11 October 2006

Psoriasis ups heart attack risk

Psoriasis sufferers may face an increased risk of having a heart attack, a new study suggests.

Psoriasis sufferers may face an increased risk of having a heart attack, a new study suggests.

The risk appears to be most pronounced among younger patients with more severe forms of the disease, according to a paper appearing in the October 11 issue of the Journal of the American Medical Association.

"This study is really quite important," said Liz Horn, director of research for the National Psoriasis Foundation. "There have been a few other studies, but this one is important because it uses such a large database. This is just one more very important study that gives more evidence."

While more studies are needed to confirm the findings, "the potential is there for someone who has severe psoriasis who is in their 50s or 40s, of having a heart attack," said lead researcher Dr Joel Gelfand, an assistant professor of dermatology at the University of Pennsylvania School of Medicine, in Philadelphia.

Risk not that high
"The relative risk due to severe psoriasis is similar to the relative risk of having a heart attack from having diabetes," he said. "But the absolute risk [to any one person] is low. If you have severe psoriasis and are in your 40s, the risk of having a heart attack due to psoriasis is about one in 600 per year."

Psoriasis is thought to be an autoimmune disorder, occurring when the body inexplicably begins overproducing skin cells. The extra cells pile up on the surface of the skin before they have a chance to mature, creating bright red patches that cause itching, burning and stinging. The disease affects 2 percent to 3 percent of the adult population.

Some previous studies had shown an association between psoriasis and cardiovascular diseases but those studies could not rule out obesity, smoking and other risk factors as the true culprits.

In this study, the authors examined medical records from a large sample of patients aged 20 to 90 in the United Kingdom. The sample included more than half a million controls (people without psoriasis), more than 125 000 patients with mild psoriasis and almost 4 000 with severe psoriasis.

Psoriasis severity tied to risk
Heart attacks were more common in patients with severe psoriasis (five heart attacks per 1 000 person-years) and mild psoriasis (four heart attacks per 1 000 person-years) compared with the controls (about 3.6 heart attacks per 1 000 person-years).

Individuals who were younger and had more severe disease had the highest relative risk, with a 30-year-old patient with mild disease having a 29 percent greater risk than a person without psoriasis. A 30-year-old patient with severe psoriasis had about triple the risk and a 60-year-old patient with severe disease had a 36 percent increased risk.

It is thought that earlier-onset psoriasis (before age 40) is more severe than later-onset disease (after age 40). About three-quarters of patients will develop psoriasis before they turn 40.

"People with psoriasis have a bigger tendency to smoke, be obese, have high blood pressure and other things we know are risk factors for cardiovascular disease," Gelfand said. "The thing we've done, which hadn't been done before for psoriasis, was to control for these risk factors. We found that psoriasis still increases the risk of having a heart attack."

Inflammation may be the key
The common denominator may be inflammation, the researchers said.

"Immune activity is important for establishing atherosclerosis or blockage of the arteries and promoting them to rupture into a heart attack," Gelfand explained. "The same immune cells involved in this are involved in psoriasis. Other diseases, like rheumatoid arthritis - which share common immune factors - [also] have an increased risk of heart disease. This is a scientific theory that has been evolving over the last decade or so but still needs additional studies to confirm."

In the meantime, patients with psoriasis should not be alarmed but should see a physician and be screened for cardiovascular risk factors, Gelfand said. And, if you do have risk factors, you should treat them according to current guidelines. This includes stopping smoking and losing excess weight.

"There needs to start being a conversation between patients and physicians about the risk of cardiovascular disease and what psoriasis patients should be doing to decrease risks," Horn said.

Still very early
"This is really important information," she said. "But it's still very early in understanding what all this means. I do think general health issues about cardiovascular disease and lifestyle modification is probably a good starting place."

"This study is of great concern and it underscores why we believe the US National Institutes of Health should be increasing research on psoriasis," Michael Paranzino, president of Psoriasis Cure Now, said in a statement. "Unlocking the apparent link between psoriasis and heart attack risk may help us improve treatments both for psoriasis and heart attack prevention. The 'heartbreak of psoriasis' is supposed to be a tired punch line, not a literal truth."

"This study suggests that estimates of the impact of psoriasis, both in terms of money spent and lives lost, may be undercounting the true burden of this disease," Paranzino added. "With NIH funding having doubled over the last decade but psoriasis funding down 20 percent, this study should serve as a wake-up call that increasing psoriasis research funding should become a priority. One of the key questions that patients need answered is whether aggressive treatment of psoriasis can reduce this increased heart attack risk." – (HealthDayNews)

Read more:
A-Z of Psoriasis
Heart Centre

October 2006


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Dr Suretha Kannenberg holds a degree in Medicine and a Masters in Dermatology from the University of Stellenbosch. She is employed as a consultant dermatologist by Stellenbosch University and Tygerberg Academic Hospital, where she is involved in clinical duties and the training of medical students and dermatology residents. Her areas of interest and research include vitiligo, eczema and acne. She also performs limited private practice work in the Northern suburbs of Cape Town in general and cosmetic dermatology.

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