At AAD 2017, Joel M. Gelfand, MD, MSCE, was honored as the recipient of the Marion B. Sulzberger, MD, Memorial Award and Lectureship. In his talk titled “Getting to the heart (and other comorbidities) of psoriasis,” Dr. Gelfand discussed the findings from research investigating associations between psoriasis and comorbidities and their relevance for providing comprehensive medical care for patients with psoriasis.
Concluding his talk, Dr. Gelfand expanded on a quote from Dr. Francis Peabody’s essay, “The Care of the Patient”, written 90 years ago.
“Dr. Peabody stated, ‘…the secret of the care of the patient is in caring for the patient.’ For the patient with psoriasis, that means we need to look beyond the skin,” said Dr. Gelfand, Professor of Dermatology and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Establishing evidential support
Focusing primarily on associations between psoriasis and cardiovascular disease, Dr. Gelfand highlighted results from population-based epidemiological studies, including those from his own clinical research laboratory analyzing data in a prospectively maintained medical record database in the United Kingdom.
“Our studies showed an independent, dose-response relationship between psoriasis severity and risks of major adverse cardiovascular events, ie., myocardial infarction, stroke, and cardiovascular disease-related mortality. Subsequently, numerous papers have been published investigating the association between psoriasis and cardiovascular risk, and results from nine meta-analyses covering more than 500,000 patients with psoriasis and more than 29 million controls largely confirm our initial findings,” he said.
Findings from laboratory investigations provide insights into the potential biological mechanisms underlying the association between psoriasis and cardiovascular disease and provide proof of principle that inflammation restricted to the skin can lead to systemic vascular complications, Dr. Gelfand said.
In addition, clinical studies using [18F]-fluorodeoxyglucose positron emission tomography/computed tomography imaging show that as psoriasis severity increases so does aortic and subcutaneous fat inflammation.
“A finding that subcutaneous fat under psoriatic plaques expresses miRNAs that modulate lipid metabolism suggests there is communication between the skin and the fat and that it plays a role in mediating some of the connections we are seeing between psoriasis and cardiometabolic disease,” Dr. Gelfand said.