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Palmer V, Cornier MA, Waring A, Valdebran M. Evaluation and treatment of metabolic syndrome and cardiovascular disease in adult patients with psoriasis. Int J Dermatol 2023; 62:1437-1446. [PMID: 37845786 DOI: 10.1111/ijd.16873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
Psoriasis is strongly associated with cardiovascular disease (CVD) and metabolic syndrome, with patients having an approximately twofold increased risk of each compared to the general population. This increased risk is based on shared underlying genetic and cytokine profiles, as well as similar environmental risks. Many screening guidelines do not address the development of CVD and metabolic syndrome in these predisposed patients. These deficits are evidenced by the exclusion of psoriasis as a risk factor in validated 10-year CVD risk calculators for adult patients with chronic inflammatory diseases, as well as insufficient screening guidelines for insulin resistance in patients with psoriasis. This manuscript aims to discuss and propose allopathic and lifestyle recommendations for the screening and management of the aforementioned comorbidities in adult patients with psoriasis.
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Affiliation(s)
- Victoria Palmer
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Marc-André Cornier
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Caroline, Charleston, SC, USA
| | - Ashley Waring
- Heart and Vascular Center, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Manuel Valdebran
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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2
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Loft N, Egeberg A, Isufi D, Rasmussen MK, Bryld LE, Dam TN, Ajgeiy KK, Bertelsen T, Skov L. Response to Interleukin-17A Inhibitors According to Prior Biologic Exposures: A Danish Nationwide Study. Acta Derm Venereol 2023; 103:adv12616. [PMID: 37987625 PMCID: PMC10680979 DOI: 10.2340/actadv.v103.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
Whether response to an interleukin (IL-17) inhibitor is different in patients with previous exposure to an IL-17 inhibitor compared with patients with exposure to biologics with other cytokine targets remains to be elucidated. Therefore, the aim of this study was to assess whether previous exposure to an IL-17A inhibitor was associated with worse response than exposure to (an)other biologic(s). All patients in the DERMBIO register treated with an IL-17A inhibitor (secukinumab or ixekizumab) were included. With an absolute Psoriasis Area and Severity Index (PASI) ≤ 2 as response, the proportion of responders treated with IL-17A inhibitors was assessed in patients previously treated with another IL-17A inhibitor and compared with patients with previous exposure to (an)other biologic(s), using a χ2 test. In total, 100, 93 and 83 patients with previous exposure to an IL-17A inhibitor and 414, 372 and 314 patients with previous exposure to (an) other biologic(s) were assessed after 3, 6 and 12 months, respectively. No differences in the proportion of patients achieving PASI ≤ 2 were observed between the 2 groups after 3 months (54% vs 57%, p = 0.59), 6months (70% vs 66%, p = 0.42) and 12 months (69% vs 60%, p = 0.14). In conclusion, when treating patients with IL-17A inhibitors the cytokine target of the previous biologic does not appear to affect the response.
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Affiliation(s)
- Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark.
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Daniel Isufi
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mads K Rasmussen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars E Bryld
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Tomas N Dam
- Dermatology Clinic, Nykoebing Falster, Denmark
| | - Kawa K Ajgeiy
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - Trine Bertelsen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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3
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Näslund-Koch C, Vedel-Krogh S, Bojesen SE, Skov L. Traditional and Non-traditional Cardiovascular Risk Factors and Cardiovascular Disease in Women with Psoriasis. Acta Derm Venereol 2022; 102:adv00789. [PMID: 36121209 PMCID: PMC9677270 DOI: 10.2340/actadv.v102.2244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 12/03/2022] Open
Abstract
Women with cardiovascular disease are underdiagnos-ed, undertreated and under-represented in research. Even though the increased risk of cardiovascular disease among patients with psoriasis is well establi-shed, only a few studies have examined women with psoriasis. This study examined the prevalence of cardio-vascular risk factors and cardiovascular disease among women with psoriasis. Using the Copenhagen City Heart Study and the Copenhagen General Population Study, 66,420 women were included in a cross-sectional design. Of these, 374 (0.56%) women had hospital-diagnosed psoriasis. Women with vs with-out hospital-diagnosed psoriasis had higher odds ratios of having traditional cardiovascular risk factors, including hypertriglyceridaemia, smoking, obesity, type 2 diabetes, and low physical activity, and of having non-traditional cardiovascular risk factors, including low level of education, high level of psycho-social stress, and low-grade inflammation. Compared with women from the general population, the multi-variable adjusted odds ratio of heart failure and ischaemic cerebrovascular disease in women with hospital-diagnosed psoriasis was 2.51 (95% confidence interval 1.33-4.73) and 2.06 (1.27-3.35). In conclusion, women with hospital-diagnosed psoriasis have a higher prevalence of traditional and non- traditional cardiovascular risk factors, and increased risk of heart failure and ischaemic cerebrovascular disease, even after adjusting for these cardiovascular risk factors.
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Affiliation(s)
- Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, DK-2900 Hellerup, Denmark.
