Inflammation looks like common thread, researcher says
MONDAY, June 15 (HealthDay News) -- People with psoriasis face an increased risk of major cardiovascular disease and death, a new study finds.
The research, which included data from a Veterans Administration medical facility study to compare 3,236 people suffering from the skin disease to 2,500 psoriasis-free individuals, found a 78 percent higher incidence of heart disease, a 70 percent higher incidence of stroke and a 98 percent higher incidence of peripheral arterial disease (blockage of arteries in the legs) in the psoriasis group.
The overall death rate for those with psoriasis was 86 percent higher than for those without the disease. In the 20 years covered by the study, 19.6 percent of those with psoriasis died, compared to 9.9 percent of those without the disease.
The cardiovascular disease calculations included effects of known risk factors such as obesity, smoking, diabetes and high blood cholesterol, said study co-author Dr. Robert S. Kirsner, vice chairman of dermatology at the University of Miami Miller School of Medicine. The team reports the finding in the June issue of the Archives of Dermatology.
"In and of itself, psoriasis imparts a risk of cardiac disease, stroke and peripheral arterial disease," Kirsner said. "Psoriasis imposes the same level of risk as high blood lipids and smoking."
The risk appears to stem from the chronic inflammation associated with psoriasis, he explained. "This systemic inflammation causes damage to blood vessels, leading to increased risk," he said.
The medical lesson of the study is that "it is critical for people who have psoriasis to understand their increased risk and have their other risk factors addressed," he said.
Cardiovascular risk is linked to the severity of the skin disease, Kirsner said, and "there are some data suggesting that treating psoriasis can lower the risk."
However, the data are only suggestive, noted Dr. Joel M. Gelfand, medical director of the University of Pennsylvania's department of dermatology clinical studies unit, which has published several reports showing the same association.
One of his group's studies, using British data, found a 55 percent increased cardiovascular risk and a 78 percent higher death rate in persons with psoriasis, Gelfand said. "But we don't have enough data to know if controlling psoriasis would also control those risks," he said. "This is a key public health question best answered in a randomized, controlled trial."
Like Kirsner, Gelfand stressed the need to address traditional cardiovascular risk factors in people with psoriasis. "Patients who have psoriasis, especially severe cases, should be screened for modifiable risk factors," Gelfand said. "We have a plan in place for our patients to achieve a healthy lifestyle, a plan that includes weight control and exercise."
Psoriasis affects 2 percent to 3 percent of the world's population, including 7 million Americans, the new report estimated.
Details on psoriasis can be found at the U.S. National Library of Medicine.
SOURCES: Robert S. Kirsner, M.D., Ph.D., professor and vice chairman, dermatology, University of Miami Miller School of Medicine; Joel M. Gelfand, M.D., medical director, University of Pennsylvania department of dermatology clinical studies unit, Philadelphia; June 2009 Archives of Dermatology
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