Psoriasis raises heart attack risk
By Cliff Collins
This is the third in a series of Psoriasis Advance articles about health risks associated with psoriasis. Previous articles discussed overall health risks and the risk of developing cancer. This and future articles will look at individual health conditions (doctors call them comorbidities) associated with psoriasis.
Until recently, doctors suspected that the association between psoriasis and heart disease owed to the prevalence of risk factors such as obesity or smoking in psoriasis patients, risks thought to be provoked by the social and psychological burdens of the disease.
That notion changed about three years ago, when a national study established that psoriasis "in and of itself, particularly when it is of a severe nature, can cause cardiovascular risk," said Dr. Bruce Strober, assistant professor of dermatology at New York University and a member of the National Psoriasis Foundation Medical Board.
That psoriasis alone, even when common heart-disease risk factors are removed, may confer a risk of heart attack was shown by Dr. Joel M. Gelfand and colleagues at the University of Pennsylvania in a paper published in 2006 in the Journal of the American Medical Association. This link was found to be greatest in patients under age 60 with severe psoriasis.
A 2008 report in the Journal of the American Academy of Dermatology co-authored by Strober cited two studies showing that psoriasis patients are at greater-than-average risk of heart disease. A large population-based study demonstrated an increased prevalence of heart attack in patients with psoriasis—particularly those with severe disease—even when looked at independently of known major cardiovascular risks such as obesity, smoking, diabetes and high blood pressure.
Similarly, a small study of a well-defined population of patients with very severe psoriasis demonstrated that these patients had a higher frequency of coronary artery disease, even when controlling for known risk factors for atherosclerosis.
The reasons behind the link between psoriasis and heart disease are uncertain. Researchers think that the inflammatory nature of psoriasis may be connected with the development of atherosclerotic plaques in blood vessels, Strober said.
"These developments have made it increasingly challenging to counsel patients who previously regarded themselves as primarily having a skin disease and, in many cases, have depended on their dermatologist to serve as both their skin expert and primary care provider," the paper’s authors wrote.
Because the concept of a higher tendency for heart disease is relatively new, dermatologists should inform psoriasis patients of the increased risk, Strober said. If, after taking a blood test and measuring blood pressure, he finds abnormally high cholesterol, blood sugar or blood pressure, he advises patients that they need to see a primary care physician.
Drugs may cut risk
The use of certain prescription drugs taken orally may have potential for reducing risks.
"We have tantalizing data that suggest (that some drugs) may cut risk," he explained. For example, the drug methotrexate has been shown to reduce the incidence of vascular disease, he said. When the drug is used with folic acid, the risk is reduced by half, he added. Methotrexate "is a very commonly prescribed drug for psoriasis, but not for that reason," Strober said. In terms of protection from heart disease, "it is in its infancy."
Still, there is hope that methotrexate or drugs known as TNF inhibitors prescribed for psoriasis may prove to have the side benefit of reducing heart disease, he said.
In the meantime, experts say people with psoriasis should not fret over factors they can’t control. Instead, they should concentrate on changing factors they can.
Dr. Gelfand, also a member of the National Psoriasis Foundation Medical Board, recommended: "If you smoke, quit. If you experience high stress, learn stress-management techniques. If you are obese, work toward maintaining a healthy body weight. And if you have high blood pressure, diabetes or high cholesterol, be sure that these are well-controlled."
Cliff Collins is a Portland, Ore., freelance writer