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Toussirot E, Gallais-Sérézal I, Aubin F. The cardiometabolic conditions of psoriatic disease. Front Immunol 2022; 13:970371. [PMID: 36159785 PMCID: PMC9492868 DOI: 10.3389/fimmu.2022.970371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriasis (PsO) and psoriatic arthritis (PsA), together known as psoriatic disease (PsD), are immune-mediated diseases with a chronic and relapsing course that affect the skin, the joints or both. The pathophysiology of PsO is complex and involves abnormal expression of keratinocytes and infiltration of the skin with dendritic cells, macrophages, neutrophils and T lymphocytes. Around 30% of patients with PsO develop arthritis with axial and/or peripheral manifestations. Both PsO and PsA share similar Th1- and Th17-driven inflammation, with increased production of inflammatory cytokines, including TNFα, IFN-γ, IL-17, IL-22, IL-23 in the skin and the synovial membrane. PsD is associated with a high burden of cardiometabolic diseases such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome and cardiovascular (CV) complications as compared to the general population. These comorbidities share common immunopathogenic pathways linked to systemic inflammation, and are associated with the extent and severity of the disease. Morever, they can influence treatment outcomes in PsD. In this short review, we summarize the available evidence on the epidemiology, clinical aspects and mechanisms of cardiometabolic conditions in patients with PsD. We also discuss the impact of targeted treatments such as methotrexate and biological agents on these cardiometabolic conditions.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, 25000 Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- *Correspondence: Eric Toussirot,
| | - Irène Gallais-Sérézal
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
| | - François Aubin
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
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5
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Loft N, Egeberg A, Rasmussen MK, Bryld LE, Nissen CV, Dam TN, Ajgeiy KK, Iversen L, Skov L. Prevalence and characterization of treatment-refractory psoriasis and super-responders to biologic treatment: a nationwide study. J Eur Acad Dermatol Venereol 2022; 36:1284-1291. [PMID: 35366361 DOI: 10.1111/jdv.18126] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Treatment with biologics often leads to clearance of psoriasis. However, some patients do repeatedly fail to respond and/or lose an achieved response (treatment refractory) to the biologic, whereas other patients achieve excellent response to one biologic and remain clear of psoriasis for several years (super-responders). OBJECTIVE To identify and characterize patients with treatment refractory psoriasis and patients who are super-responders to biologic treatment. MATERIAL AND METHODS Patients registered in DERMBIO between January 2007 and November 2019 were included. Patients were categorized as being treatment refractory if they had had treatment failure to ≥3 biologics targeting ≥2 different pathways. Super-responders were patients treated with their first biologic for minimum 5 years without an absolute psoriasis area and severity index (PASI) > 3 between 6 months and 5 years of treatment. All remaining patients from DERMBIO served as comparators. RESULTS In total, 3280 patients were included with a mean age of 45.0 years. 1221 (37%) of the patients were females. Of the included patients, 214 (6.5%) were categorized as treatment refractory and 207 (6.3%) were categorized as super-responders. Treatment refractory patients had higher mean body weight (100.6 kg vs. 90.6 kg, P < 0.0001) and higher mean BMI (32.2 vs. 29.4, P < 0.0001) compared with the rest of patients in DERMBIO. Super-responders had higher socioeconomic status and fewer comorbidities compared with the comparator group (P < 0.0001). CONCLUSION A small proportion of patients with psoriasis treated with biologics are either super-responders or treatment refractory. Treatment refractory patients have higher body weight, whereas super-responders have fewer comorbidities and higher socioeconomic status.
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Affiliation(s)
- N Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - M K Rasmussen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - L E Bryld
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - C V Nissen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - T N Dam
- Dermatology Clinic, Nykoebing Falster, Denmark
| | - K K Ajgeiy
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
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Daugaard C, Iversen L, Hjuler KF. Comorbidity in Adult Psoriasis: Considerations for the Clinician. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:139-150. [PMID: 35712227 PMCID: PMC9196664 DOI: 10.2147/ptt.s328572] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis is associated with several comorbidities ranging from cardiovascular comorbidity and mental disorders to other immune mediated inflammatory diseases. However, most of these co-morbidities are often overlooked or diagnosed late. Furthermore, evidence suggests that comorbidities are undertreated. Here, we provide an overview of comorbidities in psoriasis and present a simple rundown of considerations of relevance to the clinician. We hope that this review may raise clinicians' awareness of comorbidities in psoriasis and provide simple guidance regarding screening tools and treatment decisions in psoriasis with comorbidities.
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Affiliation(s)
- Christine Daugaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
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Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
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Loft N, Egeberg A, Rasmussen MK, Bryld LE, Nissen CV, Dam TN, Ajgeiy KK, Iversen L, Skov L. Outcomes Following a Mandatory Nonmedical Switch From Adalimumab Originator to Adalimumab Biosimilars in Patients With Psoriasis. JAMA Dermatol 2021; 157:676-683. [PMID: 33825804 DOI: 10.1001/jamadermatol.2021.0221] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The efficacy of adalimumab biosimilars is similar to that of brand-name adalimumab (Humira, hereinafter originator) in clinical trials. However, limited knowledge about real-world data exists for adalimumab biosimilars. Objective To assess the outcomes following a mandatory nonmedical switch from adalimumab originator to adalimumab biosimilars in patients with psoriasis. Design, Setting, and Participants This cohort study assesses the outcomes following a switch from adalimumab originator to an adalimumab biosimilar. Patients in the Biological Treatment in Danish Dermatology (DERMBIO) registry, a Danish nationwide registry of all patients treated with biologics (including biosimilars) for psoriasis since 2007, were assessed for eligibility. All patients who switched from adalimumab originator to an adalimumab biosimilar between November 1, 2018, and May 1, 2019, were included in the adalimumab biosimilar cohort. All patients with a visit between May 1, 2017, and November 1, 2017, treated with adalimumab originator were included in the adalimumab originator cohort. Data were analyzed from June 1, 2020, to October 10, 2021. Exposure Switch from adalimumab originator to an adalimumab biosimilar. Main Outcomes and Measures The primary outcome was 1-year drug retention in patients switching to adalimumab biosimilars compared with patients treated with adalimumab originator. Crude and adjusted retention rates for the adalimumab biosimilar cohort were compared with the adalimumab originator cohort with Cox proportional hazards regression using robust variance. Results A total of 348 patients were included in the adalimumab biosimilar cohort (mean [SD] age, 52.2 [13.6] years; 251 [72.1%] male) and 378 patients in the adalimumab originator cohort (mean [SD] age, 51.1 [14.1] years; 272 [72.0%] male). The 1-year drug retention rates were 92.0% (95% CI, 89.0%-94.9%) for the adalimumab biosimilar cohort and 92.1% (95% CI, 89.4%-94.8%) for the adalimumab originator cohort. Similar hazard ratios were observed between the 2 cohorts. The crude hazard ratios were 1.02 (95% CI, 0.61-1.70; P = .94) for all causes of drug discontinuation, 0.82 (95% CI, 0.39-1.73; P = .60) for insufficient effect, and 1.41 (95% CI, 0.52-3.77; P = .50) for adverse events for the adalimumab biosimilar cohort when compared with the adalimumab originator cohort. Conclusions and Relevance In this cohort study from Denmark, a nonmedical switch from adalimumab originator to adalimumab biosimilars was not associated with drug retention.
