Pharmacological Undertreatment of Coronary Risk Factors in Patients with Psoriasis: Observational Study of the Danish Nationwide Registries

BACKGROUND: Patients with psoriasis have increased prevalence of coronary risk factors and limited recent results have suggested that these risk factors are undertreated in patients with psoriasis. This may contribute to the increased risk of cardiovascular diseases observed in patients with psoriasis. OBJECTIVE: To examine the pharmacological treatment of coronary risk factors in patients with severe psoriasis treated with biologic agents in a real-world setting. METHODS AND FINDINGS: Medical history of patients with severe psoriasis treated with biologic agents in the time period 2007-09 was retrieved from a Danish nationwide registry (DERMBIO). Individual-level linkage of nationwide administrative registries of hospitalizations, concomitant medications, and socioeconomic status was performed to gain insights into the use of pharmacological treatment. A total of 693 patients (mean age 46.1 ± 12.7 years, 65.7% male) with severe psoriasis treated with biologic agents were identified. Hypertension, hypercholesterolemia, and diabetes mellitus were identified in 16.6%, 9.2%, and 6.7% of cases, respectively. Patients with severe psoriasis were significantly less likely to receive cardiovascular pharmacotherapy compared to age, sex, and coronary risk factor matched controls. In psoriatic patients with hypertension 27.7% received no antihypertensive pharmacotherapy. Patients with dyslipidemia received cholesterol-lowering medications in 55.8% of cases and patients with diabetes mellitus received angiotensin converting enzyme inhibitors/angiotensin II receptor blockers and cholesterol-lowering medications in 42.1% and 23.7% of cases, respectively. Similar results were found for the subset of patients with >1 coronary risk factor and for high risk patients with established atherosclerotic disease. CONCLUSION: This nationwide study of patients with severe psoriasis demonstrated substantial undertreatment of coronary risk factors. Increased focus on identifying cardiovascular risk factors and initiation of preventive cardiovascular pharmacotherapy in patients with psoriasis is warranted

Secondary cardiovascular prophylaxis in patients with established atherosclerotic disease (n = 6).^*

*<p>Previous hospitalization with a diagnosis of ischemic heart disease, cerebrovascular disease, or peripheral vascular disease.</p>**<p>ACE-I; angiotensin-converting enzyme inhibitor, ARB; Angiotensin II receptor blocker.</p

Medical management of coronary risk factors.

*<p>ACE-1; angiotensin-converting enzyme inhibitor, ARB; Angiotensin II receptor blocker.</p

Baseline characteristics of patients with psoriasis.

*<p>PASI; psoriasis activity and severity index.,</p>**<p>Established atherosclerosis; ischemic heart disease, cerebrovascular disease, peripheral vascular disease.</p>***<p>UVA; ultraviolet A light.</p

Medical management of coronary risk factors in patients with psoriasis and age- and sex matched controls.

*<p>ACE-1; angiotensin-converting enzyme inhibitor, ARB; Angiotensin II receptor blocker.</p