Higher risk of atrial fibrillation, thromboembolic events in severe psoriasis
Severe psoriasis significantly increases the risk of atrial fibrillation (AF) and thromboembolic events (AE), a recent nationwide population-based study from Korea has shown.
The study included 13,385 psoriasis patients, of which 14.5 percent (n=1,947) had severe psoriasis. A total of 739,459 participants without psoriasis were included. The investigators tracked the development of nonvalvular AF. Secondary outcomes were TE, ischaemic stroke and systemic thromboembolism.
The incidence rate of AF in patients without psoriasis was 1.65 per 1,000 patient-years which was lower than that in mild psoriasis (2.48 per 1,000 patient-years) and severe psoriasis (4.05 per 1,000 patient-years) patients.
Similarly, TE incidence rates were higher in severe psoriasis patients (8.14 per 1,000 patient-years) than in mild and nonpsoriasis patients (5.13 and 3.63 per 1,000 patient-years, respectively).
Severe psoriasis significantly increased the risk of AF in both the multivariable (hazard ratio [HR], 1.44; 95 percent CI, 1.14 to 1.82; p=0.002) and propensity score-matched (HR, 1.77; 1.39 to 2.24; p<0.001) models.
Similarly, the risk of TE was also significantly higher in both multivariable (HR, 1.26; 1.07 to 1.47; p=0.005) and propensity score-matched (HR, 1.55; 1.32 to 1.84; p<0.001) models for the severe psoriasis patients.
In contrast, patients with mild psoriasis did not show significantly higher risks of AF (p=0.133 and p=0.365) or TE (p=0.382 to p=0.707) in both multivariable and propensity score-matched models, respectively.
Psoriasis, an autoimmune inflammatory skin disorder, has been shown to be associated with various cardiovascular risk factors. While recent studies have also shown a link between psoriasis and AF or TE, these have failed to control for traditional cardiovascular risk factors leaving the conclusions controversial. [J Am Acad Dermatol 2006:54:614-621; J Invest Dermatol 2013;133:2340-2346]