Abstract MP089: Cardiovascular Protection Profile and All-cause and CVD Mortality among U.S. Adults

Introduction: Epidemiologic studies suggest that multiple cardiovascular (CVD) protection-factors (i.e., non-smoking, physically active, normal blood pressure, normal blood glucose, normal total cholesterol, non-obese, and healthy diet) are associated with significantly reduced risk of cardiovascular disease incidence and mortality. Hypothesis: We assessed the hypothesis that the increased number of CVD protection-factors is associated with reduced risk for all-cause and CVD mortality and adherence to low CVD risk profile could result in significant lower rates of all-cause and CVD mortality. Methods: We used the Third National Health and Nutrition Examination Survey (NHANES III 1988-1994) Linked Mortality File (through 2006), a prospective cohort study of a nationally representative sample of 12,861 U.S. adults to examine the prevalence, associations, and population attributable fraction (PAF) of seven CVD protection-factors in relation to risk of all-cause and CVD mortality. Results: Only 3.1% of U.S. adults had all seven CVD protection-factors. The average follow-up was 14.5 years. After multivariable adjustment for potential confounders, hazard ratios (HR) were: 0.30 (95% CI 0.22-0.40), 0.21 (0.12-0.34), and 0.17 (0.09-0.32), comparing individuals with ≥six protection-factors to those with ≤one protection-factors for all-cause, CVD, and IHD mortality respectively. Elevated blood pressure was responsible for the largest number of all-cause and CVD death followed by smoking and poor diet. Overall, 59% (95% CI 27-78) of total deaths and 66% (95% CI 22-88) CVD death would have been avoided during the average of 14.5 years follow-up if the population were changed to the high CVD protection-factors status (with ≥six protection-factors). Conclusions: Few adults in this U.S.-based study population had all seven desirable CVD protection-factors. The presence of an increasing number of CVD protection-factors was associated with a progressively lower risk of total and CVD mortality. Comprehensive population-based initiatives are needed to improve modifiable CVD risk factors, resulting in substantial reductions of all-cause and CVD mortality in the U.S. population.

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Abstract 039: Adherence to a Healthy Lifestyle in Relation to Cardiovascular Disease Incidence and Mortality Among Adults With Type 2 Diabetes

Circulation ◽

10.1161/circ.137.suppl_1.039 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Gang Liu ◽

Yanping Li ◽

Yang Hu ◽

Geng Zong ◽

Shanshan Li ◽

...

Keyword(s):

Lower Risk ◽

Healthy Lifestyle ◽

Lifestyle Factors ◽

Low Risk ◽

Diabetes Diagnosis ◽

Stroke Incidence ◽

Incidence And Mortality ◽

Reduced Risk ◽

Cvd Mortality

Objective: To examine the associations of individual and combined low-risk lifestyle practices, including non-smoking, engaging in moderate to vigorous intensity physical activity (≥150 min/week), drinking alcohol in moderation (5-15 g/day for women and 5-30 g/day for men), and eating a high quality diet (top two fifths of Alternative Healthy Eating Index), with the risk of subsequent cardiovascular events among adults with incident diabetes. Methods: The prospective study included 11,527 participants with diabetes diagnosed during follow-up (8,970 women from the Nurses’ Health Study and 2,557 men from the Health Professionals Follow-Up Study), who were free of cardiovascular disease (CVD) and cancer at the time of diabetes diagnosis. Diet and lifestyle factors after diabetes diagnosis were repeatedly assessed every 2-4 years. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of total CVD, coronary heart disease (CHD), and stroke incidence, and CVD mortality. Results: There were 2,311 incident CVD cases (including 498 stroke cases) and 858 CVD deaths during an average of 13.3 years of follow-up. After multivariate adjustment including medication use, the individual low-risk lifestyle factors after diabetes diagnosis were each significantly associated with a lower risk of CVD incidence and mortality. The multivariate-adjusted HR (95% CI) for participants with three or more low-risk lifestyle factors compared with zero was 0.48 (0.40-0.59) for total CVD incidence, 0.53 (0.42-0.66) for CHD incidence, 0.33 (0.21-0.51) for stroke incidence, and 0.32 (0.22-0.47) for CVD mortality (all P trend<0.001). The population-attributable-risk for poor adherence to low-risk lifestyle was 42.6% (26.7%-55.1%) for CVD mortality. In addition, greater improvements in lifestyle factors from pre- to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and mortality. For per one number increment in low-risk lifestyle factors, there was a 16% reduced risk of incident total CVD, a 12% reduced risk of CHD, a 21% reduced risk of stroke, and a 30% reduced risk of CVD mortality (all P <0.001). Similar results were observed when analyses were stratified by diabetes duration, sex/cohort, body mass index at diabetes diagnosis, smoking status, and lifestyle factors before diabetes diagnosis. Conclusions: Greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and mortality among adults with type 2 diabetes. These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in diabetic patients.

