Wakkee, M.

Psoriasis Is Not Associated with Atherosclerosis and Incident Cardiovascular Events: The Rotterdam Study (Article)

2013-03-14T00:00:00Z

Psoriasis has been suggested to be an independent risk factor for cardiovascular disease (CVD); however, available studies have shown inconsistent results. In this study, embedded within the population-based Rotterdam Study, we aimed to assess the association between psoriasis and cardiovascular outcomes. Adjusted means were calculated for subclinical atherosclerosis using general linear models. Using Cox regression, the hazards of cardiovascular events for psoriasis, as a time-dependent variable, were calculated. A total of 262 psoriasis (24% systemic/UV treatment) and 8,009 reference subjects were followed up for a mean of 11 years. Psoriasis patients were significantly younger, smoked more, and had higher diastolic blood pressure and body mass index levels. The adjusted carotid intima-media thickness was 1.02±0.18 mm for psoriasis and 1.02±0.16 mm for reference subjects. Similarly, crude and adjusted ankle-brachial index, pulse-wave velocity, and coronary artery calcium scores did not differ between the two groups. The risk of incident CVD was not increased in psoriasis (adjusted hazard ratio 0.73, 95% confidence interval 0.50-1.06). The results were similar when coronary heart disease, stroke, and heart failure were analyzed separately. Psoriasis patients with predominantly mild disease from the general population are as likely to develop atherosclerosis and cardiovascular events as subjects without psoriasis.Journal of Investigative Dermatology advance online publication, 4 April 2013; doi:10.1038/jid.2013.131.

Increased risk of infectious disease requiring hospitalization among patients with psoriasis: A population-based cohort (Article)

2011-06-10T00:00:00Z

Background: Immunologic alterations caused by psoriasis and/or its therapies may affect the risk of serious infections. Objective: For patients with psoriasis, we explored the overall and therapy-related risk of contracting an infectious disease (ID) requiring hospitalization in a large population-based cohort. Methods: The incidence of ID was compared between patients with psoriasis and a randomly selected cohort (ratio 1:5) using hospital and pharmacy databases covering 2.5 million Dutch residents between 1997 and 2008. First and multiple IDs were defined and categorized into 20 groups based on primary International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnoses. Multivariate Cox regression and Poisson event-count models were used to test the risk difference of IDs between patients with psoriasis and reference cohort. Results: A total of 25,742 patients with psoriasis and 128,710 reference subjects were followed up for approximately 6 years. The likelihood of IDs in patients with psoriasis was twice as high as the reference population (908 vs 438 events/100,000 person-years, crude hazard ratio 2.08, 95% confidence interval 1.96-2.22). In a multivariate model the hazard ratio decreased to 1.54 (95% confidence interval 1.44-1.65). This risk was highest for patients with more severe psoriasis (adjusted hazard ratio 1.81, 95% confidence interval 1.57-2.08), but was not associated with recent systemic antipsoriatic drug dispensing. Respiratory tract, abdominal, and skin infections occurred most frequently in patients with psoriasis. Multiple event analysis that counted the total number of infectious discharge diagnoses gave similar results. Limitations: No data were available on lifestyle factors. Conclusion: The risk of severe infections was significantly higher for patients with psoriasis compared with control subjects and could not be explained by exposure to systemic antipsoriatic drugs.

Psoriasis: Comorbidity and Treatment (Doctoral Thesis)

2010-04-15T00:00:00Z

Psoriasis is universal in occurrence, although the worldwide prevalence varies between 0.6% and 4.8%.The prevalence of psoriasis in people of Caucasian descend is approximately 2%. In the Netherlands it is therefore estimated that approximately 300,000 people are diagnosed as having psoriasis. Its prevalence is equal in men and women and can first appear at any age, from infancy to elderly, although the mean age of development has suggested to be around 30 years old. Some studies suggest the presence of two forms of psoriasis related to the age at onset. Early onset psoriasis, which comprises approximately 75% of the psoriasis population, presents itself before the age of 40 mostly with a positive family history and with more severe disease. While late onset psoriasis presents itself after the age of 40 and may have a less severe clinical course. However, other studies were not able to confirm the presence of more severe psoriasis in those subjects with an early age of onset. The extent of body surface area affected by psoriasis is variable, but in most people the severity of their psoriasis is reasonably stable over time. Based on a patient survey the prevalence of moderate to severe psoriasis (i.e. more than 3% of the body surface area affected) was recently estimated to be approximately 17%.

