Assessment of Cardiovascular Risk in Patients With Moderate to Severe Plaque Psoriasis
October 2014 | Volume 13 | Issue 10 | Original Article | 1240 | Copyright © October 2014
Hector Fernández-Llaca MD,a Pablo de la Cueva MD,b Jesús Luelmo MD,c Jose Carlos Armario-Hita MD,d
M Luz Samaniego,e and Carmen GarcÃa-Calvo MDf [Representing the RECOR Study Group.],
aDepartment of Dermatology, Hospital Universitario Marqués de Valdecillas, Santander, Spain
bDepartment of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
cDepartment of Dermatology, Corporació Sanitaria Parc TaulÃ, Sabadell, Spain
dDepartment of Dermatology, UCG Bloque Quirúrgico, Hospital Universitario de Puerto Real, Universidad de Cádiz, Cádiz, Spain
eStatistical Department, Trial Form Support, Madrid, Spain
fMedical Department, Pfizer Spain, Madrid, Spain
Abstract
BACKGROUND: Cardiovascular morbidity and mortality have been demonstrated to be greater in psoriasis patients than in the general population. Our study aimed to assess the 10-year cardiovascular risk in patients with moderate to severe psoriasis compared with those suffering from other dermatological diseases, using the calibrated Framingham risk score and the Systematic Coronary Risk Evaluation (SCORE) risk charts.
METHODS: A cross-sectional, multicentre study was made of 477 patients, of whom 238 had moderate to severe psoriasis (cases) and 239 were diagnosed with another dermatological disease (controls).
RESULTS: The proportion of patients with intermediate to high 10-year cardiovascular risk using the Framingham equation was significantly higher among psoriasis patients (38.5%; 80/208) than among the controls with other dermatological diseases (23.4%; 50/214,
P<.05). No significant differences were observed between the 2 groups with respect to cardiovascular risk using the SCORE risk charts (
P=.591). The case group included a greater proportion of obese and morbidly obese patients, as well as patients with higher triglyceride and low density lipoprotein cholesterol levels (
P<.05); while high density lipoprotein cholesterol levels were significantly more favorable in patients in the control group (
P<.05).
CONCLUSIONS: Cardiovascular risk was greater in patients with moderate to severe psoriasis than in patients with other dermatological conditions, suggesting that early detection and tailored management of risk factors is essential to reducing cardiovascular morbidity in these patients.
J Drugs Dermatol. 2014;13(10):1240-1247.
INTRODUCTION
Psoriasis is a chronic, immune-mediated inflammatory disease that affects 1% to 3% of the general population.1,2 Recent studies have shown that psoriasis is not just an inflammatory skin disease, as various comorbidities have been identified, including cardiovascular disease.3,4 The relationship between psoriasis disease and cardiovascular risk factors such as diabetes, dyslipidemia, hypertension, smoking, obesity, and metabolic syndrome has been studied extensively. An association between psoriasis and the development of coronary heart disease, independent of these factors, has also been widely reported.5-11 However, despite this growing body of evidence, data describing the prevalence of cardiovascular risk factors among psoriasis patients in Spain are limited.3
This study sought to assess the prevalence of cardiovascular risk factors, including metabolic syndrome, as well as other comorbidities in patients with moderate to severe plaque psoriasis, compared with a control population of patients with other dermatological disorders. The primary objective was to assess the 10-year cardiovascular risk using the calibrated Framingham risk score and the Systematic Coronary Risk Evaluation (SCORE) risk charts among moderate to severe psoriatic patients in Spain.
MATERIALS AND METHODS
Design
This was an epidemiological, cross-sectional study conducted in 81 dermatology units in Spain between 2010 and 2011. Patients enrolled (1) were over the age of 18 years, (2) presented with a diagnosis of moderate to severe plaque psoriasis (cases) or other dermatologic conditions apart from psoriasis (controls), (3) had undergone a routine analytical test within the 6 months prior to study enrolment, (4) had medical records available in the Dermatology Department, and (5) had provided informed consent. Excluded were patients who had taken part in another clinical trial and/or those with insufficient medical information in their records.
