Link Found Between Psoriasis, Abdominal Aortic Aneurysms

Patients with psoriasis have a greater risk of developing abdominal aortic aneurysms (AAAs), with the threat increasing as the severity of the inflammatory skin condition worsens, a retrospective cohort study shows.

The relationships are independent of traditional cardiovascular risk factors, Usman Khalid, MD (Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark), and colleagues report online April 14, 2016, ahead of print in Arteriosclerosis, Thrombosis, and Vascular Biology.

They say further research is needed to explore potential mechanisms but note that “recent evidence has shown striking similarities between central inflammatory pathways involved in AAA and those occurring in psoriasis.”

Commenting on the study for TCTMD, David Meyerson, MD, JD (Johns Hopkins Bayview Medical Center, Baltimore, MD), also called for additional research into the observed link.

“While not speaking to the precise mechanism of causation, this study does forward our knowledge base and drives home the point that screening for AAA should be considered when screening for coronary artery, cerebrovascular, and peripheral vascular disease in patients with systemic inflammatory disease processes, among which psoriasis is numbered,” said Meyerson, a spokesperson for the American Heart Association.

Khalid and colleagues examined data from Danish national registries on nearly 5.5 million adults who did not have a history of psoriasis or AAA at baseline. During follow-up, 59,423 and 11,566 patients were identified with mild or severe psoriasis, respectively, and 23,986 were diagnosed with AAA. Mean follow-up was 5.7 years for the patients with psoriasis and 14.4 years for the rest of the participants.

The rate of AAA—per 10,000 person-years—was 3.72 for patients without psoriasis, 7.30 for those with mild psoriasis, and 9.87 for those with severe disease. After multivariate adjustment, the rate remained elevated in patients with mild psoriasis (incidence rate ratio [IRR] 1.20; 95% CI 1.03-1.39) and severe psoriasis (IRR 1.67; 95% CI 1.21-2.32).

Results of various sensitivity analyses were consistent with the main findings.

Inflammation Key?

According to the authors, newer data suggest that the development and progression of AAA is related to multiple factors, including inflammation, matrix degradation, thrombosis, and aortic wall stress. Inflammation is also a primary component of psoriasis.

“Furthermore, a central pathogenic role for tumor necrosis factor has been suggested for both AAA and psoriasis, and more specifically, recent studies have indicated that T-helper-17 cells and interleukin-17 can be of pivotal importance in the inflammatory pathogenesis of AAA, as was established long ago for psoriasis,” they write.

“Taken together, these data support the notion that shared inflammatory mechanisms contribute to the psoriasis severity-dependent increased risk of AAA observed in the current study,” they conclude.

“This finding clearly requires independent replication and the clinical consequences are unclear at present—eg, whether patients with psoriasis should undergo increased ultrasonic screening for AAA, and whether anti-tumor necrosis factor and other anti-inflammatory treatment of psoriasis may reduce the risk of AAA,” they write.

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