Clinical Investigation| Volume 365, ISSUE 4, P329-336, April 2023

Association of psoriasis with myocardial infarction in end-stage renal disease patients

Published:August 28, 2022DOI:



      Previous research in non-dialysis patients suggests that the inflammatory skin disease psoriasis is associated with an increased risk of severe vascular events like myocardial infarction (MI). Thus, we determined whether psoriasis represents a significant risk factor for MI in end-stage renal disease (ESRD) patients.


      We queried the United States Renal Data System for ESRD patients starting dialysis between 2004 and 2015. ICD-9 and ICD-10 codes were used to identify those with at least two diagnoses of psoriasis, a diagnosis of MI, and other clinical risk factors. Logistic regression was used to examine the association of psoriasis and various risk factors with MI.


      Of a cohort of 1,062,693, we identified 6823 (0.6%) subjects with psoriasis and 181,960 (17.1%) with MI. Of the 6823 patients with psoriasis, 1671 (24%) developed an MI. Psoriasis was associated with an increased risk of MI in an unadjusted model [odds ratio (OR) = 1.34; confidence interval (CI) = 1.26–1.42]. However, after controlling for demographics, dialysis modality, access type, and various conditions related to the Charlson Comorbidity Index, psoriasis was not associated with MI (OR = 0.95, CI = 0.89–1.01). Confounders of the association of psoriasis with MI included congestive heart failure (OR = 5.26, CI = 5.17–5.36), pulmonary disease (OR = 1.25, CI = 1.23–1.26), and diabetes with complications (OR = 1.82, CI = 1.79–1.85).


      Contrary to prior research in the general population, in the ESRD population psoriasis was not associated with an increased risk of MI after controlling for various demographic and clinical parameters. These data emphasize the importance of an integrated approach since comorbidities may influence the choice of therapy for psoriasis and outcomes.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rachakonda T.D.
        • Schupp C.W.
        • Armstrong A.W.
        Psoriasis prevalence among adults in the United States.
        J Am Acad Dermatol. 2014; 70: 512-516
        • Oliveira Mde F.
        • Bde O.R
        • Duarte G.V.
        Psoriasis: classical and emerging comorbidities.
        An Bras Dermatol. 2015; 90: 9-20
        • Hu S.C.S.
        • Lan C.C.E.
        Psoriasis and cardiovascular comorbidities: focusing on severe vascular events, cardiovascular risk factors and implications for treatment.
        Int J Mol Sci. 2017; 18: 2211
        • Tinggaard A.B.
        • et al.
        Prevalence and severity of coronary artery disease linked to prognosis in psoriasis and psoriatic arthritis patients: a multi-centre cohort study.
        J Intern Med. 2021; 290: 693-703
        • Mansouri B.
        • et al.
        Comparison of coronary artery calcium scores between patients with psoriasis and type 2 diabetes.
        JAMA Dermatol. 2016; 152: 1244-1253
        • Xu T.
        • Zhang Y.H.
        Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies.
        Br J Dermatol. 2012; 167: 1345-1350
        • Ungprasert P.
        • Raksasuk S.
        Psoriasis and risk of incident chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis.
        Int Urol Nephrol. 2018; 50: 1277-1283
        • Lee E.
        • et al.
        Risk of end-stage renal disease in psoriatic patients: real-world data from a nationwide population-based cohort study.
        Sci Rep. 2019; 9: 16581
        • Mehta N.N.
        • et al.
        Attributable risk estimate of severe psoriasis on major cardiovascular events.
        Am J Med. 2011; 124: 775. e1-6
        • Ni C.
        • Chiu M.W.
        Psoriasis and comorbidities: links and risks.
        Clin Cosmet Investig Dermatol. 2014; 7: 119-132
        • Schwade M.J.
        • et al.
        Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: a retrospective cohort study.
        Am J Med Sci. 2021;
        • Armstrong A.W.
        • et al.
        Under-treatment of patients with moderate to severe psoriasis in the united states: analysis of medication usage with health plan data.
        Dermatol Ther. 2017; 7: 97-109
        • Horn E.J.
        • et al.
        Are patients with psoriasis undertreated? Results of national psoriasis foundation survey.
        J Am Acad Dermatol. 2007; 57: 957-962
      1. United States Renal Data System. 2019 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2019.