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Affiliation(s)
- Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Lars Erik Bryld
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | | | | | | | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
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9
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Abstract
BACKGROUND Psoriasis is a chronic incurable disease, and patients develop associated diseases such as obesity, diabetes, high blood pressure, dyslipidemia. OBJECTIVE The aim of the study is to determine the frequency of comorbidities (obesity, diabetes, dyslipidemia, high blood pressure) in men with psoriasis, and the relationship between the duration of psoriasis and the occurrence of comorbidities. METHODS A prospective study was conducted and included 88 male subjects, mean age 52,70 (SD=± 14,05) years, mean psoriasis duration 15,13 (SD=±12,43) years. RESULTS The incidence of obesity was 30,68%, high blood pressure 29,55%, dyslipidemia 22,73%, diabetes 13,64%. There was a weak correlation between the duration of psoriasis and the occurrence of obesity (r=0,11), dyslipidemia (r=0,18), diabetes (r=0,01), and high blood pressure (r=-0,02). CONCLUSION Comorbidities occur in men with psoriasis, and their occurrence is not related to the duration of the disease.
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Affiliation(s)
| | - Sadat Kurtalic
- Cantonal Hospital “Irfan Ljubijankic“ Bihac, Bosnia and Herzegovina
| | - Esed Omerkic
- Health Center Zivinice, Zivinice, Bosnia and Herzegovina
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10
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Telmisartan Lowers Elevated Blood Pressure in Psoriatic Mice without Attenuating Vascular Dysfunction and Inflammation. Int J Mol Sci 2019; 20:ijms20174261. [PMID: 31480330 PMCID: PMC6747395 DOI: 10.3390/ijms20174261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Psoriasis is hallmarked by vascular dysfunction, arterial hypertension, and an increased risk for cardiovascular diseases. We have shown recently that skin-driven interleukin (IL)-17A expression promotes psoriasis-like disease in mice, and this is associated with vascular inflammation, vascular dysfunction, and hypertension. As an intensive risk-factor reduction is recommended for psoriasis patients, we aimed to elucidate the impact of the angiotensin II receptor type 1 (AT1) antagonist telmisartan in a mouse model of severe psoriasis-like skin disease. METHODS AND RESULTS Elevated blood pressure measured by tail-cuff plethysmography in mice with keratinocyte-specific IL-17A overexpression (K14-IL-17Aind/+ mice) was significantly reduced in response to telmisartan. Importantly, vascular dysfunction, as assessed by isometric tension studies of isolated aortic rings, vascular inflammation measured by flow cytometry analysis of CD45+CD11b+ immune cells, as well as the increased peripheral oxidative stress levels assessed by L-012-enhanced chemiluminescence were not attenuated by telmisartan treatment of K14-IL-17Aind/+ mice, nor was the persisting skin inflammation. CONCLUSION We provide first evidence for an effective antihypertensive treatment in experimental psoriasis by AT1 blockade, but without any impact on vascular inflammation and dysfunction in our mouse model of severe psoriasis-like skin disease. This suggests that vascular function and inflammation in psoriasis might not be attenuated as long as skin inflammation persists.
