Conflicts of interest M.M. is an employee at Merck Serono International SA.
Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case–control analysis
Article first published online: 4 FEB 2009
© 2009 The Authors. Journal Compilation © 2009 British Association of Dermatologists
British Journal of Dermatology
Volume 160, Issue 5, pages 1048–1056, May 2009
How to Cite
Brauchli, Y.B., Jick, S.S., Miret, M. and Meier, C.R. (2009), Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case–control analysis. British Journal of Dermatology, 160: 1048–1056. doi: 10.1111/j.1365-2133.2008.09020.x
- Issue published online: 14 APR 2009
- Article first published online: 4 FEB 2009
- Accepted for publication 27 October 2008
- incidence rates;
- myocardial infarction;
- transient ischaemic attack
Background Systemic inflammation may increase the risk for cardiovascular diseases in patients with psoriasis, but data on this risk in patients with early psoriasis are scarce.
Objectives To assess and compare the risk of developing incident myocardial infarction (MI), stroke or transient ischaemic attack (TIA) between an inception cohort of patients with psoriasis and a psoriasis-free population.
Methods We conducted an inception cohort study with a nested case–control analysis within the U.K.-based General Practice Research Database. The study population encompassed 36 702 patients with a first-time recorded diagnosis of psoriasis 1994–2005, matched 1 : 1 to psoriasis-free patients. We assessed crude incidence rates (IRs) and applied conditional logistic regression to obtain odds ratios (ORs) with 95% confidence intervals (CIs).
Results Overall, the IRs of MI (n = 449), stroke (n = 535) and TIA (n = 402) were similar among patients with or without psoriasis. However, the adjusted OR of developing MI for patients with psoriasis aged < 60 years was 1·66 (95% CI 1·03–2·66) compared with patients without psoriasis, while the OR for patients aged ≥ 60 years was 0·99 (95% CI 0·77–1·26). The adjusted ORs of developing MI for patients of all ages with ≤ 2 or > 2 prescriptions/year for oral psoriasis treatment were 2·48 (95% CI 0·69–8·91) and 1·39 (95% CI 0·43–4·53), with a similar finding for stroke and TIA.
Conclusions The risk of developing a cardiovascular outcome was not materially elevated for patients with early psoriasis overall. In subanalyses, however, there was a suggestion of an increased (but low absolute) MI risk for patients with psoriasis aged < 60 years, mainly with severe disease.