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Psoriasis, electrocardiographic characteristics, and incidence of atrial fibrillation

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Abstract

Psoriasis patients have an increased incidence of cardiovascular disease. Atrial fibrillation is the most common cardiac arrhythmia and is associated with increased morbidity and risk of stroke. In this study, we assessed the association between psoriasis, electrocardiographic characteristics, and incident atrial fibrillation. Two cohorts were studied to address this question. First, the electrocardiograms of 169 subjects with psoriasis and coronary heart disease were reviewed and matched to patients without psoriasis. The Framingham risk score for atrial fibrillation was calculated to predict incident atrial fibrillation. Second, a larger cohort of 2,078 patients with psoriasis was matched to 6,234 patients without psoriasis. In the first group, psoriasis patients had no significantly different electrocardiographic characteristics, but a trend towards a decreased predicted incidence of atrial fibrillation using the Framingham risk score (12.8 vs. 14.6 % over a 10-year period, P = 0.06), suggesting that patients with psoriasis do not have a higher prevalence of risk factors for atrial fibrillation based on established risk scores. In the second group, the 5-year incidence of atrial fibrillation among patients with psoriasis was 2.5, vs. 3.3 % for matched controls (P = 0.4). The rates of atrial fibrillation per 1,000 person-years ranged from 4.8 events/1,000 person-years for mild psoriasis to 5.4 for patients with moderate/severe psoriasis. On multivariable analysis, there remained no association between mild psoriasis (adjusted HR 1.32, 95 % CI 0.91–1.89) or moderate-to-severe psoriasis (adjusted HR 1.27, 95 % CI 0.54–3.03) and incident atrial fibrillation.

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References

  1. Ahlehoff O, Gislason GH, Jorgensen CH, Lindhardsen J, Charlot M, Olesen JB, Abildstrom SZ, Skov L, Torp-Pedersen C, Hansen PR (2011) Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish nationwide cohort study. Eur Heart J 33:2054–2064

    Article  PubMed  Google Scholar 

  2. Armstrong AW, Lin SW, Chambers CJ, Sockolov ME, Chin DL (2011) Psoriasis and hypertension severity: results from a case–control study. PLoS One 6:e18227

    Article  PubMed  CAS  Google Scholar 

  3. Armstrong AW, Voyles SV, Armstrong EJ, Fuller EN, Rutledge JC (2011) A tale of two plaques: convergent mechanisms of t-cell-mediated inflammation in psoriasis and atherosclerosis. Exp Dermatol 20:544–549

    Article  PubMed  CAS  Google Scholar 

  4. Armstrong AW, Voyles SV, Armstrong EJ, Fuller EN, Rutledge JC (2011) Angiogenesis and oxidative stress: common mechanisms linking psoriasis with atherosclerosis. J Dermatol Sci 63:1–9

    Article  PubMed  CAS  Google Scholar 

  5. Casale PN, Devereux RB, Kligfield P, Eisenberg RR, Miller DH, Chaudhary BS, Phillips MC (1985) Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol 6:572–580

    Article  PubMed  CAS  Google Scholar 

  6. Friedewald VE, Cather JC, Gelfand JM, Gordon KB, Gibbons GH, Grundy SM, Jarratt MT, Krueger JG, Ridker PM, Stone N, Roberts WC (2008) AJC editor’s consensus: psoriasis and coronary artery disease. Am J Cardiol 102:1631–1643

    Article  PubMed  Google Scholar 

  7. Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ (2005) Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol 141:1537–1541

    Article  PubMed  Google Scholar 

  8. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB (2006) Risk of myocardial infarction in patients with psoriasis. JAMA 296:1735–1741

    Article  PubMed  CAS  Google Scholar 

  9. Gelfand JM, Dommasch ED, Shin DB, Azfar RS, Kurd SK, Wang X, Troxel AB (2009) The risk of stroke in patients with psoriasis. J Invest Dermatol 129:2411–2418

    Article  PubMed  CAS  Google Scholar 

  10. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 285:2370–2375

    Article  PubMed  CAS  Google Scholar 

  11. Issac TT, Dokainish H, Lakkis NM (2007) Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol 50:2021–2028

    Article  PubMed  CAS  Google Scholar 

  12. Kimball AB, Gladman D, Gelfand JM, Gordon K, Horn EJ, Korman NJ, Korver G, Krueger GG, Strober BE, Lebwohl MG (2008) National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol 58:1031–1042

    Article  PubMed  Google Scholar 

  13. Kurd SK, Gelfand JM (2009) The prevalence of previously diagnosed and undiagnosed psoriasis in us adults: results from NHANES 2003–2004. J Am Acad Dermatol 60:218–224

    Article  PubMed  Google Scholar 

  14. Lip GY, Brechin CM, Lane DA (2012) The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest 142:1489–1498

    Article  PubMed  Google Scholar 

  15. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, Carolei A (2005) Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 36:1115–1119

    Article  PubMed  Google Scholar 

  16. Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM (2010) Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J 31:1000–1006

    Article  PubMed  Google Scholar 

  17. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, Tsang TS (2007) Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol 49:986–992

    Article  PubMed  Google Scholar 

  18. Naccarelli GV, Varker H, Lin J, Schulman KL (2009) Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 104:1534–1539

    Article  PubMed  Google Scholar 

  19. Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM (2006) Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 55:829–835

    Article  PubMed  Google Scholar 

  20. Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG (2009) Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol 145:700–703

    Article  PubMed  Google Scholar 

  21. Schnabel RB, Larson MG, Yamamoto JF, Kathiresan S, Rong J, Levy D, Keaney JF Jr, Wang TJ, Vasan RS, Benjamin EJ (2009) Relation of multiple inflammatory biomarkers to incident atrial fibrillation. Am J Cardiol 104:92–96

    Article  PubMed  CAS  Google Scholar 

  22. Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB Sr, Newton-Cheh C, Yamamoto JF, Magnani JW, Tadros TM, Kannel WB, Wang TJ, Ellinor PT, Wolf PA, Vasan RS, Benjamin EJ (2009) Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 373:739–745

    Article  PubMed  Google Scholar 

  23. Schnabel RB, Aspelund T, Li G, Sullivan LM, Suchy-Dicey A, Harris TB, Pencina MJ, D’Agostino RB Sr, Levy D, Kannel WB, Wang TJ, Kronmal RA, Wolf PA, Burke GL, Launer LJ, Vasan RS, Psaty BM, Benjamin EJ, Gudnason V, Heckbert SR (2010) Validation of an atrial fibrillation risk algorithm in whites and African Americans. Arch Intern Med 170:1909–1917

    Article  PubMed  Google Scholar 

  24. Sokolow M, Lyon TP (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37:161–186

    Article  PubMed  CAS  Google Scholar 

  25. Wakkee M, Herings RM, Nijsten T (2010) Psoriasis may not be an independent risk factor for acute ischemic heart disease hospitalizations: results of a large population-based Dutch cohort. J Invest Dermatol 130:962–967

    Article  PubMed  CAS  Google Scholar 

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Correspondence to April W. Armstrong.

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Armstrong, A.W., Azizi, S., Wu, J. et al. Psoriasis, electrocardiographic characteristics, and incidence of atrial fibrillation. Arch Dermatol Res 305, 891–897 (2013). https://doi.org/10.1007/s00403-013-1419-5

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  • DOI: https://doi.org/10.1007/s00403-013-1419-5

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