Patients with Psoriatic Arthritis at Greater Risk for Developing Arrhythmias

Analysis of a population-based cohort indicates that patients with psoriasis and psoriatic arthritis face an elevated risk of developing heart arrhythmias such as atrial fibrillation.

Researchers used records from the Taiwan National Health Insurance Research Database to match 40,637 psoriasis patients with 162,548 controls of similar age and sex as well as a comparable incidence of hypertension, diabetes and coronary heart disease.

Still, at baseline, the psoriasis patients were more likely to be obese and more likely to have been diagnosed with hyperlipidemia, heart failure, sleep apnea, thyroid dysfunction, chronic kidney disease and chronic obstructive pulmonary disease. The researchers, however, were able to adjust for medical history and medication use and ran the numbers on arrhythmia.

Overall, patients in the psoriasis group were more than a third more likely to suffer from arrhythmia (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.29-1.39). Oddly, the risk of psoriasis was more elevated in patients with mild psoriasis (HR, 1.35; 95% CI, 1.30-1.41) than in patients with severe psoriasis (HR, 1.25; 95% CI, 1.12-1.39).

Further analysis found that the arrhythmia gap between control patients and those who had both psoriasis and psoriatic arthritis (HR, 1.46; 95% CI, 1.22-1.74) was greater (but not significantly so) than the gap between control patients and psoriasis patients with no psoriatic arthritis (HR, 1.33; 95% CI, 1.28-1.39).

The study team noted several limitations in its work. Most important among them was the failure of the National Health Insurance Research Database to provide information about alcohol consumption, cigarette smoking or patient outcomes on the Psoriasis Area and Severity Index.

Still, team members wrote in the Journal of the American Academy of Dermatology, the results were strong enough to reveal a significant relationship: “Patients with psoriasis were at higher risk of developing arrhythmia, particularly for those with psoriatic arthritis, independent of traditional cardiovascular risk factors…

“These findings may indicate that psoriasis can be added to future risk stratification scores for arrhythmia. Moreover, these results indicate that patients with psoriasis, especially young patients and those with [psoriatic arthritis], should be more closely screened for various types of arrhythmia.”

Previous efforts to see if psoriatic arthritis is associated with increased risk of cardiovascular disease have reached differing conclusions. A review article published byCirculation in 2007 reported that data from Olmstead County, Minnesota found comparable death rates between psoriatic arthritis patients and the public at large, while a Spanish study on 50 such patients found no evidence of clinical cardiovascular disease or even collectively elevated risk factors among the people with psoriatic arthritis.

On the other hand, the authors of the review wrote, “A recent US study based on health plan data found that patients with psoriatic arthritis had higher prevalences of both cardiovascular disease risk factors and ischemic heart disease, peripheral vascular disease, and congestive heart failure than age- and sex-matched control subjects. However, the higher prevalences of diseases were not adjusted for risk factors.”

More recently, a study that appeared in The Scientific World Journal found that 94 outpatient psoriasis patients were significantly more likely than 51 control group members to exhibit both atrial and ventricular arrhythmias when examined by researchers.