Psoriasis and cardiovascular disease: epidemiology, mechanisms, and clinical implications

Kelly C Pearson¹, April W Armstrong^2
1Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, ²Department of Dermatology, University of California, Davis, Sacramento, CA, USA

Abstract: Psoriasis is a systemic inflammatory disorder, which has been reported to be associated with adverse cardiovascular (CV) risks. CV comorbidities, such as diabetes, dyslipidemia, hypertension, and obesity appear to be increased in psoriasis patients compared with the general population. Psoriasis may contribute independently to adverse cardiac outcomes after accounting for traditional CV risk factors. In this article, it was aimed to summarize large population studies that examine the relationship between psoriasis and CV risk factors and major adverse cardiac outcomes, and highlight proposed mechanisms for the observed epidemiologic link. Specifically, large population-based studies with over 1000 total subjects from 1975 to September 2008 in the English literature are highlighted. The relevant search terms in the Ovid Medline database were applied. The majority of the studies presented evidence for an increased incidence of CV risk factors and an increased risk for major adverse cardiac outcomes in patients with severe psoriasis. The increased risk in severe psoriasis necessitates regular screening for other comorbidities. Current guidelines for screening CV risk factors among psoriasis patients are discussed. Also reviewed is the scarce literature in therapeutic strategies to reduce CV risk factors and major adverse cardiac outcomes in psoriasis patients. Specifically, an emerging area of research on the effects of biologic agents on CV risk factors and CV adverse outcomes in psoriasis is discussed.

Keywords: cardiovascular disease, cardiovascular risk factors, psoriasis, diabetes mellitus, myocardial infarction, major adverse cardiovascular events, MACE, hypertension