Psoriasis Determined as Risk Factor for Abdominal Aortic Aneurysms

Psoriasis was found to be an independent risk factor for abdominal aortic aneurysms (AAA), according to a new Danish study, published in Arteriosclerosis, Thrombosis, and Vascular Biology.

As the researchers explained, “Emerging evidence suggests that AAA is a focal representation of a systemic disease with a distinct inflammatory component, rather than a mere consequence of atherosclerosis.” Interestingly, while psoriasis has been established as an independent risk factor for atherosclerotic disease, the risk of AAA in patients with psoriasis has not been previously studied.

A total of 5 495 203 patients were eligible for the study—59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis—which took place from 1997 through 2011. Researchers compared the patients with psoriasis with a reference population of 5 404 544 individuals.

The mean follow-up period was 5.7 years for patients with any type of psoriasis and 14.4 years for the reference population. Individuals with a history of psoriasis and AAA were excluded.

Patients with mild psoriasis had an incidence of 7.30 per 10 000 person-years and patients with severe psoriasis had an incidence of 9.87 per 10 000 person-years in comparison to the reference population of 3.72. Therefore, the observed risk of AAA increased with the severity of psoriasis.

In the fully adjusted statistical models that controlled for age, sex, calendar year, comorbidity, concomitant medications, socioeconomic status, and smoking history, AAA risk associated with psoriasis remained significant with incidence rate ratios (IRR) of 1.20 (95% confidence interval [CI]: 1.03-1.39) for mild disease and 1.67 (95% CI: 1.21-2.32) for severe disease.

In a sensitivity analysis, researchers discovered 88 910 patients with mild and 23 059 patients with severe psoriasis using “more liberal criteria” for psoriasis. The results were similar to the primary analyses with increased IRRs in patients with mild (IRR: 1.41; 95% CI: 1.26-1.57) and severe psoriasis (IRR: 1.66; 95% CI: 1.35-2.03).

In addition, the estimated risk of ruptured AAA in patients with psoriasis produced increased IRRs for mild (IRR: 1.60; 95% CI: 1.21-2.12) and severe psoriasis (IRR: 1.94; 95% CI: 1.01-3.36). IRs per 10 000 person-years of undergoing surgery for AAA were estimated to be 7.73 and 8.09 for mild (n=254) and severe psoriasis (n=41) vs 3.03 for the reference population (n=22 455).

“These findings add importantly to current evidence of psoriasis as a clinically relevant risk factor for cardiovascular disease and may require increased focus on heightened risk of AAA in patients with psoriasis,” researchers concluded.

Reference

Khalid U, Egeberg A, Ahleoff O, Smedegaard L, Gislason GH, Hansen PR. Nationwide study on the risk of abdominal aortic aneurysms in patients with psoriasis. Arterioscler Thromb Vasc Biol. 2016. doi: 10.1161/ATVBAHA.116.307449.