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11
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Affiliation(s)
- Mina Amin
- Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Erica B. Lee
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Jashin J. Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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12
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Leisner M, Lindorff Riis J, Gniadecki R, Iversen L, Olsen M. Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study. J Eur Acad Dermatol Venereol 2018; 32:2185-2190. [DOI: 10.1111/jdv.15021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/28/2018] [Indexed: 12/17/2022]
Affiliation(s)
- M.Z. Leisner
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus N Denmark
| | - J. Lindorff Riis
- Department of Dermatology; Aarhus University Hospital; Aarhus N Denmark
| | - R. Gniadecki
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - L. Iversen
- Department of Dermatology; Aarhus University Hospital; Aarhus N Denmark
| | - M. Olsen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus N Denmark
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13
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Egeberg A, Ottosen M, Gniadecki R, Broesby-Olsen S, Dam T, Bryld L, Rasmussen M, Skov L. Safety, efficacy and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol 2018; 178:509-519. [DOI: 10.1111/bjd.16102] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 12/26/2022]
Affiliation(s)
- A. Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - M.B. Ottosen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - R. Gniadecki
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - S. Broesby-Olsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - T.N. Dam
- Skin Clinic; Nykøbing Falster Denmark
| | - L.E. Bryld
- Department of Dermatology; Roskilde Hospital; Roskilde Denmark
| | - M.K. Rasmussen
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - L. Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
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14
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Dattilo G, Imbalzano E, Casale M, Guarneri C, Borgia F, Mondello S, Laganà P, Romano P, Oreto G, Cannavò S. Psoriasis and Cardiovascular Risk: Correlation Between Psoriasis and Cardiovascular Functional Indices. Angiology 2017; 69:31-37. [DOI: 10.1177/0003319717699329] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evidence suggests that psoriasis together with other cardiovascular (CV) risk factors is associated with increased vascular morbidity, but it is not clear whether psoriasis is an independent risk factor. Consecutive patients (n = 33; 35.6 ± 5.7 years; 13 females) with mild psoriasis (Psoriasis Area and Severity Index <10) without comorbidities and 33 healthy participants (36.3 ± 5.9 years; 15 females) were enrolled. Both groups underwent echocardiography, speckle tracking (2-dimensional strain echocardiography [2D-SE]), and pulse wave velocity (PWV) testing. Clinical and conventional echocardiographic characteristics were comparable between both groups. Global longitudinal strain (GLS) was significantly lower ( P = .002) in the psoriasis group (22.39% ± 2.28%) than in controls (24.15% ± 2.17%). The PWV was significantly lower ( P = .004) in controls (8.06 ± 1.68 m/s) than in the psoriasis group (9.23 ± 1.53 m/s). Significant correlations between GLS and disease duration ( r = −.66, P < .0001) and between GLS and patient age at diagnosis ( r = .48, P = .0043) were found. Psoriasis may be an independent CV risk factor, causing cardiac and vascular impairment. Both 2D-SE and PWV may be useful tools for the screening of CV risk in these patients.
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Affiliation(s)
- Giuseppe Dattilo
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Egidio Imbalzano
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Matteo Casale
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Borgia
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Stefania Mondello
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Pasqualina Laganà
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Pietro Romano
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Oreto
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sarafinella Cannavò
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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15
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Tocci G, Goletti D, Marino V, Matucci A, Milano GM, Cantini F, Scarpa R. Cardiovascular outcomes and tumour necrosis factor antagonists in chronic inflammatory rheumatic disease: a focus on rheumatoid arthritis. Expert Opin Drug Saf 2017; 15:55-61. [PMID: 27924645 DOI: 10.1080/14740338.2016.1218469] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Many chronic rheumatic diseases have an inflammatory etiology, leading to accelerated atherosclerosis and increased occurrence of vascular diseases. In rheumatoid arthritis (RA), a reduction in cardiovascular (CV) events has been reported under treatments reducing systemic inflammation. Areas covered: Given the central role of tumour necrosis factor alpha (TNFα) in chronic inflammatory conditions and in atherosclerosis, it has been suggested that TNFα-antagonists may reduce CV risk and mortality. Although there are no randomized controlled or head-to-head trials investigating the effect of specific anti-TNF-agents on CV outcomes, observational cohort studies, national registry data, and meta-analyses in RA have reported improved CV outcomes with anti-TNF therapy. Expert opinion: It is unclear whether this is due to reduced systemic inflammation or a specific anti-TNF effect at the atherosclerotic plaque level. Observed CV benefits appear to correlate with anti-TNF response. Conversely, although inconsistently, anti-TNF agents have also been linked with increased incidence/worsening of heart failure. Additional CV adverse events with anti-TNFs include vasculitis and venous thromboembolic events. We provide an overview of the likely effects of anti-TNF therapy on CV risk and adverse events, and evaluated differences in CV outcomes among different anti-TNF-agents.
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Affiliation(s)
- Giuliano Tocci
- a Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , University of Rome Sapienza , Sant'Andrea Hospital, Rome , Italy.,b IRCCS Neuromed , Pozzilli , Italy
| | - Delia Goletti
- c Translational Research Unit, Department of Epidemiology and Preclinical Research , National Institute for Infectious Diseases , Rome , Italy
| | | | - Andrea Matucci
- e Immunoallergology Unit , Department of Biomedicine, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy
| | - Giuseppe Maria Milano
- f Department of Pediatric Hematology, Oncology and Transplant Unit , IRCCS Ospedale Pediatrico Bambino Gesù , Rome , Italy
| | - Fabrizio Cantini
- g Division of Rheumatology , Misericordia e Dolce Hospital , Prato , Italy
| | - Raffaele Scarpa
- h Rheumatology Research Unit, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
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16
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Duarte GV, de Oliveira MDFSP, Follador I, Silva TS, de Carvalho Filho EM. Diagnosis and underdiagnosis of comorbidities in psoriasis patients - need for a multidisciplinary approach. An Bras Dermatol 2016; 91:743-747. [PMID: 28099594 PMCID: PMC5198231 DOI: 10.1590/abd1806-4841.20164716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND: Psoriasis is an immune-mediated disease that manifests predominantly in the skin, although systemic involvement may also occur. Although associated comorbidities have long been recognized and despite several studies indicating psoriasis as an independent risk factor for cardiovascular events, little has been done in general medical practice regardind screening. In the United States, less than 50% of clinicians are aware of these recommendations. OBJECTIVE: To identify the prevalence of these comorbidities in 296 patients followed up at a university dermatology clinic. METHODS: Systematically investigated comorbidity frequencies were compared with general practitioners' registry frequencies. Clinical features correlated with comorbidities were also investigated. RESULTS: High prevalences of systematically investigated comorbidities such as hypertension (30%) and dyslipidemia (26.5%) were documented. Conversely, data from general practitioners' records showed that 33% of dyslipidemia cases were undiagnosed and indicated possible underdiagnosis of some comorbidities. Furthermore, an association was found between: the number of comorbidities and psoriasis duration, age and high body mass index an association was found between the number of comorbidities and psoriasis duration, age, high body mass index, waist circumference or waist-to-hip ratio. (p<0.05). CONCLUSION: Disease duration, age and high body mass index, waist circumference or waist-to-hip ratio are possible criteria for choosing which patients should be screened for comorbidities. Underdiagnosis of comorbidities by general practitioners highlights the need for a multidisciplinary approach in psoriasis management.
