Psoriasis Linked to Cardiovascular Disease,
Increased Mortality in Study of Senior Citizens
Far-reaching implications, as these vascular
conditions represent a major cost to health care
system, as well as a major cause of disability and death.
June 15, 2009 - The skin disease psoriasis is
associated with atherosclerosis (a buildup of plaque in the arteries)
characterized by an increased prevalence of ischemic heart disease,
cerebrovascular disease, peripheral artery disease and an increased risk
of death, according to a study of senior citizens.
Psoriasis affects nearly 2 percent to 3 percent of
the world's population, including 7 million Americans, according to
background information in the article on the study in the June issue of
Archives of Dermatology, one of the JAMA/Archives journals.
In addition to its effects on the skin, psoriasis
is associated with arthritis, depression and a lower quality of life.
"More recently, psoriasis has also been shown to be
a systemic inflammatory condition, with similarities to other
inflammatory immune disorders," the authors write.
"Since the risk of myocardial infarction is
increased in rheumatoid arthritis and systemic lupus erythematosus,
which are both inflammatory conditions, attention has been focused on
the association between psoriasis, cardiovascular risk factors and
myocardial infarction."
Srjdan Prodanovich, M.D., of the University of
Miami Miller School of Medicine, and colleagues analyzed the
computerized records of 3,236 patients with psoriasis and 2,500
individuals without psoriasis who were seen at the same Veterans
Administration facility.
Patients in the psoriasis group were slightly older
than those in the control group without psoriasis (average age 67.9 vs.
65.1) and were more likely to be men (95.5 percent vs. 88.2 percent).
"After age, sex and history of hypertension,
diabetes, dyslipidemia (abnormal cholesterol levels) and smoking status
were controlled for, patients with psoriasis were significantly more
likely than controls to carry a diagnosis of atherosclerosis," the
authors write.
Patients with psoriasis were also more likely to
have an additional diagnosis of another blood vessel disease, including
ischemic heart disease (affecting vessels leading to the heart),
cerebral vascular disease (vessels leading to the brain) or peripheral
arterial disease (vessels outside the heart and brain).
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About
Psoriasis
Psoriasis is a chronic,
autoimmune disease that appears on the skin. It occurs when the
immune system sends out faulty signals that speed up the growth
cycle of skin cells. Psoriasis is not contagious.
There are five types of
psoriasis: plaque, guttate, inverse, pustular and erythrodermic.
The most common form, plaque psoriasis, appears as raised, red
patches or lesions covered with a silvery white buildup of dead
skin cells, called scale. Psoriasis can occur on any part of the
body and is associated with other serious health conditions,
such as diabetes, heart disease and depression.
According to the National
Institutes of Health, as many as 7.5 million Americans have
psoriasis.
>>
National Psoriasis Foundation |
"This result is not surprising, given the systemic
nature of atherosclerosis," the authors write.
"It has tremendous and far-reaching clinical
implications, as all of these vascular conditions represent a major
financial cost to the health care system as well as a major cause of
disability and death. The latter finding was corroborated by our
analysis, whereby we concluded that psoriasis is an independent risk
factor for mortality; i.e., we found a higher percentage of deaths among
patients with psoriasis than among patients without psoriasis (19.6
percent vs. 9.9 percent)."
Future studies should investigate whether
aggressive treatment of either cardiovascular risk factors or psoriasis
will lead to an improvement in atherosclerosis in these patients, the
authors conclude.
"In the meantime, we recommend that health care
providers who are caring for patients with psoriasis be vigilant with
respect to traditional risk factor screenings," they write.
"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."
