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Burden and cardiovascular impact of depression in psoriasis and psoriatic arthritis : a population-based study

University of British Columbia

Introduction: Psoriasis (PsC) and psoriatic arthritis (PsA) represent common, lifelong inflammatory diseases of the skin and joints (respectively) with substantial cardiovascular morbidity. Considering the important deleterious impact that depression can have on disease complications and long-term health outcomes, we investigated the population burden of physician-diagnosed depression among individuals with PsC and PsA and the potential long-term impact of depression on acute myocardial infarction (AMI) risk in this patient population. Objectives: 1) To evaluate the incidence and prevalence of depression in the context of PsC and PsA; 2) To compare the odds of depression among individuals with PsC and PsA to healthy controls; 3) To determine whether depression is an independent risk factor for AMI in PsC and PsA; and 4) To determine whether depression modifies the risk of AMI associated with PsC and PsA. Methods: Epidemiologic methods were used to address Objectives 1-4 based on population-based cohorts of PsC and PsA patients compared to age-, sex-, and index date-matched controls. Results: 1) The incidence of depression among individuals with PsC and PsA was 3.35 per 1,000 person-years (PY) and the corresponding prevalence during a mean observation period of 4.8 years was 24.63%; 2) There was a 16% increased odds of depression among individuals with PsC and PsA compared to controls; 3) Incident depression increased the risk of incident AMI by 75% in PsC and PsA, and; 4) An increased risk of AMI among individuals with PsC and PsA was observed among individuals with prevalent depression (i.e., depression modified the effect). Conclusion: These population-based data provide evidence for a substantial burden and increased odds of depression in PsC and PsA compared to controls. Depression was observed to be an independent risk factor for AMI among patients with PsC and PsA. Moreover, depression acted as an effect modifier for AMI in the context of PsC and PsA, such that PsC and PsA only led to an increased risk of AMI among individuals with depression. These data underscore the need to actively screen for depression among PsC and PsA patients and closely monitor cardiovascular health in this high-risk group to improve long-term survival.

Text

2013-09-03

Attribution-NoDerivs 2.5 Canada

http://hdl.handle.net/2429/45012

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nd/2.5/ca/