Study Shows Psoriasis Does Not Increase Heart Attack Risk in Patients with Kidney Disease

Although prior research suggests that psoriasis is an independent risk factor for heart attacks among the general population, a recent study published in The American Journal of the Medical Sciences suggests this is not true among patients with end-stage renal disease (ESRD), which has similar risk factors to heart disease.

“There are a lot of things that contribute to (myocardial infarction [MI]) and our target population has a lot of them,” said corresponding study author Wendy B. Bollag, PhD, cell physiologist in the Department of Physiology at the Medical College of Georgia (MCG) at Augusta University, in a press release. “We were asking: ‘Is the population with end-stage renal disease that also has psoriasis at increased risk for a heart attack?’ and they weren’t.”

The research team at MCG and the Charlie Norwood VA Medical Center analyzed the United States Renal Data System for patients with ESRD who had dialysis initiated between 2004 and 15, had at least 2 diagnoses of psoriasis, a diagnosis of a heart attack, or MI, and other risk factors for heart disease.

The study population included 6283 patients, the majority of whom were white, male, and on hemodialysis. The researchers said they expected to find a direct associated risk between ESRD patients with psoriasis and the risk of heart attack. They found that 24% (1671) of the total patient population with ESRD and psoriasis also had a heart attack, which supports an increased risk.

In examining the data without accounting for demographics such as race and other comorbid conditions, psoriasis still appeared to be an independent risk factor for heart attack as suggested in previous studies. However, when the investigators controlled for those other risk factors, psoriasis dropped from consideration.

The study confirmed that patients with psoriasis are considered to have an increased risk for both chronic kidney disease and ESRD, because inflammation plays a significant role in those conditions as well as heart disease. Further, many of the same immune cell types are involved in psoriasis and heart disease, according to the study.

The researchers used the Charlson Comorbidity Index, which enables them to predict 10-year survival in patients with multiple comorbidities to identify conditions that could impact or exacerbate a patient’s condition. These conditions include stroke, congestive heart failure, dementia, pulmonary disease, mild liver disease, tobacco use, cancer, and heart attack.

The researchers controlled for all those conditions except for heart attack and they only examined conditions that occurred since the patient started dialysis for kidney failure and before their heart attack. These adjustments for more conditions enabled them to focus on the impact of psoriasis on heart attack in patients with ESRD, which the investigators said likely helps explain the differences between these findings and prior research.

The database did not indicate the severity of psoriasis or how it was being treated, which may also help explain the findings, according to the study authors. The added that previous studies found that more severe psoriasis produced greater internal inflammation.

They did find evidence that supports a relationship between psoriasis and congestive heart failure in addition to the known independent association between heart failure and heart attacks. The research team recommends that patients with ESRD and psoriasis get annual evaluations for their risk factors.

REFERENCE

Psoriasis does not appear to increase heart attack risk in people with significant kidney disease. JagWire. October 18, 2022. Accessed October 18, 2022. https://jagwire.augusta.edu/psoriasis-does-not-appear-to-increase-heart-attack-risk-in-people-with-significant-kidney-disease/