Psoriasis is an inflammatory autoimmune disease that affects the skin. Recently, psoriasis and its consequential lifestyle and dietary habits have been associated with increased risks for cardiovascular diseases. This article discusses the connection between cardiovascular disorders and psoriasis and the effects of available treatment options on cardiovascular risk. A PubMed search revealed 11 articles that were analyzed for information regarding this association, its effects, and potential courses of treatment. Both the presence and severity of psoriasis increases the risk for cardiovascular disorders and co-morbidities. Forty percent of psoriasis patients met metabolic syndrome criteria as compared with 23 % of non-psoriasis control subjects. Rate ratios for atrial fibrillation are correlated with the severity of psoriasis; patients with severe and mild psoriasis produced rate ratios of 1.63 and 1.31, respectively. Studies also show an increase in the risks for myocardial infarction, atherosclerosis, ischemic stroke, and other cardiovascular disorders. The exact mechanisms behind this affiliation are still uncertain; however, the psychological and physiological effects of psoriasis and the overlapping pathogenesis behind atherosclerosis and psoriasis may play a role. Since the risk for cardiovascular disorders increases with the presence and severity of psoriasis, psoriasis treatment should not only address the disease and its symptoms, but also its co-morbidities. Recent National Psoriasis Foundation (NPF) guidelines have provided recommendations for psoriasis patient care. Histories of co-morbidities, screenings for potential diseases, increased exercise, decreased alcohol consumption, and smoking cessation should be implemented. Unfortunately, while there are data for the increased risk for cardiovascular diseases within psoriasis patients, there are presently no data stating that increasing cardiovascular screening rates in patients produces a significant difference.
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Fernandez-Torres R, Pita-Fernandez S, Fonseca E. Psoriasis and cardiovascular risk: assessment by different cardiovascular risk scores. J Eur Acad Dermatol Venereol. 2012. [Epub ahead of print].
Mercuri SR, Naldi L. Potential role of ustekinumab in the treatment of chronic plaque psoriasis. Biologics. 2010;4:119–29.
Naldi L, Mercuri SR. Epidemiology of comorbidities in psoriasis. Dermatol Ther. 2010;23(2):114–8.
Horn EJ, Fox KM, Patel V, et al. Are patients with psoriasis undertreated? Results of National psoriasis foundation survey. J Am Acad Dermatol. 2007;57(6):957–62.
Love TJ, Qureshi AA, Karlson EW, et al. Prevalence of the metabolic syndrome in psoriasis: results from the National health and nutrition examination survey, 2003–2006. Arch Dermatol. 2011;147(4):419–24.
Prodanovich S, Kirsner RS, Kravetz JD, et al. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009;145(6):700–3.
Gisondi P, Farina S, Giordano MV, et al. Usefulness of the Framingham risk score in patients with chronic psoriasis. Am J Cardiol. 2010;106(12):1754–7.
Jensen P, Thyssen JP, Zachariae C, et al. Cardiovascular risk factors in subjects with psoriasis: a cross-sectional general population study. Int J Dermatol. 2012. [Epub ahead of print].
Ahlehoff O, Gislason GH, Jorgensen CH, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish nationwide cohort study. Eur Heart J. 2012;33(16):2054–64.
Kremers HM, McEvoy MT, Dann FJ, et al. Heart disease in psoriasis. J Am Acad Dermatol. 2007;57(2):347–54.
Zhang K, Li X, Yin G, et al. Functional characterization of T cells differentiated in vitro from bone marrow-derived CD34 cells of psoriatic patients with family history. Exp Dermatol. 2010;19(8):e128–35.
Libby P. The molecular mechanisms of the thrombotic complications of atherosclerosis. J Intern Med. 2008;263(5):517–27.
Miossec P. IL-17 and Th17 cells in human inflammatory diseases. Microbes Infect. 2009;11(5):625–30.
Eid RE, Rao DA, Zhou J, et al. Interleukin-17 and interferon-gamma are produced concomitantly by human coronary artery-infiltrating T cells and act synergistically on vascular smooth muscle cells. Circulation. 2009;119(10):1424–32.
Cheng X, Yu X, Ding YJ, et al. The Th17/Treg imbalance in patients with acute coronary syndrome. Clin Immunol. 2008;127(1):89–97.
Kagen MH, McCormick TS, Cooper KD. Regulatory T cells in psoriasis. Ernst Schering Res Found Workshop. 2006;56:193–209.
Mor A, Luboshits G, Planer D, et al. Altered status of CD4(+)CD25(+) regulatory T cells in patients with acute coronary syndromes. Eur Heart J. 2006;27(21):2530–7.
Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361(5):496–509.
Tonel G, Conrad C. Interplay between keratinocytes and immune cells: recent insights into psoriasis pathogenesis. Int J Biochem Cell Biol. 2009;41(5):963–8.
Pietrzak AT, Zalewska A, Chodorowska G, et al. Cytokines and anticytokines in psoriasis. Clin Chim Acta. 2008;394(1–2):7–21.
Csiszar A, Ungvari Z. Synergistic effects of vascular IL-17 and TNFalpha may promote coronary artery disease. Med Hypotheses. 2004;63(4):696–8.
Armstrong AW, Voyles SV, Armstrong EJ, et al. A tale of two plaques: convergent mechanisms of T-cell-mediated inflammation in psoriasis and atherosclerosis. Exp Dermatol. 2011;20(7):544–9.
