The study, published in The American Journal of the Medical Sciences, suggests that psoriasis does not affect the risk of heart attacks in patients with malignant cancers. “There are a lot of things that contribute to MI and our target population has a lot of them,” says Dr. Wendy B. Bollag, a cell physiologist in the Department of Physiology at the Medical College of Georgia at Augusta University.
“We were asking if there is a population with end-stage kidney disease that also has psoriasis at increased heart attack risk and they were not,” says Bollag, the study’s corresponding author.
Investigators from the MCG and Charlie Norwood VA Medical Center queried the United States Renal Data System for patients with end-stage kidney disease, or ESRD, who began dialysis between 2004–15, who had at least two episodes of psoriasis. There were diagnoses (they two wanted to help ensure a proper diagnosis because psoriasis is both a diagnosis and a misdiagnosis), a diagnosis of heart attack, or myocardial infarction, and other risk factors for heart disease.
They found that 24% – 1,671 of the 6,283 patients with ESRD and psoriasis – also had MI, a significant percentage that again suggested an increased risk.
These individuals were mostly white, male and on hemodialysis and the investigators expected to find a very direct associated risk. When co-author and MCG biostatistician Dr. Jennifer Waller examined the data without accounting for demographics such as race and several so-called comorbid conditions, psoriasis again looked like an independent risk factor for MI as indicated by previous studies. Get.
“But when Waller controlled for those other risk factors, “psoriasis fell out,” Bollag said. “I think the confounding variables affect both the risk, which is psoriasis, and the outcome, which is MI. , so this kind of blurs the relationship between the two,” said first author, MCG medical student Naomi Siddiqui.
Patients with psoriasis are thought to be at increased risk for both chronic kidney disease and ESRD. Inflammation is an important factor in all of those conditions as well as heart disease. Multiple types of the same immune cell are involved in psoriasis and heart disease.
To better understand how the conditions might work together against patients, they used the Charlson Comorbidity Index, which predicts 10-year survival in patients with multiple “comorbidities,” basically diabetes and diabetes. Two or more conditions are from a long list of problems such as high blood pressure. To identify conditions that may affect or otherwise worsen a patient’s condition, the two most common causes of chronic kidney disease.
It also includes problems like stroke, congestive heart failure, dementia, pulmonary disease, mild liver disease, tobacco use and cancer. For this study, the investigators controlled for all of them except MI, and they only looked at conditions that accounted for the patient’s kidney failure and after starting dialysis before their heart attack.
They suspect that their adjustments to more conditions, to improve the effect of psoriasis on MI in patients with ESRD, possibly help explain the differences between them and others.
While other studies have been prospective, meaning that they follow people and see if they have had a heart attack, the fact that they looked at these conditions retrospectively in a large database means that they are more likely to follow other studies. One can better control for the myriad of factors that may contribute to MI. , Bolg said.
“We would have controlled for a lot more factors than in other studies,” Siddiqui said. “The fact that the database they used did not indicate the severity of psoriasis or how it was being treated, it is often treated and what they found may also help explain it.” , she says.
Siddiqui noted that previous studies have logically referred to more severe psoriasis as causing more internal inflammation. They found evidence to support a known independent association between psoriasis and congestive heart failure, as well as heart failure and heart attack, and the investigators advised patients with ESRD and psoriasis to receive an annual assessment of their cardiovascular risk factors. give.
While psoriasis is widely viewed as a skin disorder that can also affect the joints, there is increasing evidence that its effects are more widespread in the body. Severe psoriasis can shorten lifespan by up to five years and heart disease is known to be a major contributor.
ESRD, which is on the rise in the United States, makes patients dependent on some form of dialysis or kidney transplantation to help restore important kidney functions such as filtering toxins from the blood so that they can be eliminated in the urine. .
Most of the patients whose data they examined were on dialysis. Investigators reported last year in The American Journal of the Medical Sciences that patients on dialysis who also have psoriasis are at increased risk of infection and that appropriate treatment of their skin condition may be less likely. risk of infection and death.