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The NCBI psoriazis gri site requires JavaScript to function. Psoriasis is associated with increased risk of cardiovascular events and increased prevalence of cardiovascular risk factors. Diabetes mellitus DM is a major contributor to cardiovascular morbidity and mortality that may be associated with psoriasis, but conflicting results have been presented and nationwide data on the risk of new-onset DM in patients with psoriasis have not been reported.

Psoriazis gri on comorbidity, concomitant medication, and socioeconomic status was linked on an individual level. The primary study end point was DM requiring pharmacotherapy. Incidence rates for the development of DM events per 1, observational years psoriazis gri calculated psoriazis gri adjusted.

Incidence rate ratios IRRs were estimated by Poisson regression. A total of 4, subjects were eligible for analysis, with a maximum follow-up of 13 years. In the study period, 52, patients with psoriasis, including 6, patients with severe psoriasis, were identified. The overall incidence rates for new-onset DM were 3. Compared with the reference population, the IRR of new-onset DM psoriazis gri increased in all patients with psoriasis, i.

In this nationwide cohort, psoriasis was associated with increased incidence rates of new-onset DM. The association remained statistically significant after adjustment for confounding factors. Studies have demonstrated that psoriasis is associated with cardiovascular disorders probably due, in part, to shared inflammatory pathways 2. Similarly, diabetes mellitus DM is a serious and growing public health problem worldwide with severe complications, including increased cardiovascular morbidity and mortality 34.

Although previous studies have examined the association between psoriasis and risk of impaired glucose tolerance and DM, conflicting results have been reported, limited data are available on the impact of psoriasis severity on risk of DM, and nationwide data have not been presented 5 — Therefore, our aim with the current study was to examine the association between psoriasis and new-onset DM, including the impact of psoriasis severity, in a nationwide setting.

The study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology STROBE recommendations In Denmark, all citizens have a unique and life-long personal civil registration number that enables click here linkage of information across nationwide registers. All medications dispensed from pharmacies were obtained from the national prescription registry the Danish Registry of Medicinal Product Statisticswhere all dispensed prescriptions from Danish pharmacies have been recorded since psoriazis gri The National Prescription Registry is directly linked to the system for reimbursement psoriazis gri drug expenses and has la psoriazis simptome de 3 copii ani been validated Deaths were identified from the Central Population Register, in which deaths are psoriazis gri within 2 weeks.

Morbidity was obtained from the Danish National Patient Register, psoriazis gri all hospital admissions, out-patient consultations, learn more here, and procedures have been recorded since according to the ICD ICD-8 until and ICD thereafter. Comorbidity at study entry was described psoriazis gri Charlson comorbidity index, as defined by 19 prespecified diagnoses at study entry and up to 1 year previously, and modified to ICD Socioeconomic status was defined by the individual average yearly gross income during a 5-year period prior to psoriazis gri inclusion, and patients were divided into quintiles according to their income.

Data on death, comorbidity, concomitant medication, and socioeconomic status were linked on an individual case level. The entire Danish population 10 years of age or older as of 1 January baseline of study was followed until 31 Decemberemigration, new-onset DM, or death. Patients with psoriasis were identified by dispensed prescriptions of topical vitamin D derivatives, i.

Patients were classified as having severe psoriasis at the time of their third hospitalization or outpatient consultation for psoriazis gri ICD L40 or psoriatic arthritis M—M This method for identification and psoriasis severity classification has previously been validated 19 Drugs are registered in the national prescription registry according to the international Anatomical Therapeutic Chemical ATC classification system. Patients with psoriasis were identified by their claimed prescriptions of topical vitamin D derivates ATC D05AX.

The primary end point was the development of DM needing pharmacotherapy, which was defined by initiation of glucose-lowering drugs A10identified by claimed prescriptions from pharmacies, as done previously 1921 Glucose-lowering drugs are not available over the counter in Denmark.

In addition, the rates of all-cause mortality and cardiovascular mortality I0-I99 were examined. Baseline characteristics were summarized as means with standard deviations or frequencies and percentages, as appropriate.

Incidence rates were summarized as new-onset DM cases per 1, patient-years. We estimated the incidence rate ratio IRR for each study end point with Poisson regression models adjusted for confounding factors, including age, sex, calendar year, concomitant medication, comorbidity, and socioeconomic status. Cox regression is routinely used for epidemiological cohort studies of censored data but is less efficient when large datasets are analyzed.

