Psoriasis and risk of nonfatal cardiovascular disease in US women: a cohort study

Background Psoriasis has been linked to cardiovascular comorbidities in cross-sectional studies, but evidence regarding the association between psoriasis and incident cardiovascular disease (CVD) is limited. Objectives To make a prospective evaluation of the association between psoriasis and risk of incident nonfatal CVD. Methods Participants (n = 96 008) were included from the Nurses' Health Study II, and followed for 18 years. Information on physician-diagnosed psoriasis was obtained by self report and diagnosis was confirmed by supplementary questionnaires. We included 2463 individuals with self reported psoriasis and a subsample of 1242 with validated psoriasis. The main outcome was incident nonfatal CVD events [nonfatal myocardial infarction (MI) and nonfatal stroke], ascertained by biennial questionnaires and confirmed. Results During 1 709 069 person years of follow up, 713 incident nonfatal CVD events were confirmed. Psoriasis was associated with a significantly increased multivariate-adjusted hazard ratio (HR) of nonfatal CVD, 1.55 [95% confidence interval (CI): 1.04-2.31] HRs for nonfatal MI and stroke were 1.70 (95% CI: 1.01-2.84) and 1.45 (95% CI: 0.80-2.65), respectively. The association remained consistent in a sensitivity analysis of confirmed psoriasis (HR: 2.06, 95% CI: 1.31-3.26). For individuals with concomitant psoriatic arthritis, the risk of nonfatal CVD was even higher (HR: 3.47; 95% CI: 1.85-6.51). Women diagnosed with psoriasis at < 40 years of age or with duration of psoriasis >=. 9 years had substantial elevations in CVD risk: HR: 3.26 (95% CI: 1.21-8.75) and 3.09 (95% CI: 1.15-8.29), respectively. Conclusions Psoriasis is an independent predictor for nonfatal CVD among women, with particularly high risk for those with longer duration] of psoriasis and concomitant psoriatic arthritis.