Psoriasis adds to increased risk of cardiovascular procedures, surgery in patients with hypertension.
Patients with psoriasis and hypertension are at a higher risk of having to undergo cardiovascular procedures and surgery, compared with patients with hypertension alone, according to Hsien-Yi Chiu, MD, PhD, from the department of dermatology at the National Taiwan University Hospital in Hsinchu and his colleagues.
"The results suggested that hypertensive patients with concurrent psoriasis experienced an earlier and more aggressive disease progression of hypertension, compared with general hypertensive patients," they wrote in the Journal of Dermatology. "Thus, patients with hypertension and psoriasis should be considered for more aggressive strategies for prevention of primary [cardiovascular disease] and more intense assessments for cardiovascular interventions needed to improve [cardiovascular disease] outcome in these patients."
They performed a nationwide cohort study of patients in the Taiwan National Health Insurance Research Database with new-onset hypertension from 2005 to 2006. Those with psoriasis (4,039 patients) were matched by age and sex to patients diagnosed with hypertension but not psoriasis; mean follow-up was 5.62 years. Their mean age was 58 years and about 31% of the psoriasis cohort were female. They were divided into groups based on psoriasis severity (mild and severe) and type (psoriasis with and without arthritis). Patients with psoriasis and hypertension also had higher rates of cerebrovascular disease, coronary heart disease, hyperlipidemia, and diabetes during the year before the study.
The outcome measured was having a cardiovascular procedure (percutaneous coronary intervention with/ without stenting or percutaneous transluminal coronary angioplasty and transcatheter radiofrequency ablation for arrhythmia) and cardiovascular surgery (coronary artery bypass grafting and other surgery for heart valves, arrhythmia, cerebrovascular disease, peripheral vessels, and the aorta).
Patients with both psoriasis and hypertension were at an increased risk for having a cardiovascular procedure and surgery (adjusted hazard ratio, 1.28; 95% confidence interval, 1.071.53), compared with patients with only hypertension. The risk of this outcome was also increased among patients with severe psoriasis or psoriatic arthritis, compared with patients who had mild psoriasis (aHR, 1.22; 95% CI, 0.98-1.51) and with patients with psoriasis but not arthritis (aHR, 1.15; 95% CI, 0.84-1.58); however, the results did not reach statistical significance after adjustment, which the researchers attributed to the small subgroup size.
Limitations in the study included reliance on claims data for psoriasis diagnosis, lack of blood pressure data to identify hypertension severity, and unmeasured factors and confounders.
This study was supported in part through grants by the National Taiwan University Hospital, Asia-Pacific La Roche-Posay Foundation 2014, and the Ministry of Science and Technology. Dr. Chiu is on the speaker's bureau for Abb Vie, Eli Lilly, Janssen Pharmaceuticals, Novartis, and Pfizer. Another author has conducted clinical trials for or received fees for being a consultant or speaker for companies that include Abbvie, Boehringer Ingelheim, and Celgene. The remaining authors reported no relevant conflicts of interest.
BY JEFF CRAVEN
SOURCE: Chiu H-Y et al. J Dermatol. 2018 Oct 16. doi: 10.1111/1346-8138.14654.
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|Date:||Dec 1, 2018|
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