Original article
Underdiagnosis and undertreatment of cardiovascular risk factors in patients with moderate to severe psoriasis

https://doi.org/10.1016/j.jaad.2011.06.035Get rights and content

Background

Patients with psoriasis are known to have an increased number of cardiovascular (CV) risk factors and be at increased risk for CV events.

Objectives

We sought to describe and characterize the underdiagnosis and undertreatment of CV risk factors in patients with moderate to severe psoriasis.

Methods

Medical histories including diabetes, hypertension, and hyperlipidemia were obtained from 2899 patients in 3 phase III ustekinumab trials, a therapeutic anti-interleukin (IL)-12/IL-23p40 monoclonal antibody. Reported history was compared with measured fasting glucose, fasting lipids, and blood pressure. Ten-year Framingham risk scores and the proportion of patients achieving glycemic, lipid, and blood pressure targets were evaluated.

Results

Significant risk factors existed in patients with moderate to severe psoriasis (58.6% and 28.8% of patients had ≥2 and ≥3 established CV risk factors, respectively). Based on Framingham risk score, 18.6% of patients were at high risk and 12.3% were at intermediate risk for CV events. At baseline, a small proportion of patients with diabetes (2.3%), hypertension (9.1%), or hyperlipidemia (4.9%) were previously without a diagnosis. However, 19.1%, 21.8%, and 38.6% of patients with diabetes, hypertension, or hyperlipidemia, respectively, were untreated at baseline, and the proportion at treatment goal was not ideal (hypertension 59.6% and hyperlipidemia 69.7%), especially for diabetes (36.7%).

Limitations

Results are based on a clinical trial population and findings may not be generalizable to the general psoriasis population.

Conclusions

In this moderate to severe psoriasis population, a high prevalence of undiagnosed and undertreated CV risk factors existed, emphasizing the importance of screening patients with psoriasis for CV risk factors.

Section snippets

Study population

The pooled study population consisted of all patients enrolled in phase III clinical trials of ustekinumab, including the PHOENIX 118 (n = 766), PHOENIX 219 (n = 1230), and ACCEPT20 (n = 903) trials. Each of these multicenter trials enrolled patients with moderate to severe plaque-type psoriasis based on a Psoriasis Area and Severity Index score of at least 12, at least 10% body surface area involvement, and disease severity that warranted phototherapy or systemic therapy. At baseline, patients

Study population

Baseline skin disease characteristics of the overall pooled patient population were consistent with other clinical trial populations and may indicate more severe disease than in the general psoriasis population.12 At baseline, 39.6% (1147 of 2899) of all patients had at least one modifiable CV risk factor (diabetes, hypertension, or hyperlipidemia). Adding obesity or current tobacco use would have significantly increased the proportion of patients with at least one modifiable CV risk factor to

Discussion

Using a large pooled psoriasis clinical trial database, this study for the first time to our knowledge documents the underdiagnosis and undertreatment of CV risk factors in patients with moderate to severe plaque psoriasis. Despite the known association between psoriasis and CV risk factors, diabetes, hypertension, and hyperlipidemia were moderately underdiagnosed in these patient cohorts. Furthermore, even if the diagnosis of these CV risk factors was recognized, there was a high rate of

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  • Cited by (0)

    Supported by Centocor Research and Development Inc.

    Disclosures: Dr Kimball was a consultant and investigator for Abbott, Amgen, Centocor, and Novartis; a consultant for Idera; and an investigator for Pfizer. Dr Mrowietz has received honoraria as a speaker and/or advisor, travel reimbursement, or educational grants from Abbott, Biogen-Idec, Celgene, Centocor, Forward Pharma, Janssen, Leo Pharma, MSD, and Wyeth/Pfizer. Dr Reich has received honoraria as a consultant and/or advisory board member and/or acted as paid speaker and/or contributed in clinical trials sponsored by Abbott, Basilea, Biogen-Idec, Celgene, Centocor, Essex Pharma, Forward Pharma, Janssen-Cilag, Leo Pharma, Novartis, Pfizer, Schering-Plough, UCB, and Wyeth. Dr Langley has received research grants, served on scientific advisory boards, and been a speaker for Amgen, Biogen-Idec, Centocor, Genentech, Novartis, Schering-Plough, and Serono. Ms You and Dr Hsu are employees of Centocor. Drs Szapary and Yeilding are employees of Centocor and own stock in Johnson & Johnson, of which Centocor is a fully owned subsidiary. Dr Rader has been a consultant for Johnson & Johnson. Dr Mehta has no conflicts of interest to declare.

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