Acta Dermato-Venerelogica Issue No 7, 2017 97-7CompleteContent | Page 15

819 CLINICAL REPORT Risk of Myocardial Infarction in Patients with Psoriasis and Psoriatic Arthritis: A Nationwide Cohort Study Alexander EGEBERG 1 , Jacob P. THYSSEN 1 , Peter JENSEN 1 , Gunnar H. GISLASON 2–4 and Lone SKOV 1 Department of Dermatology and Allergy, 2 Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, The Danish Heart Foundation, and 4 The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark 1 3 Psoriasis has been associated with increased risk of myocardial infarction (MI) in some, but not all, studies. This study investigated the risk of MI in patients with psoriasis and psoriatic arthritis in Denmark. All resi- dents aged ≥18 years from 1 January 2008 through 31 December 2012 were included. Adjusted hazard ratios (HRs) did not show an increased risk of MI in patients with mild psoriasis (HR 1.02; 95% confidence interval (95% CI) 0.96–1.09), whereas the risk was slightly increased in patients with severe psoriasis (HR 1.21; 1.07–1.37). Stratified by age, there was no increased risk of MI in any specific age group, regardless of se- verity. Limited to first-time MI, the risk was increased only in patients with severe psoriasis aged <50 years (HR 1.52; 1.03–2.25). The same applied to patients without psoriatic arthritis (severe psoriasis aged <50 years; HR 1.74; 1.11–2.72). In analyses restricted to patients with psoriatic arthritis, age-specific strata did not show any association between psoriatic arthritis and MI risk. Key words: psoriasis; psoriatic arthritis; myocardial infarction; cardiovascular disease. Accepted Mar 22, 2017; Epub ahead of print Mar 28, 2017 Acta Derm Venereol 2017; 97: 819–824. Corr: Alexander Egeberg, Department of Dermatology and Allergy, Her- lev and Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark. E-mail: [email protected] P soriasis is one of the most common immune-mediated inflammatory diseases, with an estimated preva- lence of 2–3% in Europe (1). Approximately 70–80% of patients are mildly affected and can be managed with topical treatment (2, 3). Psoriatic arthritis is the most common comorbidity, affecting approximately 30% of patients, and as much as 42% in a Danish study (4). Risk factors for cardiovascular disease, such as hypertension, dyslipidaemia, diabetes, obesity, smoking, and exces- sive alcohol intake, occur more frequently in patients with psoriasis compared with healthy controls (5, 6). In 1973, small studies (7, 8) indicated an increased risk of cardiovascular disease (CVD) in patients with psoriasis. In 2004, Mallbris et al. (9) reported an increased cardio- vascular mortality in hospitalized younger patients with severe psoriasis compared with the general population. In contrast, there was no excessive risk in outpatients with psoriasis. The most consistent association between psoriasis and CVD is the risk of myocardial infarction (MI), which could be increased up to 2-fold in severe psoriasis and particularly increased in young individuals according to a meta-analysis (10). However, this association has been extensively debated due to conflicting data. For example, based on data from the United Kingdom General Practice Research Datalink between 1987 and 2002, Gelfand et al. (11) found a significantly increased risk of MI in patients with psoriasis. Interestingly however, another study with overlapping cohorts (1994–2009) found somewhat op- pos