Psoriasis beyond the skin: a review of the literature on cardiometabolic and psychological co-morbidities of psoriasis

Abstract

Psoriasis is increasingly associated with a range of co-morbid diseases and risk factors. Patients with co-morbidities are more likely to need hospitalisation for non-dermatological conditions, and incur greater total costs than those without co-morbidities. A literature review was conducted on two of the most common co-morbidities of psoriasis (cardiovascular (CV) and psychological co-morbidities), to establish their incidence and impact and to raise awareness of unanswered questions and highlight knowledge gaps. A large number of small controlled or cross-sectional studies report increased prevalence of cardiometabolic and psychological co-morbidities in psoriasis patients. A number of large cohort studies documented the incidence of various cardiometabolic comorbidities. Severe psoriasis is associated with increased mortality, and the most common cause of death is CV disease. Studies on the management of co-morbidities and their impact on psoriasis treatment are scarce. Many questions on the co-morbidities of psoriasis remain to be answered.

Is enhanced platelet activation the missing link leading to increased cardiovascular risk in psoriasis?

“…While psoriasis is considered previously to be a primary cutaneous disease a recent report points out the importance of regarding psoriasis as a systemic disease far beyond the confines of skin [19]. Though some reports such as Wakkee et al [20] indicate that there is no direct relationship between psoriasis and cardiovascular disease, the predominant view in a more recent report suggests that psoriasis patients are prone to have increased cardiometabolic risk factors [21].…”

Cardiovascular and Metabolic Diseases Comorbid with Psoriasis: Beyond the Skin

“…The association of psoriasis with metabolic syndrome (obesity, glucose intolerance, hypertension and dyslipidemia) has also been well documented (48, 49). As Henseler and Christophers reported in an earlier study (50), obesity and type 2 diabetes mellitus are significantly associated with psoriasis in the United Kingdom (51), Israel (52, 53), Italy (54), Germany (55) and Denmark (56) (Table 2).…”

Moderate to severe psoriasis patients' subjective future expectations regarding health‐related quality of life and longevity

“…Psoriasis is a common inflammatory, immune‐mediated condition that requires lifelong treatment and disease management. Multiple co‐morbidities, including psoriatic arthritis, inflammatory bowel diseases, diabetes, metabolic syndrome, obesity, dyslipidaemia, cardiovascular disease and psychological or psychiatric disorders are often related to psoriasis . Severe psoriasis is associated with increased mortality due to various causes, of which the most common is cardiovascular disease …”

“…Multiple co-morbidities, including psoriatic arthritis, inflammatory bowel diseases, diabetes, metabolic syndrome, obesity, dyslipidaemia, cardiovascular disease and psychological or psychiatric disorders are often related to psoriasis. 1,2 Severe psoriasis is associated with increased mortality due to various causes, of which the most common is cardiovascular disease. 3 Several cross-sectional studies described substantial healthrelated quality of life (HRQOL) impairment in psoriasis incorporating physical, psychological, social and economic dimensions.…”