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17
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Martin G, Strober BE, Leonardi CL, Gelfand JM, Blauvelt A, Kavanaugh A, Stein Gold L, Berman B, Rosen T, Stockfleth E. Updates on Psoriasis and Cutaneous Oncology: Proceedings from the 2016 MauiDerm Meeting based on presentations by. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2016; 9:S5-S29. [PMID: 27800119 PMCID: PMC5077303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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18
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Armstrong EJ, Krueger JG. Lipoprotein Metabolism and Inflammation in Patients With Psoriasis. Am J Cardiol 2016; 118:603-9. [PMID: 27392508 DOI: 10.1016/j.amjcard.2016.05.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 12/21/2022]
Abstract
Psoriasis is a chronic inflammatory disease associated with a variety of co-morbid conditions, including cardiovascular disease. Advancements in our understanding of the cellular and molecular mechanisms of psoriasis have led to a better understanding regarding its pathogenesis, which in turn has stimulated ongoing research to identify the underlying pathophysiology responsible for the increased risk of cardiovascular events associated with psoriasis. Although not yet fully elucidated, emerging evidence points to immune-mediated inflammation as a process that contributes to endothelial cell dysfunction, dyslipidemia, and atherosclerosis as key processes influencing cardiovascular disease in psoriasis. In particular, the dyslipidemia present in psoriasis may be associated with altered lipoprotein function and increased atherogenicity. Here, we review how the cytokine networks involved in lipoprotein metabolism and inflammation could impact on the cardiovascular disease risk for patients with psoriasis.
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Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, University of Colorado School of Medicine, Denver, Colorado.
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
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19
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Lønnberg AS, Skov L. Co-morbidity in psoriasis: mechanisms and implications for treatment. Expert Rev Clin Immunol 2016; 13:27-34. [DOI: 10.1080/1744666x.2016.1213631] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ann Sophie Lønnberg
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lone Skov
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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20
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Rutter MK, Kane K, Lunt M, Cordingley L, Littlewood A, Young HS, Chew-Graham CA, Hilton R, Symmons DPM, Griffiths CEM. Primary care-based screening for cardiovascular risk factors in patients with psoriasis. Br J Dermatol 2016; 175:348-56. [PMID: 26990294 PMCID: PMC5113692 DOI: 10.1111/bjd.14557] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
Abstract
Background Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons. Objectives To investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross‐sectional study. Methods Patients listed as having psoriasis in primary care were recruited, screened and risk assessed by QRISK2. Results In total, 287 patients attended (mean age 53 years, 57% women, 94% white British, 22% severe disease, 33% self‐reported psoriatic arthritis). The proportion with known and screen‐detected (previously unknown) risk factors was as follows: hypertension 35% known and 13% screen‐detected; hypercholesterolaemia 32% and 37%; diabetes 6·6% and 3·1% and chronic kidney disease 1·1% and 4·5%. At least one screen‐detected risk factor was found in 48% and two or more risk factors were found in 21% of patients. One in three patients (37%) not previously known to be at high risk were found to have a high (> 10%) 10‐year CVD risk. Among the participants receiving treatment for known CVD risk factors, nearly half had suboptimal levels for blood pressure (46%) and cholesterol (46%). Conclusions Cardiovascular risk factor screening of primary care‐based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen‐detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended. What's already known about this topic? Several studies have suggested that patients with psoriasis have a greater number of risk factors for cardiovascular disease (CVD) and a higher risk for vascular events compared with the general population. However, the prevalence data used to support systematic CVD risk factor screening in psoriasis have been limited by selection bias, inappropriate choice of control groups or reliance on risk factors measured for other clinical reasons.
What does this study add? Cardiovascular risk factor screening of primary care‐based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen‐detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended.
Plain language summary available online
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Affiliation(s)
- M K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - K Kane
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - M Lunt
- Arthritis Research U.K. Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, U.K
| | - L Cordingley
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - A Littlewood
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - H S Young
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Centre for Dermatology Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - C A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, U.K.,South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, U.K
| | - R Hilton
- Bridgewater Community Healthcare NHS Trust, Wigan, U.K
| | - D P M Symmons
- Arthritis Research U.K. Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, U.K
| | - C E M Griffiths
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Centre for Dermatology Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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21
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Egeberg A, Skov L. Management of cardiovascular disease in patients with psoriasis. Expert Opin Pharmacother 2016; 17:1509-16. [DOI: 10.1080/14656566.2016.1190336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Gulliver WP, Randell S, Gulliver S, Connors S, Bachelez H, MacDonald D, Gladney N, Morrissey A, Fleming P. Do Biologics Protect Patients With Psoriasis From Myocardial Infarction? A Retrospective Cohort. J Cutan Med Surg 2016; 20:536-541. [PMID: 27207347 DOI: 10.1177/1203475416650430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome. METHODS We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI). RESULTS Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056). CONCLUSION Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.
