Patients with psoriasis are at increased risk of arrhythmia, with the risk even greater for younger patients and those with psoriatic arthritis, according to a population-based cohort study conducted in Taiwan.
Dr. Hsien-Yi Chiu of National Taiwan University and Wei-Lun Chang of National Yang-Ming University, both in Taipei, and their colleagues, looked at records from 40,637 patients diagnosed with psoriasis and 162,548 age- and sex-matched controls without psoriasis, over a mean follow-up of about 6 years, for the incidence of arrhythmias over a mean of 6 years.
In an article published in the September issue of the Journal of the American Academy of Dermatology, the investigators reported that those patients with psoriasis were at a significantly higher risk of developing arrhythmia, independent of traditional cardiovascular risk factors (adjusted hazard ratio, 1.34; 95% confidence interval, 1.29-1.39). Increased risk for patients with mild disease (aHR,1.35; 95% CI, 1.30-1.41) was comparable to that of patients with severe disease (aHR, 1.25; 95% CI 1.12-1.39) and more pronounced in the subgroup of patients with psoriatic arthritis (aHR, 1.46; 95% CI, 1.22-1.74). Younger patients, between aged 20 and 39 years, were at a higher risk (aHR, 1.39; 95% CI, 1.26-1.54) than older patients in the cohort (J Am Acad Dermatol. 2015 Sep;73:429-38).
Although previous studies have shown severe psoriasis to be associated with a nearly 60% increase in cardiovascular morbidity and mortality beyond traditional risk factors, less is known about arrhythmias specifically. “Inflammation may contribute to the alteration of cardiomyocyte electrophysiology, such as dysregulation of ion channel function, leading to increased risk of arrhythmia,” the investigators wrote.
The authors noted that limitations of their study were the potential surveillance bias for psoriasis patients due to increased hospital visits, and the fact that alcohol and tobacco use was not captured in the patient data. Treatment with systemic therapies may lower cardiovascular risk in psoriasis patients, they added, which may have explained why the arrhythmia risk among patients with severe disease was similar to those with mild disease.
The findings indicate “that psoriasis can be added to future risk-stratification scores for arrhythmia,” the investigators wrote, adding that patients with psoriasis, “especially young patients and those with PsA [psoriatic arthritis] , should be more closely screened for various types of arrhythmia,” with the hope of earlier intervention leading to reduction of cardiovascular morbidity and mortality.