr. Joel Gelfand is currently examining whether biologic DMARDs improve cardiovascular risk in patients with psoriasis, she said.These findings suggest the importance of improving strategies for managing cardiovascular risk factors in patients with these diseases, researchers conclude.
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