Should all patients with psoriasis receive statins? Analysis according to different strategies<sup>,</sup>

Masson, Walter; Lobo, Martín; Molinero, Graciela; Rossi, Emiliano

doi:10.1016/j.abd.2019.03.001

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Investigation • An. Bras. Dermatol. 94 (6) • 2019 • https://doi.org/10.1016/j.abd.2019.03.001 copy

Should all patients with psoriasis receive statins? Analysis according to different strategies^☆ ☆ How to cite this article: Massom W, Lobo M, Molinero G, Rossi E. Should all patients with psoriasis receive statins? Analysis according to different strategies. An Bras Dermatol. 2019;94:691-7. ^,^☆☆ ☆☆ Study conducted at the Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis.

Objective:

To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy.

Methods:

A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed.

Results:

A total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1-27.0%) and 1.9% (IQR 0.4-5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively.

Study limitations:

This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis.

Conclusion:

This population with psoriasis was mostly classified at moderate-high risk and the statin therapy indication was similar when applying the two strategies evaluated.

KEYWORDS
Hydroxymethylglutaryl-CoA reductase inhibitors; Lipids; Psoriasis

	2018 ACC/AHA guidelines
	With statin-indication (n = 536)	Without statin-indication (n = 356)	p
Continuous variables, mean (SD)
Age, years	63.7 (11.6)	54.3 (12.7)	<0.001
Systolic blood pressure, mmHg	131.4 (16.2)	121.7 (13.7)	<0.001
Diastolic blood pressure, mmHg	79.8 (9.7)	75.0 (9.1)	<0.001
Body mass index, kg/m²	28.9 (6.2)	27.1 (5.6)	0.002
Total cholesterol, mg/dL	202.1 (44.1)	192.7 (38.4)	0.001
LDL-C, mg/dL	128.1 (35.9)	117.3 (30.6)	<0.001
HDL-C, mg/dL	49.8 (13.8)	54.1 (15.1)	<0.001
Triglycerides, mg/dL	125.7 (67.9)	110.4 (73.4)	0.002
Non HDL-C, mg/dL	152.4 (42.1)	138.7 (36.3)	<0.001
Blood glucose, mg/dL	103.9 (29.4)	96.2 (18.2)	<0.001
Creatinine, mg/dL	0.91 (0.26)	0.88 (0.26)	0.362
Categorical variables (%)
Male gender	57.5	27.5	<0.001
Hypertension	66.9	35.1	<0.001
Smoking	29.5	17.7	<0.001
Diabetes	14.9	12.4	0.278
Obesity	37.4	21.4	<0.001
Psoriatic arthritis	8.6	4.5	0.019
	2016 ESC/EAS guidelines
	With statin-indication (n = 536)	Without statin-indication (n = 356)	p
Continuous variables, mean (SD)
Age, years	67.4 (12.7)	47.9 (14.7)	<0.001
Systolic blood pressure, mmHg	130.7 (16.3)	122.5 (13.9)	<0.001
Diastolic blood pressure, mmHg	78.7 (9.6)	76.6 (9.7)	0.002
Body mass index, kg/m²	28.6 (6.1)	27.5 (5.8)	0.074
Total cholesterol, mg/dL	203.2 (42.6)	190.5 (40.2)	0.001
LDL-C, mg/dL	129.4 (34.3)	115.5 (32.4)	<0.001
HDL-C, mg/dL	51.5 (14.9)	51.3 (13.9)	0.865
Triglycerides, mg/dL	124.2 (70.8)	112.2 (69.5)	0.014
Non HDL-C, mg/dL	151.7 (40.7)	139.2 (38.8)	<0.001
Blood glucose, mg/dL	105.4 (30.6)	93.5 (12.2)	<0.001
Creatinine, mg/dL	0.91 (0.27)	0.87 (0.64)	0.341
Categorical variables (%)
Male gender	50.6	37.4	<0.001
Hypertension	66.2	35.1	<0.001
Smoking	26.7	21.6	0.08
Diabetes	21.9	1.4	<0.001
Obesity	34.3	25.4	<0.001
Psoriasic arthritis	7.9	5.4	0.196

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[1] * Corresponding author. E-mail:walter.masson@hospitalitaliano.org.ar (W. Masson).

Continuous variables, mean (SD)	n = 892
Age, years	59.9 (16.5)
Systolic blood pressure, mmHg	127.5 (15.9)
Diastolic blood pressure, mmHg	77.9 (9.7)
Body mass index, kg/m²	28.2 (5.9)
Total cholesterol, mg/dL	198.3 (42.2)
LDL-C, mg/dL	123.6 (34.2)
HDL-C, mg/dL	51.5 (14.5)
Triglycerides, mg/dL	119.6 (70.5)
Non HDL-C, mg/dL	146.9 (40.5)
Blood glucose, mg/dL	100.8 (25.8)
HbA1c, % (patients with diabetes)	6.3 (1.0)
Creatinine, mg/dL	0.87 (0.22)
Categorical variables (%)
Male gender	45.5
Hypertension	54.3
Smoking	24.8
Diabetes	13.9
Obesity	30.9
Psoriatic arthritis	7.0