Therefore, we used Poisson regression analyses as done previously Psoriasis was included as a time-dependent psoriazis gri. Age and calendar year were also included as time-dependent variables. Comorbidity and concomitant medication were included as fixed variables obtained at baseline. A sensitivity analysis, to determine whether a potential risk of surveillance bias affected our primary results, was carried out by excluding all subjects with a history of hospitalizations and prescription claims.

Patients with psoriatic arthritis may be more likely to receive treatment with psoriazis gri hence, to attenuate the potential psoriazis gri of glucocorticoids on the risk of DM, we excluded patients with psoriatic arthritis in a sensitivity analysis. To address the impact of bias caused by the increased psoriazis gri care consumption associated with our study criteria for psoriazis gri diagnosis, we also conducted analyses psoriazis gri altered criteria of psoriasis inclusion criteria.

In accordance with the altered criteria, D8, remedii chinezești pentru psoriazis Abzug with psoriasis were identified by their first psoriazis gri D prescription claim and classified as having severe disease at the time of their first in- or outpatient hospitalization with this diagnosis, i. Model assumptions, including absence of interaction between covariates, were tested.

A statistically significant interaction between severe psoriasis and age was found; however, age stratification did not provide further clinically relevant information and therefore overall results i.

All statistical analyses were performed with SAS statistical software version 9. The study comprised 4, subjects with a maximum follow-up of 13 years. During the study period, 45, subjects with mild and 6, subject with severe psoriasis were identified, including 2, with psoriatic arthritis.

They were compared with the reference population of 4, individuals. An illustration of the study population selection is presented in Fig. Compared with the reference population, psoriasis patients had a similar use of cardioprotective medications and comorbidity at baseline, psoriazis gri use of NSAIDs, cholesterol-lowering drugs, and antidepressive drugs was slightly increased in patients with severe psoriasis compared with mild psoriasis and the reference population, respectively.

Follow-up psoriazis gri individual groups and baseline characteristics of the study population are summarized in Table 1. Psoriasis was associated psoriazis gri increased incidence rates of all-cause mortality, cardiovascular mortality, and new-onset DM Table 2. The overall incidence rates per 1, person-years for all-cause psoriazis gri were Correspondingly, the rates psoriazis gri cardiovascular psoriazis gri were 5.

The incidence rates per 1, person-years for new-onset DM were 3. The Poisson regression analyses, adjusted for age and sex, confirmed increased incidence rates for new-onset DM in all patients with psoriasis compared with the reference psoriazis gri with IRR 1. The IRRs associated with psoriasis remained statistically significant in fully adjusted statistical models controlling for age, sex, calendar year, comorbidity, concomitant medications, and socioeconomic status Table 3.

After exclusion of patients with psoriatic arthritis, the results were not altered significantly. When the criteria for identifying psoriasis were altered to the first vitamin D psoriazis gri claim for mild psoriasis and first hospitalization for severe psoriasis, a total of 66, patients with mild psoriasis and 17, with severe psoriasis were identified. Psoriazis gri this analysis, the results were unaffected by the criteria alteration and fully comparable to results of the primary analyses; Psoriazis gri 1.

In the current study, we compared psoriazis gri incidence rates of new-onset DM in patients with psoriasis with those of the general population in an unselected, nationwide register—based cohort followed for a maximum of 13 years. After psoriazis gri for age, sex, concomitant medication, comorbidity, and socioeconomic status, the IRRs of new-onset DM were significantly increased in all psoriazis gri with psoriasis compared with the general population.

Psoriazis gri, the IRR of new-onset DM increased with psoriasis severity. Psoriasis is a chronic psoriazis gri disease characterized by regulatory T-cell dysfunction and activation of T-helper 1 Th1 and Th17 T cells producing proinflammatory cytokines 24 Similarly, inflammatory processes play a pivotal role in the development and progression of DM, and increased levels of proinflammatory cytokines, such as tumor necrosis factor-α, are associated with insulin resistance and type 2 DM 26 Furthermore, chronic inflammation in psoriatic individuals gives rise to increased levels of insulin-like growth factor-II, which promote epidermal proliferation and are linked to DM and atherosclerosis 28 — Indeed, systemic inflammation may contribute to both Psoriazis gri and cardiovascular disease in patients with psoriasis Along this line, increasing evidence has linked other chronic inflammatory diseases, e.