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Cardiovascular mortality risk in young adults with isolated systolic hypertension: findings from population-based MONICA/KORA cohort study

Journal of Human Hypertension ◽

10.1038/s41371-021-00619-z ◽

2021 ◽

Author(s):

Atasoy Seryan ◽

Middeke Martin ◽

Johar Hamimatunnisa ◽

Peters Annette ◽

Heier Margit ◽

...

Keyword(s):

Young Adults ◽

Systolic Hypertension ◽

Antihypertensive Medication ◽

Population Based ◽

Protective Effects ◽

Isolated Systolic Hypertension ◽

Cvd Risk ◽

Increased Risk ◽

Cvd Mortality

AbstractThe clinical significance of isolated systolic hypertension in young adults (ISHY) remains a topic of debate due to evidence ISHY could be a spurious condition resulting from exageratted pulse pressure amplification in “young tall men with elastic arteries”. Hence, we aimed to investigate whether ISHY is associated with an increased risk of cardivascular (CVD) mortality in a sample of 5597 young adults (49.8% men, 50.2% women) between 25 and 45 years old from the prospective population-based MONICA/KORA cohort. ISHY was prevalent in 5.2% of the population, affecting mostly men (73.1%), and associated with increased smoking, obesity, and hypercholesterolemia in comparison to participants with normal blood pressure (BP). Within a follow-up period of 25.3 years (SD ± 5.2; 141,768 person–years), 133(2.4%) CVD mortality cases were observed. Participants with ISHY had a hazard ratio (HR) of 1.89(1.01–3.53, p < 0.05) times higher risk of CVD mortality than participants with normal BP, even following adjustment for CVD risk factors. However, adjustment for antihypertensive medication (HR 0.46; 0.26–0.81, p < 0.001) and increasing height (HR 0.96; 0.93–0.99, p < 0.05) revealed independently protective effects against CVD mortality, suggesting that although ISHY is associated with an increased risk of CVD mortality, the protective effects of increasing height or antihypertensive medication should be considered in treatment rationale.

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Association between blood pressure categories and cardiovascular disease mortality in China

PLoS ONE ◽

10.1371/journal.pone.0255373 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255373

Author(s):

Jie Guo ◽

Jun Lv ◽

Yu Guo ◽

Zheng Bian ◽

Bang Zheng ◽

...

Keyword(s):

Blood Pressure ◽

Cox Regression ◽

Cvd Risk ◽

Hazard Ratios ◽

Disease Mortality ◽

Increased Risk ◽

Diastolic Hypertension ◽

High Prevalence ◽

Cvd Mortality

Background Blood pressure (BP) categories are useful to simplify preventions in public health, and diagnostic and treatment approaches in clinical practice. Updated evidence about the associations of BP categories with cardiovascular diseases (CVDs) and its subtypes is warranted. Methods and findings About 0.5 million adults aged 30 to 79 years were recruited from 10 areas in China during 2004–2008. The present study included 430 977 participants without antihypertension treatment, cancer, or CVD at baseline. BP was measured at least twice in a single visit at baseline and CVD deaths during follow-up were collected via registries and the national health insurance databases. Multivariable Cox regression was used to estimate the associations between BP categories and CVD mortality. Overall, 16.3% had prehypertension-low, 25.1% had prehypertension-high, 14.1% had isolated systolic hypertension (ISH), 1.9% had isolated diastolic hypertension (IDH), and 9.1% had systolic-diastolic hypertension (SDH). During a median 10-year follow-up, 9660 CVD deaths were documented. Compared with normal, the hazard ratios (95% CI) of prehypertension-low, prehypertension-high, ISH, IDH, SDH for CVD were 1.10 (1.01–1.19), 1.32 (1.23–1.42), 2.04 (1.91–2.19), 2.20 (1.85–2.61), and 3.81 (3.54–4.09), respectively. All hypertension subtypes were related to the increased risk of CVD subtypes, with a stronger association for hemorrhagic stroke than for ischemic heart disease. The associations were stronger in younger than older adults. Conclusions Prehypertension-high should be considered in CVD primary prevention given its high prevalence and increased CVD risk. All hypertension subtypes were independently associated with CVD and its subtypes mortality, though the strength of associations varied substantially.