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Affiliation(s)
- Wayne P Gulliver
- Newlab Clinical Research, St John's, NL, Canada .,Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Shane Randell
- Newlab Clinical Research, St John's, NL, Canada.,Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | | | - Sean Connors
- Division of Cardiology, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Hervé Bachelez
- Paris VII Denis-Diderot University, Assistance Publique-Hôpitaux de Paris (AP-HP), Dermatology Department, Hôpital Saint-Louis, Paris, France
| | - Don MacDonald
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Neil Gladney
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Andrea Morrissey
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Patrick Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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23
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Shiba M, Kato T, Funasako M, Nakane E, Miyamoto S, Izumi T, Haruna T, Inoko M. Association between Psoriasis Vulgaris and Coronary Heart Disease in a Hospital-Based Population in Japan. PLoS One 2016; 11:e0149316. [PMID: 26910469 PMCID: PMC4766013 DOI: 10.1371/journal.pone.0149316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Psoriasis vulgaris is a chronic inflammatory skin disease with an immune-genetic background. It has been reported as an independent risk factor for coronary heart disease (CHD) in the United States and Europe. The purpose of this study was to investigate the association between psoriasis and CHD in a hospital-based population in Japan. Methods For 113,065 in-hospital and clinic patients at our institution between January 1, 2011 and January 1, 2013, the diagnostic International Classification of Diseases (ICD)-10 codes for CHD, hypertension, dyslipidemia, diabetes, and psoriasis vulgaris were extracted using the medical accounting system and electronic medical record, and were analyzed. Results The prevalence of CHD (n = 5,167, 4.5%), hypertension (n = 16,476, 14.5%), dyslipidemia (n = 9,236, 8.1%), diabetes mellitus (n = 11,555, 10.2%), and psoriasis vulgaris (n = 1,197, 1.1%) were identified. The prevalence of CHD in patients with hypertension, dyslipidemia, diabetes, and psoriasis vulgaris were 21.3%, 22.2%, 21.1%, and 9.0%, respectively. In 1,197 psoriasis patients, those with CHD were older, more likely to be male, and had more number of the diseases surveyed by ICD-10 codes. Multivariate analysis showed that psoriasis vulgaris was an independent associated factor for CHD (adjusted odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.01–1.58; p = 0.0404) along with hypertension (adjusted OR: 7.78; 95% CI: 7.25–8.36; p < 0.0001), dyslipidemia (adjusted OR: 2.35; 95% CI: 2.19–2.52; p < 0.0001), and diabetes (adjusted OR: 2.86; 95% CI: 2.67–3.06; p < 0.0001). Conclusion Psoriasis vulgaris was independently associated with CHD in a hospital-based population in Japan.
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Affiliation(s)
- Masayuki Shiba
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takao Kato
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
| | - Moritoshi Funasako
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Eisaku Nakane
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shoichi Miyamoto
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Toshiaki Izumi
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tetsuya Haruna
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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24
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Lindhardsen J, Kristensen SL, Ahlehoff O. Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives. Am J Cardiovasc Drugs 2016; 16:1-8. [PMID: 26293235 DOI: 10.1007/s40256-015-0141-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy in these conditions has stimulated considerable research and started an ongoing discussion on the need for a multidisciplinary approach and dedicated guidelines on CVD prevention in these patients. In addition, the possibility of inhibiting inflammation as a means to preventing CVD in these patients has gained considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD prevention in patients with CID.
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Affiliation(s)
- Jesper Lindhardsen
- Department of Internal Medicine, Copenhagen University Hospital Slagelse, 4200, Slagelse, Denmark
| | - Søren Lund Kristensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 7, 2100, Copenhagen, Denmark.
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25
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Abstract
Psoriasis is a systemic inflammatory disease that confers significant risk of metabolic derangements and adverse cardiovascular outcomes. Early detection and treatment of modifiable risk factors and modulation of the systemic inflammatory response are important treatment goals. Studies have shown that there is a significant lack of awareness of the relationship between psoriasis and cardiovascular disease, so future considerations should focus on education of and collaboration with health care providers, especially those in primary care, and development of updated, rigorous screening guidelines. In addition, targeted biologic therapies such as TNF-a inhibitors have shown immense promise in targeting the systemic inflammation associated with psoriatic disease, but whether they will impact long-term cardiovascular outcomes remains to be seen.
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Affiliation(s)
- Kathryn T Shahwan
- Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 240, Boston, MA 02114, USA
| | - Alexa B Kimball
- Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 240, Boston, MA 02114, USA.
