Should all patients with psoriasis receive statins? Analysis according to different strategies

Abstract

BackgroundDifferent strategies have been proposed for the cardiovascular risk management of patients with psoriasis.ObjectiveTo 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.MethodsA 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.ResultsA 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 limitationsThis was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis.ConclusionThis population with psoriasis was mostly classified at moderate–high risk and the statin therapy indication was similar when applying the two strategies evaluated.

Psoriasis and Cardiovascular Risk: A Comprehensive Review

“…A recent study evaluated two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy [80]. The first, recommended by the European Society of Nonetheless, statins have pleiotropic effects including decreasing inflammation and may have the potential to reduce psoriasis severity.…”

“…A recent study evaluated two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy [ 80 ]. The first, recommended by the European Society of Cardiology (ESC), the European Society of Atherosclerosis (EAS) and the European League Against Rheumatism (EULAR), is to adjust the risk calculated by a multiplying factor (1.5 ×) and follow the recommendations for statin therapy of the general population [ 64 , 65 ].…”

Evaluation and treatment of metabolic syndrome and cardiovascular disease in adult patients with psoriasis

“…Demonstrating the indications for starting statin therapy in patients with psoriasis. Adapted from Masson et al 60 Table S4. Outlining the risk factors for T2DM.…”

Killing Two Birds with One Stone: Potential Therapies Targeting Psoriasis and Atherosclerosis at the Same Time

“…Accepting the elevated cardiovascular risk in patients with psoriasis, the question arises of whether all patients with psoriasis should receive statin. According to the study by Mason et al, at least 60% of patients are eligible for statin therapy [ 82 ]. Furthermore, in addition to the LDL lowering effect, statins also have pleiotropic effects, including reduction of inflammation, angiogenesis, plaque thrombogenicity, endothelial dysfunction, and cellular migration [ 83 ].…”