Poor cardiovascular-kidney-metabolic (CKM) health is significantly associated with a higher risk for psoriasis, according to study results published in the Journal of the European Academy of Dermatology & Venereology.
Researchers analyzed data of individuals without a diagnosis of psoriasis at baseline from the UK Biobank project. They evaluated the association between CKM health and the risk for incident psoriasis, whether genetic susceptibility affected the relationship, and the effect of CKM health on life expectancy among patients who developed psoriasis.
CKM was defined here as the presence of metabolic risk factors, chronic kidney disease, and cardiovascular disease. Baseline CKM syndrome stages were defined with the American Heart Association criteria, and polygenic risk scores (PRS) measuring genetic susceptibility for psoriasis were classified as low and high risk. Cox proportional hazards models were used to estimate hazard ratios (HRs) regarding the association of CKM stage with psoriasis risk.
The main analysis included 392,454 individuals, who had a mean (SD) age of 56.57 (8.09) years and of which 53.82% were women. Baseline stage 0, 1, 2, 3, and 4 of CKM syndrome was observed in 63,202 (16.10%), 64,873 (16.53%), 191,605 (48.82%), 45,403 (11.57%) and 27,371 (6.98%) individuals, respectively.
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Our findings highlight the critical importance of early detection and timely intervention during the initial CKM stages to mitigate the risk of psoriasis and enhance life expectancy.
The median follow-up was 12.3 years (IQR, 11.4-13.1 years) and 3551 new cases of psoriasis occurred. Adjusted HRs for incident psoriasis in individuals with CKM stages 1, 2, 3, and 4 were 1.21 (95% CI, 1.06-1.38), 1.38 (95% CI, 1.24-1.55), 1.64 (95% CI, 1.42-1.91) and 1.72 (95% CI, 1.47-2.01), respectively, when compared with individuals with stage 0 and after adjustment for potential confounders. CKM stages and risk for incident psoriasis had a significantly positive dose-response association per stage increase in the multivariate-adjusted model (HR, 1.15; 95% CI, 1.11-1.19).
Individuals in the high PRS group had an HR of 1.65 (95% CI, 1.54-1.77) for psoriasis compared with those in the low PRS group after adjustment. Those with CKM stage 4 and high PRS had the highest risk for psoriasis compared with those with stage 0 and low PRS (HR, 2.82; 95% CI, 2.28-3.49).
A significant positive interaction was found between advanced CKM stage and high PRS for incident psoriasis. In analysis with both factors, the risk for psoriasis increased by 0.82 (relative excess risk due to interaction, 0.82; 95% CI, 0.35-1.32) compared with each factor individually. Advanced CKM stages were associated with an increased risk for psoriasis among all PRS groups.
Individuals with psoriasis aged 45 years had a decrease in life expectancy by 0.47 years (95% CI, 0.16-0.78) compared with those without psoriasis. Those with psoriasis and CKM stage 4 had a loss of life expectancy of 2.03 years (95% CI, 0.25-3.81). Individuals without psoriasis had a loss of life expectancy of 5.10 years (95% CI, 4.60-5.60) at chronic kidney disease stage 4 compared with those at stage 0.
A significant interaction occurred between CKM stage and age (P =.025). Individuals younger than 60 years of age with advanced CKM stage had an increased risk of psoriasis compared with older individuals.
Limitations of the study include the observational nature of the study and unavailability of data on cardiac biomarkers, echocardiography results, and coronary angiography findings. Also, most individuals were middle-aged or older individuals of European White ancestry, limiting generalizability.
“Our findings highlight the critical importance of early detection and timely intervention during the initial CKM stages to mitigate the risk of psoriasis and enhance life expectancy,” the researchers stated.
This article originally appeared on Dermatology Advisor
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