Furthermore, recent studies have suggested that the use of tumor necrosis factor-α antagonists in psoriazis gri with rheumatoid arthritis or psoriasis improves insulin sensitivity and reduces the risk of Psoriazis gri and cardiovascular disease 34 From this perspective, our findings of an elevated risk psoriazis gri new-onset DM in patients with psoriasis further emphasize the considerable overlap of disease mechanisms shared by chronic inflammatory diseases and DM.

Psoriazis gri case-control and cross-sectional studies have demonstrated an psoriazis gri probability of developing DM among psoriatic individuals 5 — 811 — 1315 In contrast, a few psoriazis gri have shown no association between psoriasis and DM 910 Among the reasons for these conflicting results could be methodological issues, psoriazis gri. Although a few cohort studies of selected populations have been carried out, results from nationwide cohort studies have not been reported previously 511 Additionally, very little data are available on the potential impact psoriazis gri psoriasis disease severity on the risk of DM, and the psoriazis gri of a relationship to psoriasis severity is sparse 58 Our results, however, are clearly in agreement with previous studies demonstrating a link between chronic inflammatory diseases, including psoriasis psoriazis gri rheumatoid arthritis, and augmented risk of DM 5 — 711 — 133233 The increased risk psoriazis gri DM in patients with psoriasis is likely to contribute to the increased risk of cardiovascular morbidity and mortality observed in these patients including the population examined in the current reportpsoriazis gri this risk psoriazis gri been found to be increased even after adjustments for DM and other risk factors in agreement with the notion of independent effects of inflammation per se 192039 — Taken together, our results add to current evidence that patients with psoriasis are at increased risk of DM and cardiovascular disease and they would appear psoriazis gri underline the importance of regular evaluation of cardiovascular risk factors, including blood glucose levels, in these patients tratament negru ulei de chimen pentru psoriazis Major strengths of the current study include the use of nationwide prospectively recorded data, completeness of follow-up, and use of validated measures of exposure and outcome.

In addition, the exclusion of subjects with prevalent psoriasis and DM at the baseline ensured the most accurate allocation of time at risk. Importantly, health care in Denmark is essentially free of charge and therefore, in principle, equally accessible to all. The inclusion of the entire Danish population in psoriazis gri current study also attenuated the risk of selection psoriazis gri related to psoriazis gri, sex, socioeconomic status, and health care insurance status.

In addition, the demonstration of a dose response to psoriasis disease severity is suggestive of a direct relationship between psoriasis and risk of DM, and inflammation is likely to be a shared causal mechanism. Major limitations of psoriazis gri current study include the use of hospitalizations to classify severe psoriasis, as this may have increased the presence of comorbidities and decreased the threshold for detection of the study outcome in this patient group because of surveillance bias.

We addressed this key concern by making multiple adjustments for confounding variables, including the Charlson comorbidity index and concomitant medication. This method of classifying severe psoriasis was previously validated by examining the medical records of 50 randomly selected patients with psoriasis consecutively referred for first-time hospital-based treatment.

At presentation, psoriazis gri patients were mainly treated with topical agents and had a mean psoriasis area and severity index score of 10, which was consistent with severe psoriasis Also, the registries used in the current study did not allow for the identification of some cardiometabolic risk factors e.

Although the study design accounted for some of these effects by multivariable adjustments, e. The use of vitamin D prescription claims to identify patients with psoriasis preludes conclusions regarding patients treated with other first-line topical treatments. However, this method read more identification was validated previously by examining the hospital records of randomly selected patients with psoriasis, where Indeed, psoriazis gri latter is the preferred first-line psoriazis gri for psoriasis in Denmark and any bias related to such potential misclassification is expected to be minor and would arguably draw the results toward the null.

Furthermore, the current study used claimed prescriptions for glucose-lowering drugs to define new-onset DM; consequently, the patients psoriazis gri DM managed with diet alone were not identified. The results are therefore only valid for psoriazis gri with DM requiring pharmacotherapy. It was not possible to differentiate between type 1 and type 2 DM in the current study, as the registries do not hold data on, for example, antiglutamic acid decarboxylase antibodies or C-peptide levels.

However, the vast majority of patients treated with glucose-lowering medications have type 2 DM, and therefore, psoriazis gri results mainly reflect an increased risk of type 2 DM. Finally, the majority of the Danish population is of Caucasian descent, which may limit the extrapolation of the results to other ethnicities. This nationwide cohort study suggests that patients with psoriasis are psoriazis gri an increased risk of new-onset DM compared with the general population.

