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Prevalence of cardiovascular risk factors in patients with psoriasis

https://doi.org/10.1016/j.jaad.2006.08.040Get rights and content

Background

Previous studies suggest that patients hospitalized for psoriasis have an increased frequency of a variety of cardiovascular comorbidities. Limited population-based data exist on this association, and few studies have determined which factors are independently associated with psoriasis.

Objective

We sought to determine whether the prevalence of the major cardiovascular risk factors was higher in mild and severe psoriasis than in patients without psoriasis.

Methods

We conducted a population-based study in the United Kingdom using the General Practice Research Database. Patients were classified as having severe psoriasis if they received a code for psoriasis as well as systemic therapy. Patients were defined as having mild psoriasis if they ever received a psoriasis code but no systemic therapy. Control subjects were selected from the same practices and start dates as psoriasis patients. Patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, obesity, or smoking. Analyses were performed by using conditional logistic regression, and adjustments were made considering age, gender, person-years, and all cardiovascular risk factors.

Results

We identified 127,706 patients with mild psoriasis and 3854 with severe psoriasis. Respective prevalence rates of risk factors in those with severe psoriasis, mild psoriasis, and in controls were as follows: diabetes (7.1%, 4.4%, 3.3%), hypertension (20%, 14.7%, 11.9%), hyperlipidemia (6%, 4.7%, 3.3%), obesity (20.7%, 15.8%, 13.2%), and smoking (30.1%, 28%, 21.3%). Patients with mild psoriasis had a higher adjusted odds of diabetes (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.08-1.18]), hypertension (OR, 1.03; 95% CI, 1.01-1.06), hyperlipidemia (OR, 1.16; 95% CI, 1.12-1.21), obesity (OR, 1.27; 95% CI, 1.24-1.31), and smoking (OR, 1.31; 95% CI, 1.29-1.34) than controls. Patients with severe psoriasis had a higher adjusted odds of diabetes (OR, 1.62; 95% CI, 1.3-2.01), obesity (OR, 1.79; 95% CI, 1.55-2.05), and smoking (OR, 1.31; 95% CI, 1.17-1.47) than controls. Additionally, diabetes (OR, 1.39; 95% CI, 1.22-1.58) and obesity (OR, 1.47; 95% CI, 1.32-1.63) were more prevalent in those with severe psoriasis than with mild psoriasis.

Limitations

The study was cross-sectional and therefore the directionality of the associations could not be determined.

Conclusion

Multiple cardiovascular risk factors are associated with psoriasis. Cardiovascular risk factors that are key components of the metabolic syndrome are more strongly associated with severe psoriasis than with mild psoriasis.

Section snippets

Study design

This was a cross-sectional (prevalence) study with data collected by general practitioners (GPs) in the United Kingdom (UK), who were participating in the General Practice Research Database (GPRD) between 1987 and 2002. GPs were unaware of the hypothesis to be tested. The data were collected as part of the patient's electronic medical record and are maintained in the GPRD. GPRD contains data on more than 9 million persons with more than 35 million person-years of follow-up time and is broadly

Results

We identified 127,706 patients with mild psoriasis who were matched with 465,252 subjects without psoriasis and 3854 patients with severe psoriasis matched to 14,065 corresponding subjects without psoriasis (Table I). Psoriasis patients were slightly older than matched control patients and were more likely to be male than the controls. In addition, person-years of observation were slightly greater in both psoriasis groups compared with their respective control groups (Table I). Information on

Discussion

The results of this study suggest that diabetes, hypertension, hyperlipidemia, smoking, and increased BMI are associated with both mild and severe psoriasis. Additionally, these diseases are all independently associated with mild psoriasis; however, except for obesity and smoking, the association was negligible to modest for most of the cardiovascular risk factors and therefore unlikely to be of clinical significance. The association with severe psoriasis when controlling for traditional

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    Supported by grant K23 AR051125-01 from the National Institutes of Health and the National Institute for Arthritis, Musculoskeletal, and Skin Diseases (to J. M. G.).

    Conflicts of interest: None identified.

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