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Association of Soft Drink Intake With Cardiovascular Disease Mortality and Morbidity: A Large Prospective Cohort Study

10.21203/rs.3.rs-516666/v1 ◽

2021 ◽

Author(s):

Dan Liu ◽

Peidong Zhang ◽

Zhihao Li ◽

Dong Shen ◽

Xiru Zhang ◽

...

Keyword(s):

Cohort Study ◽

Soft Drink ◽

Population Attributable Fraction ◽

Soft Drinks ◽

Cvd Risk ◽

Mortality And Morbidity ◽

Vegetable Juice ◽

Incidence And Mortality ◽

Using Data ◽

Cvd Mortality

Abstract BackgroundThe associations of SSBs, ASBs and pure fruit/vegetable juices with CVD events have not been thoroughly evaluated. The present study determined the association of soft drinks with CVD and effects of the substitution of alternative beverages for soft drinks and the population-attributable fraction of CVD mortality due to soft drinks.MethodsA cohort study was performed using data from UK Biobank and 168007 participants (mean (SD) age, 55.6 (7.9) years) without CVD/cancer at baseline were eligible for this analysis. Dietary consumption of SSBs, ASBs and pure fruit/vegetable juices was self–reported via a 24–hour dietary questionnaire between 2009 and 2012 and followed up to 2018. ResultsDuring a median follow–up of 7.0-year, we recorded 5922 incident CVD cases and 884 CVD deaths. Multivariable adjusted analyses revealed that compared to non–consumers, participants who consumed >2.5 drinks/day had a higher risk of CVD mortality and incidence with HR (95% CI) of 1.63 (1.22–2.17) and 1.23 (1.09–1.39) for SSBs, and 1.77 (1.23–2.56) and 1.20 (1.02–1.42) for ASBs, respectively. Compared to non–consumers, moderate pure fruit/vegetable juice consumers (>0–2.5 drinks/day) have an 8% (2%–13%)–34% (16%–48%) lower risk for CVD incidence and mortality. There was a positive dose–response association of SSBs per 5% energy with CVD mortality and incidence with HR (95% CI) of 1.15 (1.17–1.25) and 1.06 (1.03–1.10), respectively. Substituting one drink/day of pure fruit/vegetable juice, un–sweetened tea/coffee for SSBs and ASBs was associated with 4%–24% lower risks for CVD mortality and incidence. A reduced SSB intake to below 5% energy may prevent 4% (1%–8%) of CVD mortality.ConclusionSSBs and ASBs was associated with a higher CVD mortality and morbidity. Pure fruit/vegetable juice and un–sweetened tea/coffee are suitable alternatives to SSBs and ASBs to reduce CVD risk.

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Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

European Heart Journal ◽

10.1093/ehjci/ehaa946.2826 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.Q Wu ◽

X Li ◽

J.P Lu ◽

B.W Chen ◽

Y.C Li ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Population Based ◽

Staple Food ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Food Factor ◽

Rural And Urban ◽

Activity Factor

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p<0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p<0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

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A longitudinal analysis of the progression from normal blood pressure to stage 2 hypertension: A 12-year Korean cohort

BMC Public Health ◽

10.1186/s12889-020-10115-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eun Sun Yu ◽

Kwan Hong ◽

Byung Chul Chun

Keyword(s):

Blood Pressure ◽

Health Insurance ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Normal Blood ◽

