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Psoriasis considered risk factor for cardiovascular disease


Epidemiological data on the prevalence and degree of cardiovascular morbidity and mortality in patients with psoriasis are contradictory. A team of German researchers recently found that the patients with psoriasis have an increased coronary artery calcification, which precedes myocardial infarction. Thus, psoriasis can be considered as a risk factor for cardiovascular disease.

Key Points

Frankfurt am Main, Germany - A recent study shows a significantly higher prevalence and severity of coronary artery calcification (CAC) as an indicator for cardiovascular disease in patients with psoriasis, compared to nonpsoriatic controls. The results indicate that the inflammatory processes underlying the pathogenesis of psoriasis are potentially of a systemic nature, and therefore, may have severe systemic repercussions.

"Recent research has shown that systemic inflammation plays a crucial role in atherosclerosis. As numerous immunological factors identified as relevant in the pathogenesis of atherosclerosis are also known to play key roles in other chronic systemic inflammatory diseases such as psoriasis, a higher-than-expected rate of cardiovascular disease could be explained based on shared pathogenic pathways," says Ralf J. Ludwig, M.D., department of dermatology, Clinic of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany.

Dr. Ludwig tells Dermatology Times that one possible marker to detect clinically silent cardiovascular disease is CAC. He and fellow researchers conducted a retrospective study consisting of 32 patients with severe and long-standing psoriasis.

Both groups of patients were then examined with a non-contrast-enhanced 16-row spiral computed tomography, and a radiologist scored the CAC.

The psoriatic patient group was matched from a database at the department of radiology with a control group including the same age, race, sex and the same risk factors for cardiovascular diseases (smoking habits, family history of cardiovascular disease, diabetes, hypertension, BMI, total cholesterol, total triglycerides and C-reactive protein).

The incidence and severity of CAC was then compared in both groups. Patients with a past or present history and/or symptoms of cardiovascular diseases (myocardial infarction, stroke, peripheral artery disease or coronary heart disease) were excluded from the study.

"The coronary artery calcification was more abundant in the psoriasis group - approximately 60 percent, compared to only 30 percent in the control group. Also, the average calcification scores were higher in patients with psoriasis, compared to the control," Dr. Ludwig says.

Following the study design, Dr. Ludwig then did a multivariate analysis and checked to determine if the presence or absence of coronary artery calcification could be predicted by age, sex, cholesterol and diabetes.

Data analysis

According to Dr. Ludwig, the data was conclusive and found psoriasis to be an independent risk factor for CAC.

"It is clear from our results that psoriasis can be viewed as a risk factor for cardiovascular disease. The inflammation is one likely trigger for coronary artery calcifications and cardiovascular disease," Dr. Ludwig says.

According to Dr. Ludwig, psoriasis patients generally do not have a healthy lifestyle. Most of them are obese, smoke and/or have type II diabetes.

He says physicians should strive to dampen the inflammatory response to psoriasis, which justifies the use of novel therapeutic drugs such as the biologics.

"If you have all these other risk factors which you are able to positively influence, the physician should aim at dampening these risk factors, in addition to treating their patients with state-of-the-art psoriasis therapies," Dr. Ludwig says.

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