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Estudio primario

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Psoriasis is Associated with a High Comedication Burden: A Population Based Register Study.

Revista Dermatology and therapy
Año 2020
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INTRODUCTION: A large body of evidence supports the association between psoriasis and concomitant diseases. However, the study of comedication for these diseases in patients with psoriasis is limited. The current study aimed to investigate the prescription and drug dispensation for comorbidity associated with psoriasis. METHODS: We conducted a retrospective case-control study from 9 April 2008 until 1 January 2016 using an electronic medical records database covering the entire population of the County of Jönköping and the Swedish Prescribed Drug Register. ICD-10 and Anatomical Therapeutic Chemical codes were used to identify patients with psoriasis and dispensed pharmaceutical prescriptions. Individuals without psoriasis were selected as controls. Patients receiving systemic treatment for psoriasis were considered as having moderate-severe psoriasis. Odds ratios for being dispensed pharmaceutical prescriptions and differences in mean number of dispensed prescriptions were explored. RESULTS: A total of 4587 patients with psoriasis were identified in the medical records, and 268,949 individuals served as controls. Patients with psoriasis had a significantly higher number of different drug dispensations compared to controls. Only 1.3% of all patients with psoriasis were without any prescription (excluding medication for psoriasis) during the study period while the number in the general population was 9.3%. Sex- and age-adjusted odds ratios for dispensation of drug groups related to comorbid disease were significantly higher among patients with psoriasis including drug groups such as anxiolytics and sedatives as well as drugs targeting COPD, migraine and erectile dysfunction. The most frequently dispensed comedications were oral antibiotics and analgesics including an increased risk for dispensation of opioids. Sex predisposed dispensation frequency for a variety of drug groups. Drugs targeting obesity, osteoporosis, psychiatric disease and anti-mycotics/-fungals were more frequent among women. CONCLUSION: Patients with psoriasis have significantly increased numbers of different dispensed prescriptions than those without psoriasis. This underlines previous findings on increased comorbidity and health care costs for patients with psoriasis.

Estudio primario

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Hypertension and risk of psoriasis incidence: An 11-year nationwide population-based cohort study.

Autores Kim HN , Han K , Song SW , Lee JH
Revista PloS one
Año 2018
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Psoriasis is a chronic inflammatory skin disease that is characterized by T-cell mediated immune response, and has been known to increase the risk of developing hypertension. However, the risk of psoriasis in patients with hypertension is not clear. Therefore, we investigated the risk of psoriasis in patients with hypertension. A total of 256,356 adults (42,726 in the hypertension group and 213,630 in the control group) were followed from 2003 to 2013 in a nationwide population-based cohort study. During the follow-up, 9,254 participants (3.6%) were found to have psoriasis (2,152 [5.0%] in the hypertension group and 7,102 [3.3%] in the control group). The hypertension group had a higher risk of psoriasis incidence (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.47-1.61, P < 0.001), and the association remained significant after adjusting for comorbidities of diabetes and dyslipidemia, antihypertensive medication and nonsteroidal anti-inflammatory drug use, and sociodemographic factors (HR 1.18, 95% CI 1.08-1.28, P < 0.001). In conclusion, hypertension was significantly associated with an increased risk of psoriasis incidence. Further studies are needed to confirm whether hypertension is associated with the incidence of psoriasis.

Estudio primario

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No increased risk of psoriasis in patients receiving androgen deprivation therapy for prostate cancer: a 17-year population-based study.

Autores Liu JM , Lin CY , Chuang HC , Hsu RJ
Revista Therapeutics and clinical risk management
Año 2018
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OBJECTIVE: Androgen deprivation therapy (ADT) use in prostate cancer (PCa) patients has been reported to exacerbate the course of psoriasis. We aimed to assess the impact of ADT on the subsequent risk of psoriasis. METHODS: We utilized data from the National Health Insurance Research Database of Taiwan between 1996 and 2013. In total, 17,168 patients with PCa were identified; 5,141 ADT patients comprised the study group with 5,141 matched non-ADT controls. We used 1:1 propensity score-matched analysis. The demographic characteristics and comorbidities of the patients were analyzed; Cox proportional hazards regression was used to calculate the HRs for the risk of psoriasis. RESULTS: Eighty-nine (0.87%) patients with newly diagnosed psoriasis were identified. Compared with non-ADT patients, ADT patients had similar risk of subsequent psoriasis with an HR of 0.95 (95% CI 0.63-1.45; P=0.816). However, a higher risk of psoriasis was observed in angiotensin-converting enzyme inhibitors patients (adjusted HR 2.14, 95% CI 1.09-4.20; P<0.05). CONCLUSION: ADT use did not increase risk of psoriasis in patients with PCa. Further studies are warranted to assess the clinical significance.

