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274 CLINICAL REPORT Psoriasis as a Predictor of Cardiometabolic Comorbidity in Women: A Study Based on the Danish National Birth Cohort Christoffer BLEGVAD 1,2 , Anne-Marie NYBO ANDERSEN 2 , Abdulfatah ADAM 2 , Claus ZACHARIAE 1 and Lone SKOV 1 Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, and 2 Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark 1 Psoriasis is associated with cardiometabolic comorbi- dity; however, whether this is due to common lifestyle- related risk factors is unclear. This study investigated the association between psoriasis and cardiometabolic comorbidity, taking body mass index and smoking into account. The population comprised expectant mot- hers in the Danish National Birth Cohort (established 1996–2002). During pregnancy, the women were as- ked about physician-diagnosed psoriasis. Any associa- tion with self-reported cardiometabolic comorbidity 11 years later was assessed using logistic regression. The cohort was also followed up for hospital-diagnosed co- morbidity, including cardiac death, until 31 December 2014, and the risk was assessed using Cox regression. A total of 2,435 women with psoriasis (2.90%) and 81,388 women without were identified. Psoriasis was significantly associated with self-reported hypercho- lesterolaemia (adjusted odds ratio 1.31; 1.01–1.70) and hospital-diagnosed hypertension (adjusted hazard ratio 1.33; 1.08–1.65). Women with psoriasis have an increased risk of developing cardiometabolic comorbi- dity in early adult life. Key words: psoriasis; cardiovascular disease; metabolic di- sease; comorbidity; risk factor; cardiometabolic disease. Accepted Nov 20, 2018; E-published Nov 21, 2018 Acta Derm Venereol 2019; 99: 274–278. Corr: Christoffer Blegvad, Copenhagen Research Group for Inflamma- tory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Kildegårdsvej 28, DK-2900 Hellerup, Denmark. E-mail: [email protected] P soriasis is an inflammatory skin disease that affects 2–4% of the population in the Western world (1, 2). Psoriasis is known mainly from registry studies to be associated with a range of comorbidities, including cardiometabolic diseases (3, 4). The underlying mecha- nism is unknown, but has been proposed to be a systemic inflammatory state known as the “psoriatic march”, in which interplay between inflammatory mediators, such as cytokines and adipokines, ultimately lead to insulin resistance, atherosclerosis, and finally cardiovascular diseases, such as myocardial infarction and stroke (5). However, this comorbidity could be due to other factors, such as overweight and smoking. Data on these important confounding factors is seldom available in the registries. In this study involving a cohort of women in which there was self-reported data available, it was possible to control doi: 10.2340/00015555-3090 Acta Derm Venereol 2019; 99: 274–278 SIGNIFICANCE Psoriasis is associated with cardiometabolic disorders; how­ ever, whether this is due to the common lifestyle-related risk factors overweight and smoking is unclear. This study investi- gated the relationship between psoriasis and cardiometabolic disorders taking these confounders into account. The study population consisted of women with and without psoriasis from a nationwide birth cohort in Denmark. Psoriasis was markedly associated with hypercholesterolaemia and hyper- tension. Women with psoriasis have an increased risk of de- veloping cardiometabolic disorders in early adult life. Scre- ening for classic risk factors might therefore be advisable. for these confounding factors. The purpose of the present study was to investigate the association between psoriasis and cardiometabolic comorbidity in women, taking the possibly confounding effects of body mass index (BMI) and smoking into account (Fig. S1 1 ). METHODS The Danish National Birth Cohort (DNBC) was used to identify study participants. The DNBC is a nationwide cohort consisting of approximately 85,000 unique mothers who were interviewed about their health status halfway through pregnancy, between 1996 and 2002 (6). The mothers and their children have since been followed up using interviews and online questionnaires. DNBC data were used from the first telephone interview, carried out during the first half of pregnancy and the follow-up questionnaire to the mothers when the child was 11 years old. In Denmark, all inhabitants are assigned a unique 10-digit personal identification number in the Danish Civil Registration System (CRS), which allows linkage at the individual level with other national registries, including the DNBC (7). Data on age and vital status were available from the CRS. In addition to the DNBC and the CRS, the Danish National Patient Registry (DNPR) was used (8). The DNPR was established in 1978 and contains information on all hospital-based inpatient diagnoses, and since 1994, also outpatient diagnoses. Diagnosis codes are recorded according to the International Classification of Diseases, eighth revision (ICD-8) until 1994 and tenth revision (ICD-10) thereafter. Baseline psoriasis status was obtained from the first interview during pregnancy, where the mothers were asked about the pre- sence of physician-diagnosed psoriasis: “Have you ever had any skin disease?” → “Was the skin disease diagnosed by a doctor?” → “What kind of skin disease?” → “Psoriasis?”. In a sub-analysis, severe psoriasis was defined as a hospital (inpatient or outpatient) diagnosis of psoriasis (ICD-8 696.19 and ICD-10 L40.0, L40.4, https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3090 1 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.