Do Biologics Protect Patients With Psoriasis From Myocardial Infarction? A Retrospective Cohort.

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome. METHODS: We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI). RESULTS: Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056). CONCLUSION: Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada.

PURPOSE: The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador. METHODS: A population-based study was carried out on children aged 0-16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas. RESULTS: A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P=0.006). Infants (0-1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2-4 years (26.0 per 100,000 P-Y) (P<0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P<0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P<0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y. CONCLUSION: Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.

Long-term prognosis and comorbidities associated with psoriasis in the Newfoundland and Labrador founder population.

BACKGROUND: Psoriasis is a common chronic immune-mediated inflammatory disorder of the skin with several associated comorbidities. OBJECTIVE: To assess the prevalence of comorbidities in a cohort of psoriasis patients within the Canadian province of Newfoundland and Labrador (NL). METHODS: This cross-sectional observational study investigated hospital-coded comorbidities associated with psoriasis in comparison to the general NL hospitalized population. RESULTS: Patients died significantly younger than the general population, with patients having an earlier disease onset (≤ 25 years) dying at a younger age than those with a later onset (> 25 years; 59.3 vs 71.2; p  =  .001). Patients were hospitalized more frequently for several system disorders than the general population, and a potential association was observed between prognostic factors such as age at onset, disease severity, and HLA-Cw6 genotype and certain comorbid conditions. CONCLUSION: This study supports an association between psoriasis and other conditions, such as circulatory and endocrine diseases.