Incidence of cardiovascular disease in individuals with psoriasis.pdf

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Incidence of cardiovascular disease in individuals with psoriasis.pdf

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Incidence of cardiovascular disease in individuals with psoriasis

Incidence of Cardiovascular Disease in Individuals with Psoriasis: A Systematic Review and Meta-Analysis Eleanor J. Samarasekera1, Julie M. Neilson1, Richard B. Warren2, Jill Parnham1 and Catherine H. Smith3 The relationship between psoriasis and increased risk of cardiovascular disease (CVD) is controversial. We critically evaluate 14 cohorts and meta-analyze the magnitude of CVD risk for the primary outcomes of CVD mortality, stroke, and myocardial infarction (MI), and establish subgroup risk for different psoriasis severities and age groups. Increased CVD risk was identified only in individuals with severe psoriasis (defined as requiring systemic therapy or hospital admission): the risk ratio relative to the general population was 1.37 (95% confidence interval (CI) 1.17–1.60) for CVD mortality, 3.04 (95% CI 0.65–14.35) for MI, and 1.59 (95% CI 1.34–1.89) for stroke. The relative risks of CVD were highest in the younger, severe psoriasis population (e.g., 3.10 (95% CI 1.98–4.86) for MI at 30 years), and absolute risks were greatest in older individuals with severe psoriasis (e.g., 23.2 excess MIs per 10,000 person-years at 60 years). Uncertainty remains about whether CVD risk is directly attributable to psoriasis, as the majority of studies failed to adequately adjust for key traditional risk factors. Journal of Investigative Dermatology (2013) 133, 2340–2346; doi:10.1038/jid.2013.149; published online 16 May 2013 INTRODUCTION Psoriasis is one of the most common immune-mediated inflammatory disorders, with prevalence estimates worldwide ranging from 0 91% (USA) to 8 5% (Norway) (Parisi et al., 2012). Extent varies from a few scaly plaques at extensor sites to whole-body involvement, and for many individuals it results in profound functional, psychological, and social morbidity (Rapp et al., 1999). Some population-based cohort studies also suggest that individuals with psoriasis (Mallbris et al., 2004; Gelfand et al., 2006; Kurd et al., 2010), in common with ot