Cardiovascular Risk in Patients With Psoriasis

Highlights

• Patients with psoriasis are at increased risk of cardiovascular disease.

• Cutaneous and systemic inflammation coupled with a background of traditional cardiovascular risk factors are thought to increase cardiovascular risk in psoriasis.

• Randomized controlled trials are needed to determine if treatment of psoriasis reduces the risk of developing cardiovascular disease.

Abstract

Psoriasis is a chronic inflammatory skin disease that affects 2% to 3% of the U.S. population. The immune response in psoriasis includes enhanced activation of T cells and myeloid cells, platelet activation, and up-regulation of interferons, tumor necrosis factor-α, and interleukins (ILs) IL-23, IL-17, and IL-6, which are linked to vascular inflammation and atherosclerosis development. Patients with psoriasis are up to 50% more likely to develop cardiovascular disease (CV) disease, and this CV risk increases with skin severity. Major society guidelines now advocate incorporating a psoriasis diagnosis into CV risk prediction and prevention strategies. Although registry data suggest treatment targeting psoriasis skin disease reduces vascular inflammation and coronary plaque burden, and may reduce CV risk, randomized placebo-controlled trials are inconclusive to date. Further studies are required to define traditional CV risk factor goals, the optimal role of lipid-lowering and antiplatelet therapy, and targeted psoriasis therapies on CV risk.