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26
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Desai SR, Frieden IJ, Gelfand JM, High W, Kavanaugh A, Marghoob AA, Ozog DM, Rosen T, Stein Gold L, Strober B, Swanson N, Martin G. Updates on Psoriasis and Cutaneous Oncology: Proceedings from the 2015 MauiDerm Meeting. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2015; 8:S4-S26. [PMID: 26504503 PMCID: PMC4591555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Seemal R Desai
- University of Texas Southwestern Medical Center Dallas, TX
| | | | | | | | | | | | - David M Ozog
- Henry Ford Hospital and Wayne State University Detroit, MI
| | - Ted Rosen
- Baylor College of Medicine Houston, TX
| | | | - Bruce Strober
- University of Connecticut Health Center Farmington, CT
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27
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Egeberg A, Riis Hansen P. Does treatment with statins protect against psoriasis? Br J Dermatol 2015; 173:327-8. [DOI: 10.1111/bjd.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Egeberg
- Department of Cardiology Gentofte Hospital University of Copenhagen Kildegårdsvej 28 Post 635 2900 Hellerup Denmark
| | - P. Riis Hansen
- Department of Cardiology Gentofte Hospital University of Copenhagen Kildegårdsvej 28 Post 635 2900 Hellerup Denmark
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Takeshita J, Wang S, Shin DB, Mehta NN, Kimmel SE, Margolis DJ, Troxel AB, Gelfand JM. Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom. JAMA Dermatol 2015; 151:161-9. [PMID: 25322196 PMCID: PMC4728300 DOI: 10.1001/jamadermatol.2014.2094] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Hypertension is prevalent among patients with psoriasis. The effect of psoriasis and its severity on hypertension control is unknown. OBJECTIVE To determine the association between uncontrolled blood pressure and psoriasis, both overall and according to objectively measured psoriasis severity, among patients with diagnosed hypertension. DESIGN, SETTING, AND PARTICIPANTS Population-based cross-sectional study nested in a prospective cohort drawn from The Health Improvement Network (THIN), an electronic medical records database broadly representative of the general population in the United Kingdom. The study population included a random sample of patients with psoriasis (n = 1322) between the ages of 25 and 64 years in THIN who were included in the Incident Health Outcomes and Psoriasis Events prospective cohort and their age- and practice-matched controls without psoriasis (n = 11,977). All included patients had a diagnosis of hypertension; their psoriasis diagnosis was confirmed and disease severity was classified by their general practitioners. MAIN OUTCOMES AND MEASURES Uncontrolled hypertension was defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher based on the blood pressure recorded closest in time to the assessment of psoriasis severity. RESULTS There was a significant positive dose-response relationship between uncontrolled hypertension and psoriasis severity as objectively determined by the affected body surface area in both unadjusted and adjusted analyses that controlled for age, sex, body mass index, smoking and alcohol use status, presence of comorbid conditions, and current use of antihypertensive medications and nonsteroidal anti-inflammatory drugs (adjusted odds ratio [aOR], 0.97; 95% CI, 0.82-1.14 for mild psoriasis; aOR, 1.20; 95% CI, 0.99-1.45 for moderate psoriasis; and aOR, 1.48; 95% CI, 1.08-2.04 for severe psoriasis; P = .01 for trend). The likelihood of uncontrolled hypertension among psoriasis overall was also increased, although not statistically significantly so (aOR, 1.10; 95% CI, 0.98-1.24). CONCLUSIONS AND RELEVANCE Among patients with hypertension, psoriasis was associated with a greater likelihood of uncontrolled hypertension in a dose-dependent manner, with the greatest likelihood observed among those with moderate to severe psoriasis defined by 3% or more of the body surface area affected. Our data suggest a need for more effective blood pressure management, particularly among patients with more severe psoriasis.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Shuwei Wang
- Division of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Stephen E Kimmel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia5Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Salahadeen E, Torp-Pedersen C, Gislason G, Hansen P, Ahlehoff O. Nationwide population-based study of cause-specific death rates in patients with psoriasis. J Eur Acad Dermatol Venereol 2014; 29:1002-5. [DOI: 10.1111/jdv.12523] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/17/2014] [Indexed: 12/12/2022]
Affiliation(s)
- E. Salahadeen
- Department of Cardiology; Copenhagen University Hospital Gentofte; Hellerup Denmark
| | - C. Torp-Pedersen
- Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - G. Gislason
- Department of Cardiology; Copenhagen University Hospital Gentofte; Hellerup Denmark
- The Danish National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - P.R. Hansen
- Department of Cardiology; Copenhagen University Hospital Gentofte; Hellerup Denmark
| | - O. Ahlehoff
- Department of Cardiology; Copenhagen University Hospital Roskilde; Roskilde Denmark
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Imbalzano E, Casale M, D’Angelo M, Mandraffino G, Giugno V, Di Bella G, Carerj S, Dattilo G. Cardiovascular Risk and Psoriasis. Angiology 2014; 66:101-3. [DOI: 10.1177/0003319714527339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Matteo Casale
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Myriam D’Angelo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Vincenza Giugno
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, Le Maître M, Ortonne JP, Paul C, Richard MA. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013; 27 Suppl 3:12-29. [PMID: 23845149 DOI: 10.1111/jdv.12163] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 12/18/2022]
Abstract
UNLABELLED Previous epidemiological studies have demonstrated a high prevalence of cardiovascular (CV) risk factors in psoriasis patients, including metabolic syndrome, cigarette smoking, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidaemia. An increase in CV morbidity and mortality attributable to psoriasis is still under question. PRIMARY OBJECTIVE to assess CV morbidity and mortality in psoriasis and psoriatic arthritis (PsA) including stroke, coronary artery disease, myocardial infarction (MI) and peripheral artery disease. SECONDARY OBJECTIVES to assess if psoriasis per se is an independent CV risk factor and if psoriasis severity is a predictor of CV risk. We also evaluated the effect of conventional systemic treatments for psoriasis on CV mortality. A systematic literature search was carried out from 1980 to December 2011, in the Embase, Medline and Cochrane Library databases, in English and French using a combination of keywords including (Psoriasis) OR (Psoriatic arthritis) AND (Myocardial infarction) OR (Coronaropathy) OR (Stroke) OR (Cardiovascular) AND (Methotrexate) AND (Ciclosporin) AND (Retinoids). Of the 929 identified references, 33 observational studies evaluating the rates of cardiovascular events (CVE) in patients with psoriasis and PsA compared with controls were selected. Meta-analysis of both cohort and cross-sectional studies showed an increased risk of MI with Odds Ratio (OR) of 1.25 (95% CI 1.03-1.52) and 1.57 (95% CI 1.08-2.27) in psoriasis and PsA, respectively, compared with the general population. The risk of MI was more pronounced for patients having severe psoriasis and for patients with psoriasis of early onset. It remained significantly elevated after controlling for major CV risk factors. The meta-analysis identified a small, but significant association between psoriasis, PsA and coronary artery disease with an OR between 1.19 (95% CI 1.14-1.24) for cross-sectional studies, 1.20 (95% CI 1.13-1.27) for cohort studies and 1.84 (95% CI 1.09-3.09) for case-control studies. The risk of coronary artery disease seemed to be more pronounced in patients with severe psoriasis and in patients with psoriasis of early onset. The meta-analysis assessing the risk of stroke gave inconclusive results: analysis of cross-sectional studies suggested that psoriasis patients had a slightly higher risk of stroke with an OR of 1.14 (95% CI 1.08-1.99), whereas the meta-analysis of cohort studies failed to show an association. There was also an increased risk of peripheral artery disease in psoriasis. No significant increased risk of CV mortality could be shown for both psoriasis and PsA patients. The use of methotrexate was associated with a reduced incidence of cardiovascular disease in two studies. The use of etretinate was associated with a reduction of CV mortality in one study. Potential selection bias such as the 'healthy user effect' prevents from drawing definite conclusions. There may be a small, but significant increased risk of CVE, but not of CV mortality in psoriasis and PsA patients. The psoriasis attributable risk remains difficult to assess due to confounding factors. The moderate quality of CV risk factors reporting in studies should be acknowledged. In addition, heterogeneity in study design, outcome definition and assessment represent major limitations. Nevertheless, screening and management of CV risk factors are important in psoriasis.
