CARDIOVASCULAR RISK FACTORS
Classic cardiovascular risk factors don’t seem to be the only reason for a potentially heightened risk; rather, systemic inflammation might be a driver of cardiovascular disease risk in patients with psoriasis. The authors point out that inflammation is linked to cardiovascular disease markers that occur more often in psoriasis patients, including impaired insulin sensitivity, carotid intima-media thickening, endothelial dysfunction, aortic stiffness, vascular inflammation and coronary plaque burden.
“These insults could occur because of the consistent vascular damage consequent to immune activation in those with longer duration disease,” they write.
But questions remain. Most—not all—studies have linked psoriasis with increased cardiovascular disease risk. It’s still debated whether having psoriasis is independently associated with cardiovascular disease.
For example, a 2015 study published in the Journal of Investigative Dermatology looked at the association between psoriasis and risk of major cardiovascular events. In a cohort of 48,523 patients with psoriasis and 208,187 controls, and in an average 5.2 year follow up, researchers found nearly 2.6 percent of those with psoriasis had a major cardiovascular event, compared to 2.3 percent of controls. They found in a multivariable analysis that inflammatory arthritis, diabetes, chronic kidney disease, hypertension, valvular heart disease, thromboembolism, congestive heart failure, depression, smoking, age and male gender were statistically significantly factors for major cardiovascular disease risk.
However, neither psoriasis nor severe psoriasis were associated with the short-to-medium term—more than three to five years--risk of major cardiovascular events, after they adjusted for known cardiovascular disease risk factors.
Another thing that’s not clear still today is how systemic therapy might affect vascular inflammation and cardiovascular events, according to the authors.
A potential limitation of this new study is the population cohort data didn’t include information about body mass index or physical exercise. And among the 190 patients imaged for vascular inflammation, previous cardiovascular disease and diabetes did not relate to vascular inflammation, but those were two major predictors of major adverse cardiovascular events in the population cohort. The inconsistency could be due to the low numbers of patients with those characteristics in the 190-patient group, the authors write.
The authors have research, consulting and other ties to numerous companies, including Pfizer, Eli Lilly, Novartis, Galderma, Janssen Pharmaceuticals, LEO Pharma and others. One of the authors is employed by Eli Lilly.
Egeberg A, Skov L, Joshi AA, et al. “The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events,” Journal of the American Academy of Dermatology. October 2017. DOI:10.1016/j.jaad.2017.06.028.
Parisi R, Rutter MK, Lunt M, et al. “Psoriasis and the Risk of Major Cardiovascular Events: Cohort Study Using the Clinical Practice Research Datalink,” Journal of Investigative Dermatology. Published online April 9, 2015 DOI:10.1038/jid.2015.87.