一般的な皮膚疾患により冠動脈疾患のリスクが上昇する

Psoriasis is a risk factor for a range of negative cardiovascular events, according to research presented at the American College of Cardiology's 59th annual scientific session.

The study - the first to ever link psoriasis with coronary problems on a nationwide scale - tracked rates of psoriasis, atrial fibrillation, stroke, heart attack, angioplasty and death in the entire adolescent and adult population of Denmark over a decade. Using a nationwide register of hospital visits and prescriptions, researchers tracked 40,262 patients with mild to severe psoriasis from the start of 1997 until the end of 2006. The researchers believed that psoriasis could be associated with coronary disease because both disorders are associated with excess inflammation.

Their hypothesis proved to be correct. Patients with severe psoriasis were more likely to experience all of the adverse cardiac events the researchers tracked and patients with mild psoriasis were more likely to experience atrial fibrillation, stroke and angioplasty.

"Although the association of psoriasis to myocardial infarction and stroke has been reported previously, the results have been ambiguous, debated, and the clinical relevance doubted," said Ole Ahlehoff, MD., Copenhagen University Hospital Gentofte and the study's lead researcher. "Our results establish psoriasis as a clinically significant and independent risk factor for a range of cardiovascular adverse events."

Psoriasis was associated with increased risk of atrial fibrillation for both mild cases (relative risk 1.22) and moderate/severe cases (relative risk 1.51). Mild psoriasis (relative risk 1.19) and moderate/severe psoriasis (relative risk 1.45) were also associated with increased risk of stroke. The increased risks of atrial fibrillation and stroke were age-dependent, with a relative risk of 2.28 and a relative risk of 1.92, respectively, in patients with moderate/severe psoriasis who were younger than 50 years old at the beginning of the study in 1997.

Mild psoriasis did not confer increased risk of all-cause mortality (relative risk 1.04), but moderate/severe psoriasis was associated with an increased risk of death (relative risk 1.67). The risk of myocardial infarction was not raised in mild psoriasis (relative risk 1.10) but was in moderate/severe psoriasis (relative risk 1.24).

Psoriasis conferred increased risk of angioplasty for both mild cases (relative risk 1.29) and moderate/severe cases (relative risk 1.59).

The researchers adjusted for a wide range of possible confounding factors and the association between psoriasis and cardiac troubles remained.

These novel findings, including the higher risk for younger patients, indicate that psoriasis patients should not only be treated for the symptoms of that disorder, but should also take steps to monitor and prevent cardiovascular problems, according to the researchers.

"I believe that our results call for increased awareness of psoriasis as a contributor to cardiovascular disease and for a discussion of future medical management," Ahlehoff said. "For example, should patients with psoriasis receive statin therapy earlier than predicted by traditional risk-scores? Since psoriasis is a common disease, affecting two to three percent of people world-wide, reducing cardiovascular risk in this large group of patients could have a considerable impact."

This study was funded by the Department of Cardiology at Copenhagen University Hospital Gentofte.