Normal Blood Pressure ◽

The Mean ◽

Stage 1

Abstract Background The study aimed to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure. Methods We selected a total of 21,172 normotensive individuals between 2003 and 2004 from the National Health Insurance Service-Health Screening and followed them up until 2015. The criteria for blood pressure were based on the American College of Cardiology/American Heart Association 2017 guideline (normal BP: SBP < 120 and DBP < 80 mmHg, elevated BP: SBP 120–129 and DBP < 80 mmHg, stage 1 hypertension: SBP 130–139 or DBP 80–89 mmHg, stage 2 hypertension: SBP ≥140 or DBP ≥ 90 mmHg). We classified the participants into four courses (Course A: normal BP → elevated BP → stage 1 hypertension→ stage 2 hypertension, Course B: normal BP → elevated BP → stage 2 hypertension, Course C: normal BP → stage 1 hypertension → stage 2 hypertension, Course D: normal BP → stage 2 hypertension) according to their progression from normal blood pressure to stage 2 hypertension. Results During the median 12.23 years of follow-up period, 52.8% (n= 11,168) and 23.6% (n=5004) of the participants had stage 1 and stage 2 hypertension, respectively. In particular, over 60 years old had a 2.8-fold higher incidence of stage 2 hypertension than 40–49 years old. After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). The mean years of progression from normal blood pressure to stage 2 hypertension were 8.7±2.6 years (course A), 6.1±2.9 years (course B), 7.5±2.8 years (course C) and 3.2±2.0 years, respectively. Conclusions This study found that the incidence of hypertension is associated with the progression at each stage. We suggest that the strategies necessary to prevent progression to stage 2 hypertension need to be set differently for each target course.

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Exposure to paternal tobacco smoking increased child hospitalization for lower respiratory infections but not for other diseases in Vietnam

Scientific Reports ◽

10.1038/srep45481 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 6

Author(s):

Reiko Miyahara ◽

Kensuke Takahashi ◽

Nguyen Thi Hien Anh ◽

Vu Dinh Thiem ◽

Motoi Suzuki ◽

...

Keyword(s):

Risk Factor ◽

Tobacco Smoking ◽

Respiratory Infections ◽

Disease Incidence ◽

Population Attributable Fraction ◽

Birth Cohort Study ◽

Effective Interventions ◽

Paternal Smoking ◽

Observation Period

Abstract Exposure to environmental tobacco smoke (ETS) is an important modifiable risk factor for child hospitalization, although its contribution is not well documented in countries where ETS due to maternal tobacco smoking is negligible. We conducted a birth cohort study of 1999 neonates between May 2009 and May 2010 in Nha Trang, Vietnam, to evaluate paternal tobacco smoking as a risk factor for infectious and non-infectious diseases. Hospitalizations during a 24-month observation period were identified using hospital records. The effect of paternal exposure during pregnancy and infancy on infectious disease incidence was evaluated using Poisson regression models. In total, 35.6% of 1624 children who attended follow-up visits required at least one hospitalization by 2 years of age, and the most common reason for hospitalization was lower respiratory tract infection (LRTI). Paternal tobacco smoking independently increased the risk of LRTI 1.76-fold (95% CI: 1.24–2.51) after adjusting for possible confounders but was not associated with any other cause of hospitalization. The population attributable fraction indicated that effective interventions to prevent paternal smoking in the presence of children would reduce LRTI-related hospitalizations by 14.8% in this epidemiological setting.

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Association between systolic blood pressure trajectories and hypertension risk at late adolescence: results from 10-year longitudinal follow-up in Chinese boys

BMJ Open ◽

10.1136/bmjopen-2020-042594 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042594

Author(s):

