Some Psoriasis Drugs May Lower Heart Attack Risk
Research increasingly shows a link between psoriasis and cardiovascular disease, which begs the question: Does treating psoriasis reduce the risk of cardiovascular disease?
After reviewing the literature on common psoriasis therapies and cardiovascular health, the National Psoriasis Foundation Medical Board concluded that methotrexate and biologics targeting tumor necrosis factor alpha (TNF-alpha) may reduce the risk of heart attack, stroke and other cardiovascular events.
More study is needed, however, board members say. The paper was published on the Journal of the American Academy of Dermatology website.
"I think it's a very controversial area, in terms of what does this mean in the real world," said Dr. Jeffrey Weinberg, of Columbia University and a member of the medical board. "I think this is just another piece of information, another aspect of these therapies. Much of this stuff has been recognized for a while."
The paper's authors analyzed all the major psoriasis therapy options and came to the following conclusions:
- Phototherapy: No major impact on cardiovascular risk.
- Acitretin: Increases serum lipids and triglycerides, but data so far does not show that it increases cardiovascular risk.
- Cyclosporine A: Increases blood pressure, serum triglycerides and total cholesterol.
- Methotrexate: Associated with a 21 percent decreased risk for cardiovascular disease and 18 percent lower risk for heart attack.
- TNF-alpha inhibitors: Associated with an overall reduction in cardiovascular events.
- Stelara (ustekinumab): Short-term use of Stelara does not appear to affect the risk of major cardiovascular events, but use over a four-year period is associated with a decrease in major heart-related complications.
There is heightened interest in the impact that psoriasis treatments may have on cardiovascular disease risk. National Psoriasis Foundation backed a study by Nicole Ward of Case Western Reserve School of Medicine who found that aggressively treating mice engineered to have psoriatic lesions reduced their risk of cardiac complications.
Weinberg said the board's aim was to provide a reference for physicians who are treating people with psoriasis, but added that the board's conclusions won't alone prompt different treatment decisions in the doctor's office.
"It helps us in a setting where we are going to talk to patients about therapies," he said. "Certain therapies will be protective in terms of cardiovascular disease."
November 6, 2013