Estudio primario

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Psoriasis risk in patients with type 2 diabetes in German primary care practices.

Autores Jacob L , Kostev K
Revista Primary care diabetes
Año 2017
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AIM: To analyze psoriasis risk in type 2 diabetes mellitus (T2DM) patients treated in German primary care practices. METHODS: The study included 87,964 T2DM patients aged 40 years or over who received their initial diabetes diagnosis between 2004 and 2013. Patients were excluded if they had been diagnosed with psoriasis prior to diabetes diagnosis or if the observation period prior to the index date was less than 365 days. After applying these exclusion criteria, 72,148 T2DM patients were included. A total of 72,148 non-diabetic controls were matched (1:1) to T2DM cases based on age, gender, type of health insurance (private or statutory), number of medical visits, and index date. The primary outcome was the diagnosis of psoriasis. Skin infections, dermatitis/eczema, hyperlipidemia, and medications associated with psoriasis (beta blockers, angiotensin-converting enzyme (ACE) inhibitors, lithium, antimalarials, nonsteroidal anti-inflammatory drugs, and benzodiazepines) were included as potential confounders. RESULTS: The mean age was 68.7 years (SD=12.7 years) and 48.6% of subjects were men. Hyperlipidemia, dermatitis/eczema, and skin infections were more frequent in T2DM patients than in controls. Beta blockers, ACE inhibitors, and nonsteroidal anti-inflammatory drugs were also more commonly used in people with T2DM than in controls. A total of 3.4% of T2DM patients and 2.8% of matched controls developed psoriasis within ten years of follow-up (p-value <0.001). T2DM patients were at a higher risk of developing psoriasis than controls (HR=1.18, 95% CI: 1.08-1.29). CONCLUSION: T2DM was positively associated with psoriasis in patients treated in German primary care practices.

Estudio primario

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Risk of myocardial infarction in psoriasis patients: a retrospective cohort study.

Autores Wu JJ , Choi YM , Bebchuk JD
Revista The Journal of dermatological treatment
Año 2015
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BACKGROUND: Psoriasis may or may not be associated with a higher risk for myocardial infarction (MI). We sought to assess differences in MI incidence between control, mild psoriasis and severe psoriasis patients. METHODS: We performed a retrospective cohort study of Kaiser Permanente Southern California members with psoriasis between 1 January 2004 and 30 June 2012, assessing the risk and incidence rates of MI. RESULTS: There were 50,865 control patients matched to 10,173 patients with mild psoriasis and 19,205 control patients matched to 3841 patients with severe psoriasis. The MI incidence per 1000 person-years for mild psoriasis controls, mild psoriasis, severe psoriasis controls and severe psoriasis were 4.9, 6.7, 3.7 and 5.1, respectively. Upon multivariable analysis, mild psoriasis patients had a significantly higher risk of MI compared to matched control patients {hazard ratio (HR) = 1.31 [95% confidence interval (CI): 1.14, 1.51]} and severe psoriasis patients had a significantly higher risk of MI compared to matched control patients [HR = 1.28 (95% CI: 1.02, 1.60)]. CONCLUSION: Patients with psoriasis are at higher risk for MI compared to control patients.

Estudio primario

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Psoriasis and risk of heart failure: a nationwide cohort study.

Revista European journal of heart failure
Año 2014
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AIMS: Psoriasis is a common inflammatory disease that is associated with increased risk of cardiovascular disease, including myocardial infarction. Heart failure (HF) is independently associated with several cardiovascular risk factors and is a major cause of cardiovascular morbidity and mortality. The association between psoriasis and HF is unclear and we therefore investigated the risk of new-onset HF in a nationwide cohort of psoriasis patients compared with the background population. METHODS: The study included the entire Danish population aged ≥18 years followed from 1 January 1997 until HF, death or 31 December 2011. Information on comorbidity and concomitant medication was identified by individual-level linkage of administrative registers. New-onset HF was defined as first hospital admission for HF. Incidence rates of new-onset HF were calculated and adjusted hazard ratios were estimated by multivariable Cox regression models adjusted for age, gender, comorbidity and cardiovascular medications. RESULTS: A total of 5 485 856 subjects were eligible for analysis. In the study period 66 389 patients with new-onset psoriasis, including 11 242 patients with severe psoriasis, were identified. The overall incidence rates of new-onset HF were 2.82, 4.22 and 4.70 per 1000 person-years for the reference population, mild psoriasis and severe psoriasis, respectively. Compared with the reference population, the fully adjusted hazard ratios for new-onset HF were increased in patients with psoriasis with a hazard ratio 1.22 (95% confidence interval 1.16-1.29) and hazard ratio of 1.53 (95% confidence interval 1.34-1.74) for those with mild and severe disease, respectively. CONCLUSION: In this nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of new-onset HF.

