Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment

Abstract

Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.

Clinical use of dimethyl fumarate in moderate‐to‐severe plaque‐type psoriasis: a European expert consensus

“…The majority of patients with psoriasis must take other medications due to the disease itself or because of associated co-morbidity (e.g., hypertension, Type 2 diabetes, depression). 63,64 Many psoriasis treatments require an adjustment in long-term medication due to drug interactions, cumulative toxicities or renal/hepatic decomposition mechanisms. 65 However, with DMF there is no evidence of drug-drug interactions and elimination mainly takes place by exhalation, therefore it can be used in patients with co-medications.…”

Association between psoriasis, psoriatic arthritis and gout: a nationwide population‐based study

“…Although traditionally regarded as a disease which mainly affects the skin, nails and joints, recent studies have demonstrated that patients with psoriasis have a higher prevalence of various systemic diseases, including hypertension, diabetes mellitus, dyslipidemia, obesity, metabolic syndrome, coronary heart disease, acute myocardial infarction, stroke and depression. 3,4,[17][18][19] In addition, treatment of psoriasis with oral immunosuppressants (such as methotrexate) and biological agents (such as tumour necrosis factor-alpha inhibitors) may reduce the risk of developing cardiovascular comorbidities. 20,21 It is possible that the presence of common inflammatory pathways may underlie the association between psoriasis and various chronic inflammatory diseases.…”

“…However, recent studies have revealed that psoriasis may be associated with the development of various systemic diseases, including metabolic syndrome (hypertension, diabetes mellitus, dyslipidemia, obesity), cardiovascular diseases (acute myocardial infarction, ischaemic heart disease), cerebrovascular disease and peripheral vascular disease. 3,4 The presence of chronic systemic inflammation in psoriasis may explain its association with various systemic inflammatory disorders. 5 Gout is a form of inflammatory arthritis that causes recurrent episodes of joint pain and swelling, particularly involving the metatarsal-phalangeal joint of the big toe.…”

Increased incidence of ischaemic heart disease and cerebrovascular disease in psoriasis patients with depression: a nationwide retrospective cohort study

“…Traditionally, the skin and joints were regarded to be the main organ systems affected by this disease. However, recent epidemiological reports have shown that psoriasis patients are at greater risk of various metabolic and cardiovascular disorders, including diabetes, hypertension, hyperlipidaemia, obesity, ischaemic heart disease, myocardial infarction and stroke . This may be due to the systemic inflammatory nature of psoriasis, which promotes the development of atherosclerosis …”

“…However, recent epidemiological reports have shown that psoriasis patients are at greater risk of various metabolic and cardiovascular disorders, including diabetes, hypertension, hyperlipidaemia, obesity, ischaemic heart disease, myocardial infarction and stroke. [6][7][8][9][10] This may be due to the systemic inflammatory nature of psoriasis, which promotes the development of atherosclerosis. 11 Patients with psoriasis are also known to have increased prevalence of psychiatric illnesses, including depression and anxiety.…”