Psoriasis patients face higher than average death risk after a heart attack

Researchers studied nearly 50,000 patients who had experienced their first heart attack between 2002 and 2006, following the 462 patients with psoriasis for an average of 19.5 months and the 48,935 controls for an average of 22 months.

They found that the patients with psoriasis had higher all-cause and specific death rates and say this indicates the need for a more aggressive approach to secondary prevention of cardiovascular disease in this group of patients.

"Psoriasis is a common skin condition that is estimated to affect 125 million people worldwide" explains lead author and cardiologist Dr Ole Ahlehoff, from Copenhagen University Hospital Gentofte.

"It is a chronic inflammatory condition where the skin cells we naturally shed all the time are replaced much quicker than normal, leading to a build up of psoriatic plaque. Heart attacks are also caused by a build-up of plaque, in the arteries leading to the heart. Our study explored the links between the two conditions, which appear to have similar inflammatory mechanisms."

Key finding of the study included:

• The incidence rates per 1000 patient years for all-cause deaths were 16 per cent higher for those with psoriasis (138.3 versus 119.4) and the adjusted hazard ratio was 1.18 (18 per cent higher).
• The incidence rates per 1000 patient years for deaths for a composite of cardiovascular death, recurrent heart attacks or stroke were 24 per cent higher for those with psoriasis (185.6 versus 149.7) and the adjusted hazard ratio was 1.26 (26 per cent higher).
• Baseline measurements showed that patients with psoriasis had a higher rate of hospitalisation for stable and / or unstable angina (severe chest pain). They also showed that a higher percentage of patients with psoriasis were treated with statins and ACE inhibitors / angiotensin 2 receptor blockers.
• Patients with psoriasis who survived their first heart attack were more likely to receive statin therapy than those without psoriasis. However the presence of other health issues, and the differences in clinical management, did not explain the worsened prognosis in patients with psoriasis.

"To our knowledge, this is the first study to assess the prognosis in patients with psoriasis following a heart attack" says Dr Ahlehoff. "Our findings show that people with psoriasis demonstrated a significantly increased risk of recurring adverse cardiovascular events and a trend for increased all-cause deaths after a heart attack.

"Furthermore, the poor prognosis faced by psoriasis patients who have had a heart attack suggests the need for a more aggressive approach to secondary prevention of cardiovascular disease in this group of patients."

More information: Prognosis following first-time myocardial infarction in patients with psoriasis: a Danish nationwide cohort study. Ahlehoff et al. Journal of Internal Medicine. 270, pp237-244. (September 2011). DOI: 10.1111/j.1365-2796.2011.02368.x

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