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Affiliation(s)
- C Horreau
- Aix-Marseille University, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, France
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Goldminz AM, Buzney CD, Kim N, Au SC, Levine DE, Wang AC, Volf EM, Yaniv SS, Kerensky TA, Bhandarkar M, Dumont NM, Lizzul PF, Loo DS, Kulig JW, Brown ME, Lopez-Benitez JM, Miller LC, Gottlieb AB. Prevalence of the metabolic syndrome in children with psoriatic disease. Pediatr Dermatol 2013; 30:700-5. [PMID: 24016334 DOI: 10.1111/pde.12218] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adults with psoriasis have a greater risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD), but few studies have investigated the prevalence of MetS and other risk factors for CVD in children with psoriasis. In an assessor-blinded study, 20 children ages 9-17 years with a current or previously documented history of psoriasis involving 5% or more of their body surface area or psoriatic arthritis were compared with a cohort of age- and sex-matched controls with benign nevi, warts, or acne. MetS, our primary endpoint, was defined by the presence of abnormal values in at least three of the following measures: triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), waist circumference, and blood pressure. Secondary endpoints included high-sensitivity C-reactive protein (hs-CRP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Thirty percent (6/20) of children with psoriasis met the criteria for MetS, compared with 5% (1/20) of the control group (p < 0.05). Subjects with psoriasis had higher mean FBG (91.1 mg/dL) than the control group (82.9 mg/dL) (p = 0.01). There were no statistically significant differences in the other four components of MetS, BMI, BMI percentile, hs-CRP, TC, or LDL-C. The results of this trial demonstrate that children with psoriasis have higher rates of MetS than age- and sex-matched controls. It may therefore be important to evaluate children with psoriasis for components of MetS to prevent future CVD morbidity and mortality.
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Affiliation(s)
- Ari M Goldminz
- Tufts University, School of Medicine, Boston, Massachusetts
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Doukaki S, Caputo V, Bongiorno MR. Psoriasis and Cardiovascular Risk: Assessment by CUORE Project Risk Score in Italian Patients. Dermatol Res Pract 2013; 2013:389031. [PMID: 24082881 PMCID: PMC3780628 DOI: 10.1155/2013/389031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 02/03/2023] Open
Abstract
Background. Psoriasis is a common inflammatory and immune-mediated skin disease. There is growing controversy as to whether cardiovascular risk is elevated in psoriasis. A number of studies suggest a high prevalence of cardiovascular risk factors as well as cardiovascular diseases in psoriasis patients. Objective. The objective of this study was to estimate cardiovascular risk score in psoriasis patients and the relation between cardiovascular risk and psoriasis features. Cardiovascular risk was assessed by CUORE project risk score built within the longitudinal study of the Italian CUORE project and suited to populations with a low rate of coronary heart disease. Results. A case-control study in 210 psoriasis outpatients and 111 controls with skin diseases other than psoriasis was performed. CUORE project risk score was higher in patients than controls (6.80 ± 6.34 versus 4.48 ± 4.38, P < 0.001). Compared to controls, psoriasis patients have higher risk of developing major cardiovascular events. Cardiovascular risk was not related to psoriasis characteristics. Conclusion. Increased focus on identifying cardiovascular risk factors and initiation of preventive lifestyle changes or therapeutic interventions in patients with psoriasis is warranted.
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Affiliation(s)
- Spyridoula Doukaki
- Department of Dermatology, University of Palermo, Via del Vespro 131, 90123 Palermo, Italy
| | - Valentina Caputo
- Department of Dermatology, University of Palermo, Via del Vespro 131, 90123 Palermo, Italy
| | - Maria Rita Bongiorno
- Department of Dermatology, University of Palermo, Via del Vespro 131, 90123 Palermo, Italy
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Bostoen J, Van Praet L, Brochez L, Mielants H, Lambert J. A cross-sectional study on the prevalence of metabolic syndrome in psoriasis compared to psoriatic arthritis. J Eur Acad Dermatol Venereol 2012; 28:507-11. [DOI: 10.1111/jdv.12071] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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