        • Charlson M.E.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Yeung H.
        • et al.
        Psoriasis severity and the prevalence of major medical comorbidity: a population-based study.
        JAMA Dermatol. 2013; 149: 1173-1179
        • Takeshita J.
        • et al.
        Psoriasis and comorbid diseases: epidemiology.
        J Am Acad Dermatol. 2017; 76: 377-390
        • Ghazizadeh R.
        • et al.
        Pathogenic mechanisms shared between psoriasis and cardiovascular disease.
        Int J Med Sci. 2010; 7: 284-289
        • Gelfand J.M.
        • et al.
        Risk of myocardial infarction in patients with psoriasis.
        JAMA. 2006; 296: 1735-1741
        • Davidovici B.B.
        • et al.
        Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions.
        J Invest Dermatol. 2010; 130: 1785-1796
        • Lin H.W.
        • et al.
        Increased risk of acute myocardial infarction in patients with psoriasis: a 5-year population-based study in Taiwan.
        J Am Acad Dermatol. 2011; 64: 495-501
      2. Catalogue of bias collaboration, Aronson JK, Bankhead C, Nunan D. Confounding. In Catalogue Of Biases. 2018.

        • Skelly A.C.
        • Dettori J.R.
        • Brodt E.D.
        Assessing bias: the importance of considering confounding.
        Evid Based Spine Care J. 2012; 3: 9-12
        • Khalid U.
        • et al.
        Psoriasis and risk of heart failure: a nationwide cohort study.
        Eur J Heart Fail. 2014; 16: 743-748
        • Victor F.C.
        • Gottlieb A.B.
        TNF-alpha and apoptosis: implications for the pathogenesis and treatment of psoriasis.
        J Drugs Dermatol. 2002; 1: 264-275
        • Lee J.L.
        • et al.
        Biologics and cardiovascular events in inflammatory arthritis: a prospective national cohort study.
        Arthritis Res Ther. 2018; 20: 171
        • Low A.S.
        • et al.
        Relationship between exposure to tumour necrosis factor inhibitor therapy and incidence and severity of myocardial infarction in patients with rheumatoid arthritis.
        Ann Rheum Dis. 2017; 76: 654-660
        • Cacciapaglia F.
        • et al.
        Cardiovascular safety of anti-TNF-alpha therapies: facts and unsettled issues.
        Autoimmun Rev. 2011; 10: 631-635
        • Nguyen T.
        • Wu J.J.
        Relationship between tumor necrosis factor-alpha inhibitors and cardiovascular disease in psoriasis: a review.
        Perm J. 2014; 18: 49-54
        • Sundararajan V.
        • et al.
        New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.
        J Clin Epidemiol. 2004; 57: 1288-1294
        • Quan H.
        • et al.
        Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.
        Health Serv Res. 2008; 43: 1424-1441
        • Asgari M.M.
        • et al.
        Validity of diagnostic codes and prevalence of psoriasis and psoriatic arthritis in a managed care population, 1996-2009.
        Pharmacoepidemiol Drug Saf. 2013; 22: 842-849
        • Armstrong A.W.
        • et al.
        Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011.
        JAMA Dermatol. 2013; 149: 1180-1185
        • Eggers P.W.
        CMS 2728: what good is it?.
        Clin J Am Soc Nephrol. 2010; 5: 1908-1909
        • Gulliver W.
        Long-term prognosis in patients with psoriasis.
        Br J Dermatol. 2008; 159: 2-9
        • Kimball A.B.
        • et al.
        National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening.
        J Am Acad Dermatol. 2008; 58: 1031-1042