New research offers strong evidence that vascular inflammation and risk of having a major adverse cardiovascular event, such as heart attack or stroke, increase with psoriasis duration.
As a result, dermatologists and other providers should consider asking how long patients have had psoriasis when assessing cardiovascular risk stratification, according to the authors.
Studies have shown that psoriasis patients are more likely than those without the disease to have cardiovascular risk factors, cardiovascular disease and vascular inflammation. Researchers have also found that cumulative exposure to inflammation increases the risks for atherosclerosis and cardiovascular events. And psoriasis can result in chronic, low-grade systemic inflammation, according to the study.
The researchers used human imaging and population-based studies to understand psoriasis duration’s effect on vascular disease and cardiovascular events.
To study vascular inflammation and psoriasis, they used fludeoxyglucose F18 positron emission tomography/computed tomography imaging on 190 psoriasis patients, with mild to moderate disease, who were primarily middle-aged men.
They found the longer the duration of psoriasis, the more inflammation in subjects’ blood vessels. And that relationship was evident despite traditional cardiovascular risk factors. Male gender, smoking, Framingham 10-year risk and body mass index were strongly associated with vascular inflammation, as well.
The researchers also studied a population cohort of 4,321,954 adults, including 87,161 with psoriasis. The maximum duration of disease among those with psoriasis was 31.1 years. They found each year of psoriasis duration was associated with a 1 percent increased risk for future cardiovascular events—an effect similar to that from smoking.
In a separate analysis, they followed patients in the population cohort for 4.7 years and report that during the followup 152,122 adults without psoriasis had a major cardiovascular event, which is about 8 people in every 1,000. That’s compared to 4,472 people with psoriasis who had major cardiovascular events in the followup, which is about 11 people in every 1,000.
Each of the major adverse cardiovascular event components—heart attack, stroke and death—increased with longer disease duration. “…we have presented novel and convincing evidence to suggest a detrimental effect of psoriasis duration on [cardiovascular disease] beyond traditional [cardiovascular] risk factors, even in patients with low [cardiovascular] risk scores,” they write.
Based on the large study population, the absolute increase is roughly 10 percent for future adverse events.