Increased Risk of Aortic Valve Stenosis in Patients With Psoriasis

A Nationwide Cohort Study

Usman Khalid; Ole Ahlehoff; Gunnar Hilmar Gislason; Lone Skov; Christian Torp-Pedersen; Peter Riis Hansen

Disclosures

Eur Heart J. 2015;36(32):2177-2183. 

In This Article

Abstract and Introduction

Abstract

Aim Psoriasis is a chronic inflammatory disease associated with increased risk of cardiovascular disease including atherosclerosis. The pathogenesis of aortic valve stenosis (AS) also includes an inflammatory component. We therefore investigated the risk of AS in patients with psoriasis compared with the general population in a nationwide cohort.

Methods The study comprised the entire Danish population aged ≥18 years followed from 1 January 1997 until diagnosis of AS, 31 December 2011, or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AS were calculated and incidence rate ratios (IRRs) adjusted for age, gender, calendar year, comorbidity, medications, and socioeconomic status, were estimated in Poisson regression models.

Results A total of 5 107 624 subjects were eligible for analysis. During the study period, we identified 58 747 patients with mild psoriasis and 11 918 patients with severe psoriasis. The overall incidence rates for AS were 8.09, 16.07, and 20.08 per 10 000 person-years for the reference population (48 539 cases [mean follow-up 12.3 years]), mild psoriasis (509 cases [mean follow-up 6.2 years]), and severe psoriasis (99 cases [mean follow-up 5.4 years]), respectively. Correspondingly, the fully adjusted IRRs for AS were markedly increased in patients with psoriasis with IRR 1.22 (95% confidence interval [CI] 1.12–1.33) and IRR 1.61 (CI 1.32–1.96) for subjects with mild and severe disease, respectively.

Conclusion In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AS. The mechanisms underlying this novel finding require further study.

Introduction

Psoriasis is a common chronic inflammatory disease estimated to affect between 0.9 (USA) and 8.5% (Norway) of the world's population.[1] Psoriasis appears to be an independent risk factor for ischaemic heart disease and shares inflammatory mechanisms with atherosclerosis.[2–8] Aortic valve stenosis (AS) is one of the most frequent valvular diseases with prevalence increasing from 0.2% in adults between 50 and 59 years to 9.8% in octogenarians, and is associated with major morbidity, mortality, and societal economic burden.[9,10] Aortic valve stenosis shares risk factors with atherosclerosis (e.g. smoking, hypertension, diabetes, and hypercholesterolaemia) and the pathogenesis of AS also has a number of similarities with atherosclerosis with active remodelling processes in which inflammation plays an important role.[9,11–14] From this perspective, a link between AS and psoriasis due to shared inflammatory pathways and overlap of classical cardiovascular risk factors may exist. We therefore used Danish nationwide registers to determine the risk of AS in patients with psoriasis compared with the general population.

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