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Psoriasis Linked to Comorbidities and Vascular Disease
 
 
  MedPage Today
June 15, 2009
 
LITTLE FALLS, N.J., June 15 -- Patients with psoriasis are at increased risk for atherosclerosis and accompanying vascular diseases, researchers found.
 
Action Points
 
* Explain to interested patients that this study found that patients with psoriasis were more likely to have vascular disease beyond coronary artery disease and this was associated with a higher percentage of deaths.
 
* Point out that a direct causal relationship between psoriasis and these events cannot be determined from these data.
 
Among predominantly male patients at a Veterans Affairs medical center, the skin disease was associated with a greater likelihood of ischemic heart disease, cerebrovascular disease, and peripheral arterial disease, as well as death, according to Robert Kirsner, M.D., Ph.D., of the University of Miami, and colleagues.
 
"This result is not surprising, given the systemic nature of atherosclerosis," the researchers wrote in the June issue of Archives of Dermatology.
 
They said the findings have "tremendous and far-reaching clinical implications, as all of these vascular conditions represent a major financial cost to the healthcare system, as well as a major cause of disability and death."
 
Because psoriasis has recently been shown to be a systemic inflammatory condition, researchers are interested in looking at its connection to cardiovascular risk factors and myocardial infarction, Dr. Kirsner and colleagues said.
 
To explore the issue, they identified 3,236 patients with psoriasis and 2,500 control patients without the condition who were treated at the Miami VA Medical Center.
 
The patients with psoriasis were slightly older (67.9 versus 65.1) and more likely to male (95.5% versus 88.2%, P<0.01 for both).
 
As expected, they were also more likely to be smokers and to have diabetes, hypertension, and dyslipidemia (P<0.01 for all).
 
After adjusting for these differences, patients with psoriasis were more likely to be diagnosed with the following conditions:
 
* Atherosclerosis (OR 2.18, 95% CI 1.59 to 3.01)
* Ischemic heart disease (OR 1.78, 95% CI 1.51 to 2.11)
* Cerebrovascular disease (OR 1.70, 95% CI 1.33 to 2.17)
* Peripheral arterial disease (OR 1.98, 95% CI 1.32 to 2.82)
 
Psoriasis was also independently predictive of death (OR 1.86, 95% CI 1.56 to 2.21).
 
Future studies are needed to determine whether aggressive treatment of psoriasis or traditional cardiovascular risk factors will improve the total atherosclerotic burden associated with the skin condition, the researchers said.
 
"In the meantime, we recommend that healthcare providers who are caring for patients with psoriasis be vigilant with respect to traditional risk factor screening," they said.
 
In addition, they continued, "it would be prudent for dermatologists to be familiar with suggested screening for cardiovascular risk factors and recommendations for aspirin use. If not, it is imperative that they work in collaboration with a primary care provider or another internal medicine specialist, who also needs to be aware of our findings."
 
They acknowledged some limitations of the study, including the possibility of inaccurate coding of diagnoses and the inability to assess temporal relationships between psoriasis and vascular disease because of the cross-sectional design.
 
The authors made no financial disclosures.
 
Primary source: Archives of Dermatology
Source reference:
Prodanovich S, et al "Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality" Arch Dematol 2009; 145: 700-03.
 
 
 
 
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