Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: Implications in cardiovascular risk factors management and primary prevention of cardiovascular disease

Abstract

Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long-term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long-term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real-world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.

Psoriasis: Behind the scenes

“…Psoriasis often coexists with other systemic diseases such as arthritis, diabetes mellitus, arterial hypertension, obesity, dyslipidemia, non‐alcoholic fatty liver diseases and cardiovascular diseases (psoriatic march) . An increased risk of cardiovascular mortality and stroke has been identified in psoriasis patients; however, this relationship requires further epidemiological analysis .…”

Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives

“…In addition to some degree of under-treatment, recent studies document suboptimal performance of established risk prediction tools [e.g., the Framingham risk score, SCORE (Systematic Coronary Risk Evaluation), and CHA 2 DS 2 VASc (Congestive heart failure, hypertension, age C75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category)] in patients with CIDs, including psoriasis and RA, which underlines the need for increased focus on these patients [39, 55,[76][77][78][79]. Suboptimal CV screening and treatment practices in patients with CIDs may therefore represent a new aspect of the treatment-risk paradox, i.e., where patients in the highest risk score categories receive less evidence-based treatment [80].…”

Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis

“…However, development of such guidelines is difficult given the relative lack of evidence to inform risk stratification among patients with these inflammatory diseases. Several studies have demonstrated that existing risk stratification tools (e.g., Framingham and SCORE) underestimate the true inflammatory burden in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis [38–42]. Additional studies to determine risk factors and develop clinical prediction models for cardiovascular disease among patients with psoriatic disease are needed [43].…”