Psoriasis and Cardiovascular Disease

Well-established comorbidities of psoriasis include:^1-11

• Heart attack, stroke, CV death
• Metabolic syndrome (obesity, insulin resistance, cholesterol abnormalities, and hypertension)
• Diabetes
• Psoriatic arthritis
• Mood disorders (anxiety, depression, and suicide)
• Crohn’s disease
• T-cell lymphoma (rare)

There is risk of cardiovascular/cardiometabolic disease in patients with more severe psoriasis:^1,2,10,12,13

• With psoriasis, there is an increased risk of MI, stroke, cardiovascular death, diabetes, and chronic kidney disease.
• Data suggest an average of 5 years of life lost due to this comorbidity.
• The 10-year risk of major CV event attributable to psoriasis is 6%.
• Patients treated for severe psoriasis are 30 times more likely to experience major adverse cardiovascular events (attributable to psoriasis) than to develop a melanoma.

Standard screening recommendations for cardiovascular disease in patients with psoriasis include:^14-16

• Hypertension:
  • Age 18–39 years, no risk factors and BP <130/85 mmHg: every 3–5 years
  • Age ≥40 and those at increased risk for high BP (BP 130–139/85–89 mmHg, overweight/obese, African Americans): yearly
• Diabetes (fasting plasma glucose, HbA1c, or OGTT):
  • Adults age 40–70 years with BMI ≥25
  • Repeat every 3 years
• Cardiovascular risk assessment:
  • Traditional risk factors every 4–6 years in patients age 20–79 years
  • Estimate 10-year risk in those age 40–79 years

REFERENCES

1. Gelfand JM et al. 2006;296:1735-1741.
2. Gelfand JM et al. J Invest Dermatol. 2006;126:2194-2201.
3. Langan SM et al. J Invest Dermatol. 2012; 132:556-562.
4. Kurd SK et al. Arch Dermatol. 2010;146:891-895.
5. Armstrong AW et al. J Hypertens. 2013;31:433-442.
6. Ma C et al. Br J Dermatol. 2013; 168:486-495.
7. Azfar RS et al. Arch Dermatol. 2012;148:995-1000.
8. Li W et al. Am J Epidemiol. 2012;175:402-413.
9. Yeung H et al. JAMA Dermatol. 2013;149:1173-1179.
10. Mehta NN et al. Eur Heart J. 2010;31:1000-1006.
11. Najarian DJ, Gottlieb AB. J Am Acad Dermatol. 2003;48:805-821.
12. Mehta NN et al. Am J Med. 2011;124:775.e1-6.
13. Wan J et al. 2013;347:f5961.
14. Siu AL; USPSTF. Ann Intern Med. 2015;163:778-786.
15. Siu AL; USPSTF. Ann Intern Med. 2015;163:861-868.
16. Goff DC Jr. et al.. J Am Coll Cardiol. 2014;63:2935-2959.