Psoriasis and Risk of Atrial Fibrillation and Ischaemic Stroke
Psoriasis and Risk of Atrial Fibrillation and Ischaemic Stroke
Aims Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis.
Methods and results Cohort study of the entire Danish population followed from 1997 to 2006 by individual-level-linkage of nationwide prospectively recorded registers. Multivariable Poisson's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke. A total of 36 765 patients with mild psoriasis and 2793 with severe psoriasis were compared with 4 478 926 individuals, i.e. the reference population. In patients with mild psoriasis, the adjusted rate ratios (RRs) for AF were 1.50 (1.21–1.86) and 1.16 (1.08–1.24) in patients aged <50 and ≥50 years, respectively. Patients with severe psoriasis had a higher risk of AF with RRs 2.98 (1.80–4.92) in patients aged <50 years and 1.29 (1.01–1.65) in patients aged ≥50 years. Patients with psoriasis also demonstrated a disease severity-dependent increased risk of ischaemic stroke, i.e. RRs 1.97 (1.66–2.34) and 2.80 (1.81–4.34) in patients aged <50 years with mild and severe psoriasis, and RRs 1.13 (1.04–1.21) and 1.34 (1.04–1.71) in patients aged ≥50 years with mild and severe psoriasis, respectively. A range of sensitivity analyses yielded comparable results.
Conclusion Psoriasis is associated with increased risk of AF and ischaemic stroke. These novel results add to a growing body of evidence, suggesting that patients with psoriasis could be considered at increased cardiovascular risk.
Psoriasis is a type 1 helper cell (Th1)/Th17 chronic inflammatory disorder affecting ~2% of the population. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with increased risk of stroke, heart failure, coronary artery disease, and cardiovascular mortality. It is well-established that atherosclerosis is also a chronic inflammatory disease and more recent evidence has linked inflammatory mechanisms to the pathogenesis of AF, e.g. with atrial infiltration of inflammatory cells and raised circulating levels of inflammatory markers and markers of oxidative stress. The relationship between psoriasis and AF is unknown and although psoriasis has been linked to acute myocardial infarction and cardiovascular death, less evidence is available regarding the risk of stroke in these patients. We therefore used Danish nationwide registers of hospitalization and drug dispensing from pharmacies to determine the risk of AF and ischaemic stroke in patients with psoriasis.
Abstract and Introduction
Abstract
Aims Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation (AF) and ischaemic stroke. We therefore investigated the risk of these endpoints in patients with psoriasis.
Methods and results Cohort study of the entire Danish population followed from 1997 to 2006 by individual-level-linkage of nationwide prospectively recorded registers. Multivariable Poisson's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke. A total of 36 765 patients with mild psoriasis and 2793 with severe psoriasis were compared with 4 478 926 individuals, i.e. the reference population. In patients with mild psoriasis, the adjusted rate ratios (RRs) for AF were 1.50 (1.21–1.86) and 1.16 (1.08–1.24) in patients aged <50 and ≥50 years, respectively. Patients with severe psoriasis had a higher risk of AF with RRs 2.98 (1.80–4.92) in patients aged <50 years and 1.29 (1.01–1.65) in patients aged ≥50 years. Patients with psoriasis also demonstrated a disease severity-dependent increased risk of ischaemic stroke, i.e. RRs 1.97 (1.66–2.34) and 2.80 (1.81–4.34) in patients aged <50 years with mild and severe psoriasis, and RRs 1.13 (1.04–1.21) and 1.34 (1.04–1.71) in patients aged ≥50 years with mild and severe psoriasis, respectively. A range of sensitivity analyses yielded comparable results.
Conclusion Psoriasis is associated with increased risk of AF and ischaemic stroke. These novel results add to a growing body of evidence, suggesting that patients with psoriasis could be considered at increased cardiovascular risk.
Introduction
Psoriasis is a type 1 helper cell (Th1)/Th17 chronic inflammatory disorder affecting ~2% of the population. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with increased risk of stroke, heart failure, coronary artery disease, and cardiovascular mortality. It is well-established that atherosclerosis is also a chronic inflammatory disease and more recent evidence has linked inflammatory mechanisms to the pathogenesis of AF, e.g. with atrial infiltration of inflammatory cells and raised circulating levels of inflammatory markers and markers of oxidative stress. The relationship between psoriasis and AF is unknown and although psoriasis has been linked to acute myocardial infarction and cardiovascular death, less evidence is available regarding the risk of stroke in these patients. We therefore used Danish nationwide registers of hospitalization and drug dispensing from pharmacies to determine the risk of AF and ischaemic stroke in patients with psoriasis.