Xijie Wang ◽

Bin Dong ◽

Sizhe Huang ◽

Zhaogeng Yang ◽

Jun Ma ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Late Adolescence ◽

Population Based ◽

Incidence Rates ◽

Hypertension Risk ◽

Logit Regression ◽

Binomial Regression ◽

Physical Examinations

ObjectiveTo identify various systolic blood pressure (SBP) trajectories in Chinese boys between 7 and 18 years of age, and to explore their high blood pressure (HBP) risk in their late adolescence years.Design and settingsA population-based cohort study in Guangdong, China.Participants4541 normal tensive boys who started primary school in 2005 in Zhongshan, Guangdong were included.OutcomesBlood pressure and relevant measurements were obtained by annual physical examinations between 2005 and 2016. HBP was defined by SBP or diastolic blood pressure ≥95th percentile for children under 13, and BP ≥130/80 mm Hg for children ≥13 years old. Logit regression for panel data and log-binomial regression model was used to estimate the risk of HBP among SBP trajectory groups.ResultsFour distinct SBP trajectory groups via group-based trajectory modelling: low stable (13.0%), low rising (42.4%), rising (37.4%) and high rising (7.3%). The overall incidence rates of HBP during the follow-up ranged from 40.24 (95% CI 36.68 to 44.19)/1000 person-years in the low stable group to 97.08 (95% CI 94.93 to 99.27)/1000 person-years in the high rising group. Compared with children with low stable SBP, those of other SBP trajectories suffered 3.05 (95% CI 2.64 to 3.46) to 4.64 (95% CI 4.18 to 5.09) times of higher risk of HBP in their late adolescence, regardless of their age, body mass index and BP level at baseline.ConclusionsSubgroups of SBP trajectories existed in Chinese boys, and are related to hypertension risk at late adolescence. Regular physical examinations could help identify those with higher risks at the beginning of pubertal growth.

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Polypill eligibility and equivalent intake in a Swiss population-based study

Scientific Reports ◽

10.1038/s41598-021-84455-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Julien Castioni ◽

Nazanin Abolhassani ◽

Peter Vollenweider ◽

Gérard Waeber ◽

Pedro Marques-Vidal

Keyword(s):

Enzyme Inhibitor ◽

Large Fraction ◽

Population Based ◽

Cvd Risk ◽

Population Based Study ◽

Current Smoking ◽

Swiss Population ◽

Men Elderly ◽

Multivariable Adjustment

AbstractThe polypill has been advocated for cardiovascular disease (CVD) management. The fraction of the population who could benefit from the polypill in Switzerland is unknown. Assess (1) the prevalence of subjects (a) eligible for the polypill and (b) already taking a polypill equivalent; and (2) the determinants of polypill intake in the first (2009–2012) and second follow-ups (2014–2017) of a population-based prospective study conducted in Lausanne, Switzerland. The first and the second follow-ups included 5038 and 4596 participants aged 40–80 years, respectively. Polypill eligibility was defined as having a high CVD risk as assessed by an absolute CVD risk ≥ 5% with the SCORE equation for Switzerland and/or presenting with CVD. Four polypill equivalents were defined: statin + any antihypertensive with (A) or without (B) aspirin; statin + calcium channel blocker (CCB) (C); and statin + CCB + angiotensin-converting enzyme inhibitor (D). The prevalence of polypill eligibility was 20.6% (95% CI 19.5–21.8) and 27.7% (26.5–29.1) in the first and second follow-up, respectively. However, only around one-third of the eligible 29.5% (95% CI 26.7–32.3) and 30.4% (27.9–33.0) respectively, already took the polypill equivalents. All polypill equivalents were more prevalent among men, elderly and in presence of CVD. After multivariable adjustment, in both periods, male gender was associated with taking polypill equivalent A (OR: 1.93; 95% CI 1.45–2.55 and OR: 1.67; 95% CI 1.27–2.19, respectively) and polypill equivalent B (OR: 1.52; 95% CI 1.17–1.96 and OR: 1.41; 95% CI 1.07–1.85, respectively). Similarly, in both periods, age over 70 years, compared to middle-age, was associated with taking polypill equivalent A (OR: 11.71; CI 6.74–20.33 and OR: 9.56; CI 4.13–22.13, respectively) and equivalent B (OR: 13.22; CI 7.27–24.07 and OR: 20.63; CI 6.51–56.36, respectively). Former or current smoking was also associated with a higher likelihood of taking polypill equivalent A in both periods. A large fraction of the population is eligible for the polypill, but only one-third of them actually benefits from an equivalent, and this proportion did not change over time.

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Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-91356-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sze-Wen Ting ◽

Sze-Ya Ting ◽

Yu-Sheng Lin ◽

Ming-Shyan Lin ◽

George Kuo

Keyword(s):

Cohort Study ◽

Herpes Zoster ◽

Population Based ◽

Research Database ◽

Newly Diagnosed ◽

Increased Risk ◽

Taiwan National Health Insurance ◽

Reduced Risk ◽

Systemic Therapies

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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