Usman Khalid1, Alexander Egeberg2, Ole Ahlehoff2, Laerke Smedegaard2, Gunnar Hilmar Gislason2, Peter Riis Hansen2. 1. From the Department of Cardiology (U.K., O.A., L.S., G.H.G., P.R.H.), Department of Dermatology (A.E.), Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark (O.A.); National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (G.H.G., P.R.H.); and Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.). usman.khalid@regionh.dk. 2. From the Department of Cardiology (U.K., O.A., L.S., G.H.G., P.R.H.), Department of Dermatology (A.E.), Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark (O.A.); National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (G.H.G., P.R.H.); and Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.).
Abstract
OBJECTIVE: Abdominal aortic aneurysm (AAA) is a complex multifactorial disease associated with a high morbidity and mortality. Increased inflammation including T-helper 17 cell-mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a T-helper 17-driven chronic inflammatory disease and in view of potentially overlapping inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a nationwide cohort. APPROACH AND RESULTS: The study comprised all Danish residents aged ≥18 years followed up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AAA were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications, socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5 495 203 subjects were eligible for analysis. During the study period, we identified 59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis. The overall incidence rates of AAA were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The corresponding adjusted incidence rate ratios for AAA were increased in patients with psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.03-1.39) and 1.67 (confidence interval, 1.21-2.32) for subjects with mild and severe disease, respectively. CONCLUSIONS: In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AAA. The mechanisms and consequences of this novel finding require further investigation.
OBJECTIVE:Abdominal aortic aneurysm (AAA) is a complex multifactorial disease associated with a high morbidity and mortality. Increased inflammation including T-helper 17 cell-mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a T-helper 17-driven chronic inflammatory disease and in view of potentially overlapping inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a nationwide cohort. APPROACH AND RESULTS: The study comprised all Danish residents aged ≥18 years followed up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AAA were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications, socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5 495 203 subjects were eligible for analysis. During the study period, we identified 59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis. The overall incidence rates of AAA were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The corresponding adjusted incidence rate ratios for AAA were increased in patients with psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.03-1.39) and 1.67 (confidence interval, 1.21-2.32) for subjects with mild and severe disease, respectively. CONCLUSIONS: In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AAA. The mechanisms and consequences of this novel finding require further investigation.