The incidence rates were highest in individuals with severe psoriasis. The results emphasize the importance of considering psoriasis a systemic inflammatory disorder rather than an isolated skin disease. Clinicians should be psoriazis gri and may want to consider early screening psoriazis gri treatment of these risk factors.

Moreover, prospective studies aimed at se psoriazisul dezvoltă adesea guttate effects of such interventions on hard outcomes are urgently needed.

This study was supported by unrestricted psoriazis gri from the LEO foundation, the Axel Muusfeldts Foundation, DERMBIO, and the Danish Psoriasis Association. The sponsors had no influence on data collection, no access to the data, and no influence on the decision to submit. No other potential conflicts of interest relevant to this article were reported.

All authors approved the final manuscript. Parts of this study were presented in oral form at the psoriazis gri European Society of Cardiology Congress, Munich, Germany, 25—29 August National Center for Biotechnology InformationU.

National Library of Medicine Rockville PikeBethesda MDUSA. NCBI Skip to main psoriazis gri Skip to psoriazis gri Resources How To About NCBI Accesskeys My NCBI Sign in to Psoriazis gri Sign Out.

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Journal List Diabetes Care v. Published online Jul Usman KhalidMD, 1 Peter Riis HansenMD, PHD, DMSC, 1 Gunnar Hilmar GislasonMD, PHD, 1 Jesper LindhardsenMD, PHD, 1 Søren Lund Psoriazis griMD, 1 Signe Abitz WintherLink, 1 Lone Skov psoriazis gri, MD, PHS, DMSC, 2 Christian Torp-PedersenMD, DMSC, 1, 3 and Ole AhlehoffMD, PHD psoriazis gri, 4.

Received Nov 9; Accepted Jan Copyright © by the American Diabetes Association. Readers psoriazis gri use psoriazis gri article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

This article has been cited by psoriazis gri articles in PMC. Abstract OBJECTIVE Psoriasis is associated with psoriazis gri risk of cardiovascular events psoriazis gri increased prevalence of cardiovascular risk factors.

RESULTS A total of 4, subjects were eligible for analysis, with a maximum follow-up of 13 years. RESEARCH DESIGN AND METHODS Data sources and study population The study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology STROBE recommendations Pharmacotherapy Drugs are registered in the national prescription registry according to the international Anatomical Psoriazis gri Chemical ATC classification system.

Outcome The primary end point was the development of DM needing psoriazis gri, which was psoriazis gri by initiation of glucose-lowering drugs A10identified by claimed prescriptions from pharmacies, as done previously 1921 Psoriazis gri analysis Baseline characteristics were summarized as means with standard deviations or frequencies and percentages, as appropriate.

RESULTS Baseline characteristics and death rates The study comprised 4, subjects with a maximum follow-up of 13 years. Flowchart of selection of study population. A high-quality color representation of this figure is available in psoriazis gri online issue. New-onset DM The incidence rates per 1, person-years for new-onset Psoriazis gri were 3. Acknowledgments This study was supported by unrestricted grants psoriazis gri the LEO foundation, the Psoriazis gri Muusfeldts Foundation, DERMBIO, and the Danish Psoriasis Association.

Nestle FO, Kaplan DH, Barker J. N Engl J Med ; Alexandroff AB, Pauriah M, Camp RD, Lang CC, Struthers AD, Armstrong DJ. Psoriazis gri than skin deep: Br J Dermatol ; Fox CS, Coady S, Sorlie PD, et al. Increasing cardiovascular disease burden due to psoriazis gri mellitus: Sarwar N, Gao P, Seshasai SR, et al.

Emerging Risk Factors Collaboration Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: Azfar RS, Seminara NM, Shin DB, Troxel AB, Margolis DJ, Gelfand JM. Increased risk of diabetes mellitus and likelihood of receiving diabetes mellitus treatment in patients with psoriasis. Brauchli YB, Jick SS, Meier CR. Psoriasis and the risk of incident diabetes mellitus: Cohen AD, Dreiher J, Shapiro Y, et al. J Eur Acad Dermatol Venereol ; Husted JA, Thavaneswaran A, Chandran V, et al.

Cardiovascular and other comorbidities in patients with psoriatic arthritis: Arthritis Care Res Hoboken ; Inerot A, Enerbäck C, Enlund F, et al. Collecting a set of psoriasis family material through a psoriazis gri organisation; clinical characterisation and psoriazis gri of additional disorders. BMC Dermatol ; 5: Kondratiouk S, Udaltsova N, Klatsky AL. Associations of psoriatic arthritis and cardiovascular psoriazis gri in a large population.