Psoriasis may not be an independent predictor for the use of cardiovascular and anti-diabetic drugs: A 5-year prevalence study (Article)

2009-10-26T00:00:00Z

Most studies investigating the association between psoriasis and cardiovascular disease have shown a significant relationship. This comparison study investigated the association between psoriasis and prevalent use of cardiovascular drugs. Drug exposure data for 1998 to 2006 were extracted from the Dutch PHARMO-Record Linkage System database. Psoriasis patients were selected using an algorithm of hospitalization and drug dispensing records specific for psoriasis and matched with controls for gender, age and time-period. From the records of 2.5 million Dutch residents, 9,804 (0.4%) psoriasis patients and 15,288 (0.6%) controls were selected. Psoriasis patients used significantly more anti-hypertensives, anti-coagulant and anti-platelet agents, digoxin, nitrates, lipid-lowering and anti-diabetic drugs than the reference population during a 5-year period observation. In a multiple linear regression model adjusting for the number of unique drugs used, psoriasis was no longer significantly associated with any of these drug classes. Psoriasis patients used more cardiovascular-related drugs, but surveillance bias appears to affect this association considerably.

Complexity of the association between psoriasis and comorbidities (Article)

2009-07-01T00:00:00Z

Multiple observational studies have recently demonstrated associations between psoriasis and several comorbidities-especially metabolic syndrome and cardiovascular disease, and now osteoporosis. It has been hypothesized that elevated levels of tumor necrosis factor-α are a biological explanation for the observed associations. In this commentary, we discuss the complexity of associations between psoriasis and comorbidities, possible residual confounding, the limitations of observational studies in proving causality, absolute versus relative risk differences, and the clinical relevance and possible clinical impact of "upgrading" psoriasis to a systemic disease.

Psoriasis May Not be an Independent Risk Factor for Acute Ischemic Heart Disease Hospitalizations: Results of a Large Population-Based Dutch Cohort (Article)

2009-01-01T00:00:00Z

Although psoriasis has been associated with components of the metabolic syndrome, its association with myocardial infarction is less clear. A cohort study was conducted using hospital and pharmacy records of 2.5 million Dutch residents between 1997 and 2008. The risk of ischemic heart disease (IHD) hospitalizations was compared between psoriasis patients and a matched reference cohort. Additional adjustments were made for healthcare consumption and use of cardiovascular drugs. A total of 15,820 psoriasis patients and 27,577 reference subjects were included, showing an incidence rate of 611 and 559 IHD per 100,000 person-years, respectively (P=0.066). The age- and gender-adjusted risk of IHD was comparable between both cohorts (hazard ratio (HR)=1.10, 95% confidence interval 0.99-1.23). Before cohort entry, psoriasis patients used more antihypertensive, antidiabetic, and lipid-lowering drugs and were more often hospitalized. Adjusting for these confounders decreased the HR for IHD, but it remained comparable between both populations. There was no different risk of IHD between the subgroup of patients who only used topicals versus those who received systemic therapies or inpatient care for their psoriasis. This study, therefore, suggests that psoriasis is not a clinically relevant risk factor for IHD hospitalizations on the population level.Journal of Investigative Dermatology advance online publication, 8 October 2009; doi:10.1038/jid.2009.321.

Psocare: Italy shows the way in postmarketing studies (Article)

2008-11-01T00:00:00Z

Knowledge, attitudes and use of the guidelines for the treatment of moderate to severe plaque psoriasis among Dutch dermatologists (Article)

