Psoriasis, a chronic skin condition that affects 2%-3% of adults may also be a risk factor for heart attack.
“In patients under age 50 with severe disease, the risk is comparable to diabetes. This is the first study to show this,” Joel M. Gelfand, MD, says. Gelfand is an assistant professor of dermatology at the University of Pennsylvania School of Medicine.
Gelfand led a team of researchers who compared heart attack risks in almost 131,000 patients with psoriasis; 3,837 of those patients had severe psoriasis. The study also included 556,995 matched patients who did not have psoriasis for comparison.
The researchers found that psoriasis was associated with an elevated risk of heart attack in all age groups, but especially in younger patients with severe disease.
“This is an important finding because psoriasis patients need to be talking to their doctors about this. Likewise, doctors need to be talking to psoriasis patients about this possible risk,” says Liz Horn, director of research at the National Psoriasis Foundation.
Several smaller, hospital-based studies have shown a link between psoriasis and an increased risk of heart attack. “But none of these studies controlled for age, gender, elevated cholesterol, diabetes, smoking, and other risk factors,” Gelfand says. “That’s what’s novel about our study.”
According to the study, excess heart attack risk is higher among psoriasis patients who are younger. For example, a 40-year-old patient with mild disease has a 20% greater risk of heart attack than a 40-year-old patient without psoriasis. But a 40-year-old patient with severe disease has more than double the risk.
The risk appears to decline somewhat in older patients. For example, the study found that a 60-year-old patient with severe disease has a 36% higher risk than a 60-year-old patient without psoriasis.
“The absolute risk is still low, even for someone who has severe disease,” Gelfand says. “If you’re in your 40s or 50s, your risk of having a heart attack each year due to psoriasis is about one in 400 to one in 600. Over 10 years, that adds up to about one in 40-60. So it does become a significant risk factor over time.”
“Only in the last 15 years have we come to understand that psoriasis is an autoimmune disease,” Gelfand says. “Only in the past 10 years have we learned that psoriasis is promoted by the same immune pathways that are active in atherosclerosis.” Atherosclerosis is hardening of the arteries, which contributes to coronary artery disease and heart attack risk.
“Our study fits in with the whole paradigm of inflammation leading to heart disease,” Gelfand says. “When people have severe psoriasis, there’s a huge amount of inflammation going on.”
People with severe disease also have higher blood levels of C-reactive protein, or CRP, an inflammatory marker associated with heart disease, Gelfand says.