Estudio primario

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Hypertension, antihypertensive medication use, and risk of psoriasis.

Autores Wu S , Han J , Li WQ , Qureshi AA
Revista JAMA dermatology
Año 2014
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IMPORTANCE: Individuals with psoriasis have an elevated risk of hypertension, and antihypertensive medications, especially β-blockers, have been linked to psoriasis development. However, the association of prior existing hypertension and antihypertensive medications with risk of incident psoriasis has not been assessed using prospective data. OBJECTIVE: To evaluate the association of hypertension and antihypertensive medications with risk of psoriasis. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study (June 1, 1996, to June 1, 2008) of 77 728 US women from the Nurses' Health Study who provided biennially updated data on hypertension and antihypertensive medications. MAIN OUTCOMES AND MEASURES: Physician-diagnosed psoriasis. RESULTS: A total of 843 incident psoriasis cases were documented during 1 066 339 person-years of follow-up. Compared with normotensive women, women with a hypertension duration of 6 years or more were at a higher risk of developing psoriasis (hazard ratio [HR], 1.27; 95% CI, 1.03-1.57). In stratified analysis, the risk of psoriasis was higher among hypertensive women without medication use (HR, 1.49; 95% CI, 1.15-1.92) and among hypertensive women with current medication use (HR, 1.31; 95% CI, 1.10-1.55) when compared with normotensive participants without medication use. Compared with women who never used β-blockers, the multivariate HRs for psoriasis for women who regularly used β-blockers were 1.11 (95% CI, 0.82-1.51) for 1 to 2 years of use, 1.06 (95% CI, 0.79-1.40) for 3 to 5 years of use, and 1.39 (95% CI, 1.11-1.73) for 6 years or more of use (P for trend = .009). No association was found between use of other individual antihypertensive drugs and risk of psoriasis. CONCLUSIONS AND RELEVANCE: Long-term hypertensive status is associated with an increased risk of psoriasis. Long-term regular use of β-blockers may also increase the risk of psoriasis.

Estudio primario

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Prevalencia del síndrome metabólico en pacientes con psoriasis: un estudio basado en la población en el Reino Unido.

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Revista The Journal of investigative dermatology
Año 2012
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El aumento de la evidencia epidemiológica sugiere que las asociaciones independientes entre psoriasis y las enfermedades cardiovasculares y metabólicas. Nuestro objetivo era poner a prueba la hipótesis de que la gravedad de la psoriasis evaluada directamente relacionada con la prevalencia del síndrome metabólico y sus componentes. Un estudio basado en la población, la sección transversal se llevó a cabo utilizando las historias clínicas informatizadas de la población del estudio Health Improvement Network incluyendo los individuos en el grupo de edad de 45 a 65 años con psoriasis y practicar los controles pareados. El diagnóstico y la extensión de la psoriasis se determinaron utilizando cuestionarios de proveedor de base. El síndrome metabólico se definió utilizando los criterios del Programa de Tratamiento National Cholesterol Education Panel III en adultos. Un total de 44.715 personas fueron incluidos: 4.065 con psoriasis y 40.650 controles. En total, 2044 participantes tenían psoriasis leve ( área de superficie del cuerpo 2% (BSA)), 1377 tenía la psoriasis moderada (3-10% de BSA), y 475 tenían psoriasis severa (> 10% de BSA). La psoriasis se asocia con el síndrome metabólico, la razón de probabilidad ajustada (adj. O 1,41, 95% intervalo de confianza (IC) 1,31 a 1,51), variando de una manera "dosis-respuesta", desde leve (adj. OR 1,22, IC 1,11-1,35) 95% a la psoriasis severa (adj. O 1,98, IC del 95% 1,62 a 2,43). La psoriasis se asocia con el síndrome metabólico y los aumentos de asociación con el aumento de la gravedad de la enfermedad. Además, las asociaciones con la obesidad, hipertrigliceridemia, hiperglucemia y aumento con el aumento de la gravedad de la enfermedad, independientemente de otros componentes del síndrome metabólico. Estos hallazgos sugieren que la detección de la enfermedad metabólica se debe considerar para la psoriasis, especialmente cuando es grave.

Estudio primario

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Psoriasis y los factores de riesgo cardiovascular: un estudio de casos y controles en pacientes que compararon la psoriasis dermatitis.

