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Sci Rep. 2017;7(1):9973.

Increased Risk of Atrial Fibrillation and Thromboembolism in Patients with Severe Psoriasis: a Nationwide Population-based Study.

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제1저자 이태민 · 교신저자 최의근

소속 (6)
  1. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  2. Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  3. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. choiek17@snu.ac.kr.
  4. Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  5. Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
  6. Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

Psoriasis increases the risk of atrial fibrillation (AF) and thromboembolic events (TE). There is limited information on the effect of psoriasis severity on AF and TE. In this study, psoriasis patients were enrolled from the Korean National Insurance Service-National Sample Cohort (2004-2008). Diagnosis and disease severity were determined from claims data. Newly diagnosed non-valvular AF and TE were identified during a 9.6-year follow-up. The effect of psoriasis severity on AF and TE was evaluated. We identified 13,385 psoriasis patients (1,947 with severe psoriasis). Severe psoriasis significantly increased the risk of AF (adjusted hazard ratio [HRadjust] 1.44 [95% confidence interval (CI) 1.14-1.82], p = 0.002) and TE (HRadjust 1.26 [95% CI 1.07-1.47], p = 0.005); mild psoriasis did not show any significant effects. Results were similar after propensity-score matching. Risk increments of AF and TE were prominent in patients with greater cardiovascular risk. A possible limitation of our study is that it has a retrospective design, and the effect of unmeasured confounders and risk of misclassification could bias the results. To conclude, our results showed that severe, but not mild, psoriasis significantly increased AF and TE risk. AF surveillance and active stroke prevention would be beneficial in such cases.

Figures

Figure 1
Figure 1 Flow of Cohort Establishment and Follow-Up. This study was a 10-year retrospective cohort study established from the Korean nationwide health insurance claim data. Abbreviations: AF, atrial fibrillation.
Figure 2
Figure 2 Comparison of Cumulative Incidence of Atrial Fibrillation and Thromboembolic Events According to the Severity of Psoriasis. Kaplan-Meier curves with cumulative hazards of atrial fibrillation (A) and thromboembolic events (B) compared by severity of psoriasis are presented. The adjusted hazard ratios were calculated by multivariable Cox regression models, including age over 65, gender, income level, resident area, hypertension, diabetes, dyslipidemia, congestive heart failure, peripheral arterial disease, prior history of stroke and myocardial infarction as covariates. Abbreviations: CI, confidence interval; HR, hazard ratio; N/A, non-applicable.
Figure 3
Figure 3 Subgroup Analyses for Atrial Fibrillation Risk in Psoriasis Patients. The effects of psoriasis on the risk of AF were shown to be weaker in subgroups with well-known CV risk factors than those without. However, the absolute increases of incidence rates were still much higher in risky subgroups. Abbreviations: CHF, congestive heart failure; CI, confidence interval; cardiovascular, cardiovascular; DM, diabetes mellitus; HR, hazard ratio; HTN, hypertension; MI, myocardial infarction.

그림 출처: PubMed Central 공개 논문 (PMC5577288)

Conflict of interest statement

The authors declare that they have no competing interests.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2017-08-30
MeSH
Adult · Aged · Aged, 80 and over · Atrial Fibrillation / complications / epidemiology · Female · Follow-Up Studies · Humans · Korea / epidemiology · Male · Middle Aged · Psoriasis / complications / pathology · Risk Assessment · Severity of Illness Index · Thromboembolism / epidemiology · Young Adult
참고문헌
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