Psoriasis and risk of nonfatal cardiovascular disease in U.S. women: a cohort study

Authors


  • Funding sources
    The work is partly supported by Department of Dermatology, Brigham and Women’s Hospital, NIH grants HL34594 and CA50385.

  • Conflicts of interest
    A.A.Q. has received a grant from Amgen/Pfizer to evaluate ‘Adipocytokines in psoriasis and psoriatic arthritis’.

Abrar A. Qureshi.
E-mail: aqureshi@bics.bwh.harvard.edu

Summary

Background  Psoriasis has been linked to cardiovascular comorbidities in cross-sectional studies, but evidence regarding the association between psoriasis and incident cardiovascular disease (CVD) is limited.

Objectives  To make a prospective evaluation of the association between psoriasis and risk of incident nonfatal CVD.

Methods  Participants (= 96 008) were included from the Nurses’ Health Study II, and followed for 18 years. Information on physician-diagnosed psoriasis was obtained by self-report and diagnosis was confirmed by supplementary questionnaires. We included 2463 individuals with self-reported psoriasis and a subsample of 1242 with validated psoriasis. The main outcome was incident nonfatal CVD events [nonfatal myocardial infarction (MI) and nonfatal stroke], ascertained by biennial questionnaires and confirmed.

Results  During 1 709 069 person-years of follow-up, 713 incident nonfatal CVD events were confirmed. Psoriasis was associated with a significantly increased multivariate-adjusted hazard ratio (HR) of nonfatal CVD, 1·55 [95% confidence interval (CI): 1·04–2·31]. HRs for nonfatal MI and stroke were 1·70 (95% CI: 1·01–2·84) and 1·45 (95% CI: 0·80–2·65), respectively. The association remained consistent in a sensitivity analysis of confirmed psoriasis (HR: 2·06, 95% CI: 1·31–3·26). For individuals with concomitant psoriatic arthritis, the risk of nonfatal CVD was even higher (HR: 3·47; 95% CI: 1·85–6·51). Women diagnosed with psoriasis at < 40 years of age or with duration of psoriasis ≥ 9 years had substantial elevations in CVD risk: HR: 3·26 (95% CI: 1·21–8·75) and 3·09 (95% CI: 1·15–8·29), respectively.

Conclusions  Psoriasis is an independent predictor for nonfatal CVD among women, with particularly high risk for those with longer duration of psoriasis and concomitant psoriatic arthritis.

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