Prevalence of cardiovascular risk factors in patients with psoriasis

Dermatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 12/2006; 55(5):829-35. DOI: 10.1016/j.jaad.2006.08.040
Source: PubMed

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

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Available from: Andrea B Troxel, Jan 06, 2014
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    • "Based on the localisation and symptoms, the disease is classified into different types (Griffiths et al. 2007). Plaque psoriasis is the most prevalent leading to complications like increased cardiovascular risk (Neimann et al. 2006), cancer, Crohn's disease and psoriatic arthritis (Traub & Marshall 2007). Prolonged use of allopathic medications/phototherapy causes side effects like nausea, ulceration, itching of the skin, squamous cell carcinoma etc. (Winterfield et al. 2005). "
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    • "Furthermore, low adherence can result in a misleading clinical picture in a patient’s treatment: if physicians erroneously assume that their patients have taken prescribed medication, they may make inappropriate medication and/or dosage changes, which in turn could result in suboptimal health outcomes [50]. Importantly, it has also been shown that poor adherence in psoriasis also increases the risk for the development of concomitant diseases, such as depression, inflammation-related coronary heart disease (CHD)/stroke, diabetes and cancer [27, 35, 58]. "
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    • "The mean serum leptin concentrations in patients with psoriasis were statistically significantly higher than those in controls. Circulating leptin levels showed marked sexual dimorphism, which was two to three times higher in females than in males (11, 34). As sex appeared to be an important factor in relation to levels of serum adipokines, all comparisons were made among sex-stratified populations. "
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