Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Hypercholesterolemia is a major risk factor for cardiovascular disease, and patients with psoriasis or psoriatic arthritis (PsA) have been shown to have elevated cholesterol levels. However, whether hypercholesterolemia is associated with an increased risk of psoriasis or PsA is unknown. We aim to evaluate whether a history of hypercholesterolemia is associated with the risk of developing psoriasis and PsA in a cohort of US women.
A total of 95,540 participants were included from the Nurses' Health Study II (1991–2005). Information on personal history of physician-diagnosed hypercholesterolemia and related medication use was collected during the follow-up. Clinician-diagnosed psoriasis and PsA was ascertained and confirmed by supplementary questionnaires.
During 1,320,765 person-years of follow-up, we documented 646 incident psoriasis and 165 concomitant PsA cases. Hypercholesterolemia was associated with an elevated risk of incident psoriasis [Hazard ratio (HR)=1.25, 95% confidence interval (CI): 1.04, 1.50] and PsA (HR=1.58, 95% CI: 1.13, 2.23) in multivariate adjusted models. Participants with hypercholesterolemia duration time ≥ 7 years were at a higher risk of developing psoriasis (HR=1.29, 95% CI: 1.03, 1.61) (Ptrend=0.0002) and PsA (HR=1.68, 95% CI: 1.12, 2.52) (Ptrend=0.002). These associations persisted among participants who never took cholesterol-lowering medications. There was no association between cholesterol-lowering drugs and risk of psoriasis or PsA.
Our study provides evidence that hypercholesterolemia, a well-known cardiovascular risk factor, is also associated with an elevated risk of psoriasis and PsA.