Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis

Abstract

PsA is characterized by a high prevalence of cardiovascular (CV) comorbidities. Recognizing these comorbidities is critical due to their influence on the quality of life and the choice of therapy. Imaging techniques also play an important role in the evaluation of the CV risk in psoriatic disease, improving the prediction of CV events when combined with clinical scores as a predictive tool. Meta-analyses point to a significant reduction in the incidence of CV events associated with the suppression of inflammatory activity when using systemic therapies. Consequently, the mortality rate in PsA patients has fallen in the last 40 years and is now similar to that of the general population, including cardiovascular causes. Obesity is an especially relevant CV comorbidity in patients with psoriatic disease, most of whom are overweight/obese. Body mass index (BMI) is a risk factor for PsA and a causal relationship with psoriasis has been demonstrated by Mendelian randomized studies. The study of fat distribution shows that patients with psoriasis are characterized by visceral fat accumulation, which correlates with CV risk measurements. These findings suggest that approaches to the prevention and treatment of psoriatic disease might come from targeting adiposity levels, in addition to the immune pathways. Weight loss treatment with low energy diets in patients with PsA has been associated with significant improvements in disease activity. Novel strategies using a multimorbidity approach, focused more on patients outcomes, are necessary to better address comorbidities, improve clinical outcomes and the quality of life of patients with psoriatic disease.

Work ability and anthropometric indices correlate with cardiovascular risk factors in public sector employees: Cross‐sectional study

“…This study demonstrated a strong correlation between physiological factors, including increased systolic BP, and anthropometric indices like weight, BMI, WC, weight‐to‐hip ratio, weight‐to‐height ratio, and work capacity as seen in literature 56–58 . This study found that demographic and lifestyle characteristics of age, marital status, BMI, and number of children correlated with job performance as recently submitted by Kaewdok et al 20 that a person's physical attributes like age, weight, and musculoskeletal capabilities and lifestyle variables like leisure‐time physical activity, diet, smoking, and sleep and his job capacity index.…”

The cardiometabolic conditions of psoriatic disease

“…These data strongly underline the need to carefully screen for and manage the different CV risk factors in PsD. In parallel to CV risk factors, obesity, diabetes and MetS require specific attention in patients with PsD to be adequately managed (7,37,43). Optimal lifestyle modification in PsO including hypocaloric and Mediterranean diet and smoking cessation if required, is a cornerstone of strategies to reduce CV disease (61).…”

“…Higher cardiovascular (CV) risk is well documented in immune-mediated diseases such as rheumatoid arthritis (RA) or systemic lupus erythematosus ( 6 ). In parallel, there is a growing interest in CV and metabolic diseases in patients with PsD ( 4 , 5 , 7 ).…”

Cardiovascular comorbidities in psoriatic arthritis: epidemiology and risk factors in two different European populations

“…In addition to classical musculoskeletal and skin manifestations, people with PsA also present with high numbers of CV and metabolic comorbidities (19), a factor that could contribute to the increasing e morbidity and mortality, even if in a recent population-based study the survival rates over 5 years of the PsA patients were comparable with the general population (11) .…”