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Revista Journal of the American Academy of Dermatology
Año 2012
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ANTECEDENTES: En informes anteriores se demostró una asociación entre la psoriasis y la enfermedad cardiovascular (ECV) factores de riesgo. Sin embargo, la mayoría de estos estudios se basaron en las bases de datos informatizadas de las consultas externas, las cuales, debido a la Clasificación Internacional de Enfermedades, problemas de codificación novena revisión, requieren validación del diagnóstico de psoriasis. OBJETIVO: Se pretende estudiar las asociaciones entre los factores de la psoriasis y de riesgo de ECV entre los pacientes con psoriasis en comparación con pacientes con dermatitis. MÉTODOS: Estudio de casos y controles se realizó utilizando las bases de datos clínicas informatizadas del Departamento de Dermatología de Rabin Medical Center en Israel. Los pacientes hospitalizados dado el diagnóstico de psoriasis se compararon con pacientes dados el diagnóstico de formas de dermatitis de la prevalencia del tabaquismo, la obesidad, la diabetes, la hipertensión, la hiperlipidemia y las enfermedades cardiovasculares. Se utilizaron modelos de regresión logística para el análisis multivariado. RESULTADOS: El estudio incluyó a 1.079 pacientes con psoriasis y 1.079 pacientes por edad y género con (pacientes de control) dermatitis. Un modelo de regresión logística multivariante demostró que la psoriasis es un factor de riesgo independiente para la diabetes (odds ratio [OR] 1,43; 95% intervalo de confianza [IC] 1,17-1,75), la hipertensión (OR 1,31; IC 95% 1,09-1,58), la obesidad ( OR 1.32, IC 95% 0,99-1,76) y el tabaquismo (OR 1.38, IC 95% 1,10-1,73). Desarrollo de ECV no se asoció significativamente con psoriasis cuando se corrige para la diabetes, la obesidad y la hipertensión. LIMITACIONES: Nuestro grupo de estudio se compone de sólo los pacientes hospitalizados, que pueden estar sesgados hacia los pacientes más ancianos con psoriasis severa que pueden haber consumido el tratamiento sistémico incluyendo inmunosupresores. Conclusiones: Nuestro estudio apoya los informes anteriores de una asociación entre los factores de la psoriasis y de riesgo de ECV, lo que sugiere que el proceso inflamatorio en la psoriasis, pero no en la dermatitis, puede tener un impacto sistémico que resulta en el desarrollo de factores de riesgo de ECV.

Estudio primario

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La psoriasis y el riesgo de enfermedad cardiovascular fatal en las mujeres de Estados Unidos: un estudio de cohorte.

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Revista The British journal of dermatology
Año 2012
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ANTECEDENTES: La psoriasis se ha relacionado con comorbilidades cardiovasculares en estudios transversales, pero la evidencia con respecto a la asociación entre la psoriasis y el incidente de la enfermedad cardiovascular (ECV) es limitada. OBJETIVOS: Para hacer una evaluación prospectiva de la asociación entre la psoriasis y el riesgo de ECV incidente fatal. MÉTODOS: Los participantes (n = 96, 008) se incluyeron desde el Nurses 'Health Study II, y seguidos durante 18 años. La información sobre la psoriasis diagnosticada por el médico fue obtenido por auto-informe y el diagnóstico se confirmó mediante cuestionarios complementarios. Se incluyeron 2.463 individuos con psoriasis auto-reporte y una submuestra de 1242 con la psoriasis validado. El resultado principal fue incidentes no mortales eventos cardiovasculares [infarto de miocardio no fatal (IM) y accidente cerebrovascular no fatal], comprobados por cuestionarios bienales y confirmada. RESULTADOS: Durante 1 709 069 personas-años de seguimiento, se confirmaron 713 incidentes eventos cardiovasculares no fatales. La psoriasis se asocia con un aumento significativo del índice de riesgo multivariable ajustados (HR) de las enfermedades cardiovasculares no fatales, 1 · [intervalo de confianza del 95% (IC): 1 · 04-2 · 31] 55. CRI para IM no fatal y accidente cerebrovascular fueron 1 · (IC del 95%: 1 · 01-2 · 84) 70 y 1 · (IC del 95%: 0 · 80-2 · 65) 45, respectivamente. La asociación se mantuvo constante en un análisis de sensibilidad de la psoriasis confirmada (HR: CI 2 · 06, 95%: 1 · 31-3 · 26). Para las personas con artritis psoriásica concomitante, el riesgo de las enfermedades cardiovasculares no fatales fue aún mayor (HR: 3 · 47; IC del 95%: 1 · 85-6 · 51). Las mujeres diagnosticadas con psoriasis a <40 años de edad o con la duración de la psoriasis ≥ 9 años tuvieron elevaciones sustanciales en el riesgo de ECV: Recursos Humanos: 3 · (IC del 95%: 1 · 21-8 · 75) 26 y 3 · 09 (95% CI: 1 · 15-8 · 29), respectivamente. CONCLUSIONES: La psoriasis es un predictor independiente de enfermedad cardiovascular no mortal entre las mujeres, con un riesgo particularmente alto para los que tienen una mayor duración de la psoriasis y la artritis psoriásica concomitante.