Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study.

ABSTRACT

BACKGROUND: Attention towards cardiovascular disease prevention in patients with moderate to severe psoriasis increased with the introduction of biological therapy. OBJECTIVE: To determine the risk of myocardial infarction (MI) following hospital-diagnosed psoriasis compared with the general population, in eras before and following the introduction of biological therapy. METHODS: We conducted a cohort study in Denmark utilising nationwide prospectively collected data from population-based registries. For the early era cohort, we identified subjects with first time hospital-diagnosed psoriasis between 1995 and 2002, and, for the late era cohort, those diagnosed between 2006 and 2013. Comparison cohorts from the general population were matched (101) on sex and birth year. All individuals were followed from date of psoriasis diagnosis (index date for matched controls) until incidence of MI, death, emigration or end of study (1 January 2002 for the early era cohort; 1 January 2013 for the late era cohort). We computed the cumulative MI incidence at 5 years of follow-up, and used Cox regression to compute HRs of MI comparing psoriasis subjects with general population subjects. RESULTS: For the early era, we identified 4302 psoriatic subjects and 43 791 general population subjects; and for the late era, 4577 psoriatic subjects (4% received biologic therapy) and 46 376 general population subjects. The cumulative incidence of MI among psoriatic subjects in the early era was 2.5% and it was 2.2% in the late era. The HRs comparing MI risk in the psoriasis and general population cohorts were 1.40 (95% CI 1.09-1.80), for the early era, and 1.39 (95% CI 1.10-1.75) for the late era, adjusting for educational level and use of cardiovascular drugs. CONCLUSION: The increased risk of MI among patients with hospital-diagnosed psoriasis, relative to the general population, remained unchanged during the initial years of increased attention towards cardiovascular disease prevention and availability of biologic therapy.