Coronary Heart Disease and Stroke Risk in Patients with Psoriasis: Retrospective Analysis

BACKGROUND: Past studies suggest an association between psoriasis and the risk of developing coronary heart disease. The objectives of this study were to estimate the 10-year risks of coronary heart disease and stroke in patients with moderate to severe psoriasis, to compare risks between patients and the general population, and to determine whether risk profiles are affected by disease severity. METHODS: Data were pooled from patients with moderate to severe psoriasis (Psoriasis Area and Severity Index [PASI] score >= 10) who were enrolled in Phase II (M02-528) or Phase III trials (Comparative Study of HUMIRA vs Methotrexate vs Placebo In PsOriasis PatieNts[CHAMPION], Randomized Controlled EValuation of Adalimumab Every Other Week Dosing in Moderate to Severe Psoriasis TriAL[REVEAL]) evaluating adalimumab. Risks of coronary heart disease and stroke were estimated using the Framingham risk score algorithm and a stroke risk function based on the Framingham Heart Study cohorts. To compare risks between patients with psoriasis and the general population, average population risks were imputed on the basis of age and gender. Wilcoxon rank-sum tests evaluated risk differences between patients with psoriasis and the general population and between patients with moderate psoriasis and patients with severe psoriasis. RESULTS: A total of 1591 patients were identified, including 1082 patients with PASI scores >= 10 and <= 20 and 509 patients with PASI scores > 20. Patients with PAST scores from 10 to 20 and PASI scores > 20 had similar 10-year risks of coronary heart disease (12.3% and 12.2%; P = .49) and stroke (8.3% and 8.7%; P = .28). Compared with the general population, 10-year risks of patients with psoriasis were 28% greater for coronary heart disease (P < .001) and 11.8% greater for stroke (P = .02). CONCLUSION: Patients with moderate to severe psoriasis had increased risks of coronary heart disease and stroke compared with the general population. (C) 2010 Elsevier Inc. All rights reserved. The American Journal of Medicine (2010) 123, 350-357