Perm J ; Li W, Han J, Hu FB, Curhan GC, Qureshi AA. Psoriasis and risk of type 2 diabetes among women and men in the United States: J Invest Dermatol ; Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol ; Qureshi AA, Choi HK, Setty Click here, Curhan GC.

Psoriasis and the risk of diabetes and hypertension: Arch Dermatol ; Reynoso-von Drateln C, Martínez-Abundis E, Balcázar-Muñoz BR, Bustos-Saldaña R, Go here M. Lipid profile, insulin secretion, and insulin sensitivity in psoriasis.

Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and the risk of diabetes mellitus: Gaist D, Sørensen HT, Hallas J. The Danish prescription registries. Dan Med Bull ; Nuttall Http://, van der Meulen J, Emberton M. Charlson scores based on ICD administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery.

J Clin Epidemiol ; Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: J Intern Med ; Ahlehoff O, Gislason GH, Jorgensen CH, et al. Psoriasis and risk psoriazis gri atrial fibrillation and ischaemic stroke: Eur Heart J ; Andersson C, Norgaard ML, Hansen PR, et al.

Heart failure severity, as determined by psoriazis gri diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: Eur J Heart Fail ; Norgaard ML, Andersen SS, Schramm TK, et al. Changes in short- and long-term cardiovascular risk of incident diabetes see more incident myocardial infarction—a nationwide study.

Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: Ann Rheum Dis ; Davidovici BB, Psoriazis gri N, Prinz JC, et al. Psoriasis and systemic inflammatory diseases: Lowes MA, Kikuchi T, Fuentes-Duculan J, et al. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. Pradhan AD, Psoriazis gri JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus.

Hu FB, Meigs JB, Li TY, Rifai N, Manson JE. Inflammatory markers and risk of developing type 2 diabetes in women. Yoo H, Kim SJ, Kim Y, Lee H, Kim TY. Insulin-like growth factor-II regulates the lipoxygenase gene expression and promotes cell proliferation in human keratinocytes via the extracellular regulatory kinase and phosphatidylinositol 3-kinase pathways.

Int J Biochem Cell Psoriazis gri ; Zaina S, Nilsson J. Insulin-like growth factor II and its receptors in atherosclerosis and in conditions predisposing to atherosclerosis. Curr Opin Lipidol ; Wakkee M, Thio HB, Prens EP, Sijbrands EJ, Neumann HA. Unfavorable cardiovascular risk profiles in untreated and psoriazis gri psoriasis psoriazis gri. Boehncke WH, Boehncke S, Tobin AM, Kirby B.

Exp Dermatol ; Gabriel SE, Crowson Psoriazis gri. Risk factors for cardiovascular disease in rheumatoid arthritis. Curr Opin Rheumatol ; Psoriazis gri JF, Gourraud PA, Cantagrel A, Davignon JL, Constantin A.

Psoriazis gri cardiovascular risk factors in rheumatoid arthritis: Joint Bone Spine ; Dixon WG, Symmons DP. What effects might anti-TNFalpha treatment be expected to have on cardiovascular morbidity and mortality in rheumatoid arthritis? A psoriazis gri of the role of TNFalpha in cardiovascular pathophysiology. Greenberg JD, Kremer JM, Curtis JR, psoriazis gri al. CORRONA Investigators Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis.

Cheng J, Kuai D, Zhang L, Yang X, Qiu B. Psoriasis increased the risk of diabetes: Arch Dermatol Res ; Solomon DH, Love TJ, Canning C, Schneeweiss S. Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis. Han C, Robinson DW, Jr, Hackett Psoriazis gri, Paramore LC, Fraeman KH, Bala MV. Cardiovascular disease and psoriazis gri factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

J Rheumatol ; Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis psoriazis gri at increased risk of cardiovascular mortality: Eur Heart J ; Ahlehoff O, Gislason GH, Lindhardsen J, psoriazis gri al. Prognosis following first-time myocardial infarction in în care tratamentul psoriazisului scalpului with psoriasis: Peters MJ, Symmons DP, McCarey D, et al.

EULAR evidence-based psoriazis gri for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Articles from Diabetes Care are provided here courtesy of American Diabetes Association. Article PubReader ePub beta PDF K Citation. Support Center Support Center. Please review our psoriazis gri policy. Psoriazis gri Library of Medicine Rockville PikeBethesda MDUSA Policies and Psoriazis gri Contact.


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