The evolving literature suggests that psoriasis is associated with multiple other diseases, including cancer, cardiovascular disease, diabetes and psychiatric disease, and that psoriasis itself may be an independent risk factor for developing atherosclerosis and myocardial infarction. The pharmacokinetics, pharmacodynamics, efficacy and safety profiles vary among biologicals and, therefore, drug and patient factors are important in selecting the optimum therapy. An higher prevalence of cardiovascular risk factors, such as dyslipidemia and obesity, has been reported in psoriatic patients 4,6. Moreover, the risk of MI was higher in young 30-year-old psoriatic patients, and this risk persisted higher after adjustment for major risk factors for MI, suggesting that psoriasis itself confers an independent risk of MI. In fact, hypertension is a well-established risk factor for CVDs and cardiovascular mortality 63. Recent studies have shown that psoriasis is associated with atherosclerosis. The presence of psoriasis is an independent risk factor for subclinical atherosclerosis. 23 Interestingly, the excessive relative risk of MI seems to persist even after adjustment for the major risk factors for CVD, suggesting that psoriasis might be considered as an independent risk factor for MI.
ConclusionsPsoriasis may confer an independent risk of MI. ObjectiveTo determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors. Psoriasis is associated with multiple cardiovascular risk factors and itself may be an independent risk factor for MI. This monograph will introduce the current AAD Consensus Statement in which it is recommended that biologics be considered among the first-line treatment options in some patients with psoriasis. A risk factor may suggest a causal relationship based on strength of study design (randomized controlled trial is the gold standard), temporal relationship, strength of the association, consistency of studies, and biological plausibility. 7 Although evolving evidence suggests that psoriasis is associated with a variety of cardiovascular risk factors, recent studies suggest that psoriasis itself is an independent risk factor for developing coronary artery disease and myocardial infarction (MI), possibly due to shared immunologic pathways that function abnormally in both diseases.
Multiple cardiovascular risk factors seem to be influenced; the blood pressure, oxidative stress, dyslipidemia, endothelial cell dysfunction, homocysteine levels and blood platelet adhesion. The higher prevalence of classic cardiovascular risk factors, like smoking, hypertension and obesity contribute to atherogenesis in psoriasis patients, but psoriasis itself and its systemic treatment may also stimulate premature atherogenesis, increasing the cardiovascular risk. The excess risk was clearly associated with the severity of psoriasis expressed as the number of hospital admissions. It also indicates that severe lipid disorders may occur in patients with type 1 diabetes, but the occurrence of elevated high-density lipoprotein cholesterol is positively associated with longevity of these patients (Figures 1 and 2). Similarly, nonrenal hypertension by itself is a significant risk factor for CVD but if adequately treated does not appear to mitigate against longevity 8. Along with lowering LDL, TLC also improves risk factors associated with the metabolic syndrome and diabetes, including blood pressure, high-density lipoprotein cholesterol (HDL), serum triglycerides, blood glucose, and weight status (Figures 2 and 3). Women with at least 10-year duration of RA had a threefold risk for myocardial infarction.
Psoriasis is associated with depression and substance abuse, including alcohol. Cardiovascular assessment (e.g. electrocardiogram, validated risk estimation tools). Although a high DLQI 10 and a low PASI 10 can be considered moderate to severe disease, the high DLQI may be a result of other factors other than the psoriasis itself. It has been linked to an increased risk of myocardial infarction, especially in the more severely affected, younger patients. They play multiple roles in inflammation, metabolism, and endothelial cell function regulation. This was the first time that psoriasis was shown to be a risk factor for cardiovascular mortality independent of the other cardiovascular risk factors. Systemic therapies in psoriasis may reduce the inflammatory milieu of the disease, but it still remains to be clarified whether and to which point they affect the real values of lipid profile, hypertension, obesity, and the additional components of metabolic syndrome. Obesity is a risk factor for fatal heart attacks even for people who do not have the conditions normally associated with cardiovascular disease, such as diabetes and high blood pressure, a study shows. Study Suggests Obesity-Heart Attack Link Is Independent of Other Risk Factors Such as Diabetes. Comorbidities may increase with age; one recent study found that patients older than 65 years had a statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. Obesity itself is an independent risk factor for developing psoriasis. It is likely that a state of chronic low-grade inflammation and traditional risk factors both contribute to the predisposition of psoriasis patients to CV and metabolic comorbidities.