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Increased Risk of Aortic Stenosis in Psoriasis Patients
Study Questions:
What is the potential link between development of aortic stenosis (AS) and psoriasis compared to the general population?
Methods:
This was a surveillance study, which included the entire Danish population aged ≥18 years, who were followed from January 1997 until diagnosis of AS, December 2011, or death. Multiple nationwide clinical data registries were cross referenced to identify newly diagnosed AS. Medication/pharmacy databases were queried for prescription information. Psoriasis was deemed to be present when a prescription for a topical vitamin D derivative had been prescribed on at least two occasions. Severe psoriasis was diagnosed at the time of a third diagnosis, which included hospitalization or outpatient consultation for psoriasis or development of psoriatic arthritis. Patients were excluded from the study if they had prior prescriptions for vitamin D derivatives, diagnosis of psoriasis, or diagnosis of AS prior to study start.
Results:
The eligible study cohort numbered 5,107,624 subjects. During this study period, 58,747 patients were diagnosed with mild psoriasis and 11,918 patients with severe psoriasis. Compared to the nonpsoriasis reference population, there were no statistically significant differences in comorbidities including vascular disease, atrial fibrillation, renal disease, chronic obstructive pulmonary disease, diabetes, or hypertension. Over the period of follow-up, a new diagnosis of AS was established in 48,539 subjects in the reference population, 509 in the mild psoriasis group, and 99 in the severe psoriasis group, for incidence rates of 8.09, 16.07, and 20.8 per 10,000 person-years. The increased risk for AS associated with psoriasis persisted after adjusting for age, gender, calendar year, comorbidity, concomitant medication, and socioeconomic status. When stratified by age (18-40, 40-65, and 65-90 years), an increase in incident rates of AS was noted for each age group.
Conclusions:
The authors concluded that psoriasis is associated with a disease severity increased risk of development of AS.
Perspective:
This study evaluated the entire Danish population for a link between psoriasis and a new diagnosis of AS. The definition of psoriasis as the prescription of a topical vitamin D medication has previously been validated in this patient cohort, and current practice of prescribing patterns within the Danish population render prescription of these drugs specific to the diagnosis of psoriasis. The study nicely demonstrates an increasing prevalence of new diagnosis of AS across all age groups, which is greater with more severe psoriasis. The mechanism for the link probably revolves around the contribution of a nonspecific inflammatory state resulting in development of aortic valve disease. Psoriasis has also been linked as an independent factor for development of atherosclerotic disease. Based on the results of this study, patients with psoriasis should probably be considered at increased risk of development of AS. This study also nicely supports the current opinion that development of AS is both degenerative and based on an ongoing inflammatory response.
Keywords: Aortic Valve Stenosis, Arthritis, Psoriatic, Comorbidity, Heart Valve Diseases, Incidence, Inflammation, Psoriasis, Registries, Risk, Secondary Prevention, Vitamin D
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