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Comorbidities


observational studies, the pooled OR for metabolic syndrome among patients with psoriasis was 2.26 (95% CI: 1.70–3.01) compared with the general population.5


association of psoriasis with the metabolic syndrome or its components seems to be highest in patients with severe psoriasis.


A population-based study of 12


patients with mild (n=127,706) and severe psoriasis (n=3854) who were matched to control patients was able to demonstrate that cardiovascular risk factors are more strongly associated with severe psoriasis than with mild psoriasis. Although patients with mild psoriasis also had a higher prevalence of diabetes (OR: 1.13; 95% CI: 1.08–1.18), of hypertension (OR: 1.03; 95% CI: 1.01–1.06), of hyperlipidaemia (OR: 1.16; 95% CI: 1.12–1.21), of smoking (OR: 1.31; 95% CI: 1.29–1.34), and of increased BMI (OR: 1.27; 95% CI: 1.24–1.31) than controls, the association, except for obesity and smoking, was low to modest and therefore the clinical relevance could be minimal. By contrast, compared with patients with mild psoriasis, patients with severe psoriasis not only had a higher adjusted odds of diabetes (OR: 1.62; 95% CI: 1.3–2.01), obesity (OR: 1.79; 95% CI: 1.55–2,05), and smoking (OR: 1.31; 95% CI: 1.17–1.47) than controls, but also were more likely to have each of the cardiovascular risk factors, with the strongest associations being with obesity (OR: 1.47; 95% CI: 1.32–1.63), diabetes (OR: 1.39; 95% CI: 1.22-1,58), and hypertension (OR: 1.16; 95% CI: 1.07–1.26).3


Taken together, the www.hospitalpharmacyeurope.com


Atherosclerotic vascular disease A meta-analysis of seven cohort studies (combined cohort size = 5,556,580 persons) found an increased risk for myocardial infarction (relative risk (RR): 1.21; 95% CI: 1.04–1.40) and stroke (RR: 1.22; 95% CI: 1.05–1.42) in patients with psoriasis (combined as composite vascular endpoint: RR 1.2; 95% CI: 1.1–1.31).6


In a retrospective cohort


study, even when adjusted for major cardiovascular risk factors such as diabetes, hypertension, BMI, smoking history and history of myocardial infarction, patients with psoriasis (n=130,976) had a significantly (p<0.001) higher risk for a myocardial infarction compared with controls (n=556,995). Patients with severe psoriasis had the highest rate of myocardial infarction.7


Xiao and


colleagues were able to demonstrate a higher prevalence of myocardial infarction in patients with severe psoriasis (n=1473; OR: 2.01: 95% CI: 1.45–2.79) and in patients with mild psoriasis (n=1619) compared with controls (n=1521) (OR: 1.72; CI: 1.29–2.30).8


0,65–14,35), cardiovascular mortality (RR: 1.37; 95% CI: 1.17–1.60), and stroke (RR: 1.59; 95% CI: 1.34–1.89) was only identified in individuals with severe psoriasis (defined as requiring systemic therapy or hospital admission).9


In sum,


an association between atherosclerotic vascular disease and psoriasis was detected most consistently among patients with severe psoriasis.


Mortality


Studies were able to demonstrate a reduced lifespan in patients with psoriasis compared with the general population, especially in patients with severe psoriasis.10


A cohort study from In a systematic review and


meta-analysis, increased risk for myocardial infarction (RR: 3.04; 95% CI:


1987 to 2002 on patients with severe psoriasis (defined as being treated with systemic therapy) (n=3603) compared with controls (n=14,330) found that patients with severe psoriasis were more likely than controls to die from cardiac disease (hazard ratio (HR): 1.57, 95% CI: 1.26–1.96). These patients were also at increased risk of death from other causes, such as malignancies (HR: 1.41, 95% CI: 1.07–1.86), chronic lower respiratory disease (HR: 2.08, 95% CI: 1.24–3.48), dementia (HR: 3.64, 95% CI: 1.36–9.72), infection (HR: 1.65, 95% CI: 1.26–2.18) and kidney disease (HR: 4.37, 95% CI: 2.24–8.53). Overall, patients with psoriasis died at a younger age than controls (mean age of 73 versus 79 years, respectively; p<0.001).11


Taken together,


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