2008-08-01T00:00:00Z

Background: In 2003, the Dutch psoriasis guidelines were among the first evidence-based medicine guidelines in dermatology. Although pivotal, the implementation of dermatological guidelines has not been assessed. Objectives: To evaluate various aspects that affect implementation of clinical guidelines such as knowledge, attitudes and practices among dermatologists. Methods: A cross-sectional anonymous postal survey was conducted among all Dutch dermatologists. In addition to questions about knowledge and practices, 24 items assessed guidelines attitudes. Factor analysis was applied to merge these items into attitudinal scales and multiple linear regression was used to identify predictors for these scales. Results: Of the 353 dermatologists, 161 (46%) completed the questionnaire. Almost all respondents were aware of the guidelines and 60% reported to have a decent knowledge of their content. Factor analysis retained 22 items divided into three scales: usefulness and content, barriers, and reliability. Apart from some disagreement on the user-friendliness and communication facilitating properties, the dermatologists' attitudes were generally positive. A larger volume of patients with psoriasis was associated with more frequent use of the guidelines [adjusted odds ratio (OR) = 2.42; 95% confidence interval (CI) 1.02-5.72]. Good familiarity predicted a more positive attitude towards the guidelines' usefulness and content (P < 0.001), perceived barriers (P < 0.001), and more frequent use in practice (adjusted OR = 8.38; 95% CI 3.08-22.81). Conclusions: Dutch dermatologists seem to know and appreciate their psoriasis guidelines and use them more often when they have a larger psoriasis population. Enhancing the familiarity of the guidelines among users may result in a more positive attitude towards them and a higher frequency of use.

Repigmentation of vitiligo during efalizumab (Article)

2008-08-01T00:00:00Z

Evaluation of the reimbursement criteria for biological therapies for psoriasis in the Netherlands (Article)

2008-05-01T00:00:00Z

Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients (Article)

2007-01-01T00:00:00Z

Psoriasis is a chronic inflammatory skin disease that is associated with an increased cardiovascular risk profile. The systemic inflammation present in psoriasis, various systemic treatments for psoriasis and an increased prevalence of unhealthy life style factors may all contribute to this unfavorable risk profile. The purpose of this article is to provide an overview of what is known about these risk factors in psoriasis, the way they influence the cardiovascular risk of psoriasis patients, and what can be done to reduce this risk. Genetic studies demonstrate that psoriasis and cardiovascular disease share common pathogenic features in which, for example inflammatory cytokines like TNF-α and IL-1 play an important role. The chronic inflammation in psoriasis has an unfavorable effect on the cardiovascular risk profile. Multiple cardiovascular risk factors seem to be influenced; the blood pressure, oxidative stress, dyslipidemia, endothelial cell dysfunction, homocysteine levels and blood platelet adhesion. Moreover, classic cardiovascular risk factors like smoking and obesity that have an increased prevalence among patients with psoriasis, indirectly also worsen the cardiovascular risk profile by stimulating the psoriasis activity. Systemic treatments in psoriasis reduce the cardiovascular risk by diminishing the inflammation, but it should be taken into account that most therapies also have adverse cardiovascular effects like dyslipidemia, hyperhomocysteinemia and hypertension. As a consequence preventive measures may be indicated at least during long-term treatments. Prospective research is warranted to accurately estimate the increased cardiovascular risk in psoriasis, to determine the underlying processes and to consider preventive measures according to the absolute risk of cardiovascular disease. The present overview provides data to advice health care providers to pay more attention to the cardiovascular risk profile in psoriasis patients.

A Shift in Valuation or an Effect of the Elicitation Procedure? (Article)

2000-01-01T00:00:00Z

Many studies suggest that impaired health states are valued more positively when experienced than when hypothetical. This study investigated to what extent this discrepancy occurs and examined four possible explanations: non-corresponding description of the hypothetical health state, new understanding due to experience with the health state, valuation shift due to a new status quo, and instability of preference. Patients and methods. Fifty-five breast cancer patients evaluated their actually experienced health state, a radiotherapy scenario, and a chemotherapy control scenario before, during, and after postoperative radiotherapy. Utilities were elicited by means of a visual analog scale (VAS), a chained time tradeoff (TTO), and a chained standard gamble (SG). Results. The discrepancy was found for all methods and was statistically significant for the TTO (predicted utilities: 0.89, actual utilities: 0.92, p ≤ 0.05). During radiotherapy, significant differences (p ≤ 0.01) were found between the utilities for the radiotherapy scenario and the actual health state by means of the VAS and the SG, suggesting non-corresponding description as an explanation. The utilities of the radiotherapy scenario and the chemotherapy control scenario remained stable over time, and thus new understanding, valuation shift, and instability could be ruled out as explanations. Conclusion. Utilities obtained through hypothetical scenarios may not be valid predictors of the value judgments of actually experienced health states. The discrepancy in this study seems to have been due to differences between the situations in question (non-corresponding descriptions).