Cardiovascular Comorbidities in Psoriatic Disease

Abstract

Psoriatic disease (PsD) is a multisystem inflammatory disorder with a high prevalence of cardiovascular (CV) risk factors contributing to accelerated atherosclerosis and its sequelae. Imaging studies, notably with ultrasound, computed tomography, and positron emission tomography (PET) scanning have confirmed significant atherosclerotic change with plaque formation and vessel stenosis. Atherosclerosis is likely driven by a combination of traditional risk factors which occur more frequently in PsD and by systemic inflammation with associated pro-inflammatory cytokine production. While the mechanisms driving atherosclerosis in PsD are incompletely understood, it is now best practice to try to minimize the impact of CV risk factors by regular assessment, prevention, and treatment and also by ensuring that inflammatory musculoskeletal and cutaneous disease is adequately suppressed. Future studies need to focus on improving our understanding of the mechanisms driving atherosclerosis and, as a consequence, developing more rationale approaches to prevention and treatment.

Comparison of cardiovascular risk burden in patients with psoriatic arthritis, ANCA-associated vasculitis and systemic lupus erythematosus

“…Overall, our ndings in PsA are consistent with previous results showing increased prevalence and incidence of traditional cardiovascular risk factors [19]. Nonetheless, data on nontraditional factors are limited although its contribution to CVD risk burden is acknowledged in various studies [20].…”

Metabolic syndrome and cardiovascular diseases: Going beyond traditional risk factors

“…Atherosclerosis is characterised by a chronic inflammatory process originating in the vascular intima layer. Its pathogenesis is closely related to the increase of local and/or systemic expression of pro‐inflammatory mediators, 27,28 recruitment and activation of leucocytes, subendothelial accumulation of lipids, and local proliferation of smooth muscle cells (SMC) and fibrous matrix 29,30 . Its clinical manifestations, in turn, account for the highest morbidity and mortality rates today and generate immeasurable costs to health services around the globe 21,31 whilst translating into most of the so‐called major cardiovascular events 27 …”

“…The incidence of atherosclerotic disease is increased by several types of chronic inflammatory and non‐inflammatory diseases. Examples are psoriasis, 30 rheumatoid arthritis, systemic lupus erythematosus, 32,33 depression, 34 personality disorders, or even chronic psychological stress, 28 nephropathies, 35 neurodegenerative diseases, and hepatopathies 29 . In addition to the greater predisposition to atherogenesis, chronically inflamed or even asymptomatic individuals with high inflammatory biomarkers, present a higher incidence of venous thromboembolism, 36 illustrating another relevant factor responsible for cardiovascular morbidity and mortality, the pro‐thrombotic state, resulting from alterations in platelet function and other components of the haemostatic system, such as thrombin, fibrinogen, and fibrin 26,27 .…”

“…In addition to the greater predisposition to atherogenesis, chronically inflamed or even asymptomatic individuals with high inflammatory biomarkers, present a higher incidence of venous thromboembolism, 36 illustrating another relevant factor responsible for cardiovascular morbidity and mortality, the pro‐thrombotic state, resulting from alterations in platelet function and other components of the haemostatic system, such as thrombin, fibrinogen, and fibrin 26,27 . From these findings, novel risk factors have been proposed, in addition to the traditional ones, as their importance in the pathogenesis of cardiovascular events became evident 30,37 …”

Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis

“…A recent review suggests that patients with psoriasis have a higher incidence of carotid artery plaque and vascular inflammation compared with controls in the preponderance of studies 31,70,71 . Moreover, psoriasis severity seems to be associated with vascular inflammation independently from cardiovascular risk factors 72 .…”