People with end-stage kidney disease and psoriasis are not at increased risk of a heart attack

People with end-stage kidney disease and psoriasis are not at increased risk of a heart attack

Studies have shown that psoriasis is an independent risk factor for heart attack in the general population, but researchers have surprisingly found that this is not the case in people with end-stage renal disease, which shares many risk factors with heart disease.

There are many things that contribute to MI and our target audience has many of them.”

Dr. Wendy B. Bollag, cell physiologist, Department of Physiology, Medical College of Georgia, Augusta University

"We asked: Are the population with end-stage renal disease who also have psoriasis at increased risk of heart attack, and they weren't," says Bollag, corresponding author of the study in the American Journal of the Medical Sciences.

Investigators from MCG and the Charlie Norwood VA Medical Center searched the United States Renal Data System for patients with end-stage renal disease (ESRD) who began dialysis between 2004-15 and had at least two diagnoses of psoriasis (they wanted two to help ensure a correct diagnosis, since psoriasis is both underdiagnosed and misdiagnosed), a diagnosis of heart attack, or myocardial infarction and other risk factors for heart disease.

They found that 24% of 6,283 patients with ESRD and psoriasis -; 1,671 people -; also had an MI, a significant percentage, again indicating increased risk. These people were largely white, male and on hemodialysis, and investigators expected to find a fairly direct associated risk.

As the co-author and MCG biostatistician Dr. When Dr. Jennifer Waller examined the data without taking into account demographic characteristics such as race and the numerous so-called comorbid diseases, psoriasis again appeared to be an independent risk factor for MI, as previous studies have shown.

But when Waller controlled these other risk factors, “psoriasis dropped out,” Bollag says.

"I think the confounding variables affect both the exposure, which is psoriasis, and the outcome, which is myocardial infarction, so the relationship between the two is kind of blurred," says lead author, MCG medical student Naomi Siddiquee.

Patients with psoriasis are considered to be at increased risk for chronic kidney disease and ESRD. Inflammation is a major factor in all of these diseases as well as heart disease. In fact, many of the same immune cell types are involved in psoriasis and heart disease.

To better understand how the conditions might work against patients, they used the Charlson Comorbidity Index, which predicts 10-year survival in patients with multiple "comorbidities," essentially two or more conditions from a long list of problems like diabetes and high blood pressure, the two most common causes of chronic kidney disease, to identify conditions that could affect or otherwise worsen a patient's condition. These also include problems such as stroke, congestive heart failure, dementia, lung disease, mild liver disease, tobacco use and cancer, as well as MI. For this study, researchers controlled all patients except MI, and they only examined conditions that occurred since the patient started dialysis for kidney failure and before his heart attack.

They suspect that their adaptations to more diseases to really refine the effects of psoriasis on MI in patients with ESRD likely help explain the differences between what they and others have found.

While other studies were prospective, meaning they followed people and saw whether they had a heart attack, the fact that they looked at these conditions retrospectively in a large database meant they could better control for the myriad other factors that could also contribute to an MI, says Bollag. “We may have controlled for many more factors than other studies,” Siddiquee adds.

The fact that the database they used gave no indication of the severity of the psoriasis or whether or how it was treated -; it is often undertreated -; could also help explain what they found, she says. Siddiquee noted that previous studies have logically found that more severe psoriasis causes greater internal inflammation.

They found evidence of a link between psoriasis and congestive heart failure, as well as the known independent link between heart failure and heart attack, and the researchers recommend that patients with ESRD and psoriasis have their cardiovascular risk factors screened annually.

While psoriasis is widely viewed as a skin condition that can also affect the joints, there is increasing evidence that its effect is more widespread throughout the body. In fact, severe psoriasis can shorten lifespan by five years, and cardiovascular disease is thought to be a major cause.

ESRD, which is increasing in the United States, leaves patients dependent on either some type of dialysis or a kidney transplant to restore important kidney functions such as filtering toxins from the blood so they can be excreted in the urine. The majority of patients whose data they examined were on dialysis.

Researchers reported last year in the American Journal of the Medical Sciences that dialysis patients who also have psoriasis are at increased risk of infection and that appropriate treatment of their skin condition could reduce the risk of infection and death.

Source:

Medical College of Georgia at Augusta University

Reference:

Siddiquee, N., et al. (2022) Association of psoriasis with myocardial infarction in patients with end-stage renal disease. The American Journal of Medical Sciences. doi.org/10.1016/j.amjms.2022.08.003.

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