Engelmann MD, Svendsen JH. Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J. 2005;26(20):2083–92.
McDonald I, Connolly M, Tobin AM. A review of psoriasis, a known risk factor for cardiovascular disease and its impact on folate and homocysteine metabolism. J Nutr Metab. 2012. [Epub ahead of print].
Graham IM, Daly LE, Refsum HM, et al. Plasma homocysteine as a risk factor for vascular disease: the European concerted action project. JAMA. 1997;277(22):1775–81.
Ahdout J, Kotlerman J, Elashoff D, et al. Modifiable lifestyle factors associated with metabolic syndrome in patients with psoriasis. Clin Exp Dermatol. 2012;37(5):477–83.
Gans KM, Risica PM, Wylie-Rosett J, et al. Development and evaluation of the nutrition component of the rapid eating and activity assessment for patients (REAP): a new tool for primary care providers. J Nutr Educ Behav. 2006;38(5):286–92.
Fortune DG, Richards HL, Griffiths CE. Psychologic factors in psoriasis: consequences, mechanisms, and interventions. Dermatol Clin. 2005;23(4):681–94.
Kimball AB, Gladman D, Gelfand JM, et al. National psoriasis foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58(6):1031–42.
Gelfand JM, Mehta NN, Langan SM. Psoriasis and cardiovascular risk: strength in numbers, part II. J Invest Dermatol. 2011;131(5):1007–10.
Prodanovich S, Ma F, Taylor JR, et al. Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis. J Am Acad Dermatol. 2005;52(2):262–7.
Abuabara K, Lee H, Kimball AB. The effect of systemic psoriasis therapies on the incidence of myocardial infarction: a cohort study. Br J Dermatol. 2011;165(5):1066–73.
Boehncke WH, Boehncke S, Schon MP. Managing comorbid disease in patients with psoriasis. BMJ. 2010;340:b5666. doi:10.1136/bmj.b5666.:b5666.
Waisman A. To be 17 again: anti-interleukin-17 treatment for psoriasis. N Engl J Med. 2012;366(13):1251–2.
Cingoz O. Ustekinumab. MAbs. 2009;1(3):216–21.
Nair RP, Ruether A, Stuart PE, et al. Polymorphisms of the IL12B and IL23R genes are associated with psoriasis. J Invest Dermatol. 2008;128(7):1653–61.
Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet. 2008;371(9625):1665–74.
Ionescu MA, Lipozencic J. Could anti IL12/23 therapy replace anti-TNF biologics? Acta Dermatovenerol Croat. 2009;17(3):166–9.
Shaker OG, Moustafa W, Essmat S, et al. The role of interleukin-12 in the pathogenesis of psoriasis. Clin Biochem. 2006;39(2):119–25.
Gudjonsson JE, Elder JT. Psoriasis. In: Goldsmith LA, Katz SI, Wolff K, et al., editors. Fitzpatrick’s dermatology in general medicine. New York: McGraw Hill; 2008. p. 169–74.
Reddy M, Davis C, Wong J, et al. Modulation of CLA, IL-12R, CD40L, and IL-2Ralpha expression and inhibition of IL-12- and IL-23-induced cytokine secretion by CNTO 1275. Cell Immunol. 2007;247(1):1–11.
Krueger GG, Langley RG, Leonardi C, et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. N Engl J Med. 2007;356(6):580–92.
Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet. 2008;371(9625):1675–84.
Kimball AB, Gordon KB, Langley RG, et al. Safety and efficacy of ABT-874, a fully human interleukin 12/23 monoclonal antibody, in the treatment of moderate to severe chronic plaque psoriasis: results of a randomized, placebo-controlled, phase 2 trial. Arch Dermatol. 2008;144(2):200–7.
Reich K, Langley RG, Lebwohl M, et al. Cardiovascular safety of ustekinumab in patients with moderate to severe psoriasis: results of integrated analyses of data from phase II and III clinical studies. Br J Dermatol. 2011;164(4):862–72.
Ryan C, Leonardi CL, Krueger JG, et al. Association between biologic therapies for chronic plaque psoriasis and cardiovascular events: a meta-analysis of randomized controlled trials. JAMA. 2011;306(8):864–71.
Tsai TF, Ho JC, Song M, et al. Efficacy and safety of ustekinumab for the treatment of moderate-to-severe psoriasis: a phase III, randomized, placebo-controlled trial in Taiwanese and Korean patients (PEARL). J Dermatol Sci. 2011;63(3):154–63.
Reich K, Papp KA, Griffiths CE, et al. An update on the long-term safety experience of ustekinumab: results from the psoriasis clinical development program with up to four years of follow-up. J Drugs Dermatol. 2012;11(3):300–12.
Tzellos T, Kyrgidis A, Zouboulis CC. Re-evaluation of the risk for major adverse cardiovascular events in patients treated with anti-IL-12/23 biological agents for chronic plaque psoriasis: a meta-analysis of randomized controlled trials. J Eur Acad Dermatol Venereol. 2012. [Epub ahead of print].
Roark CL, Simonian PL, Fontenot AP, et al. Gammadelta T cells: an important source of IL-17. Curr Opin Immunol. 2008;20(3):353–7.
Reich K. Anti-interleukin-17 monoclonal antibody ixekizumab in psoriasis (letter). N Engl J Med. 2012;367(3):274.
Papp KA, Leonardi C, Menter A, et al. Brodalumab, an anti-interleukin-17-receptor antibody for psoriasis. N Engl J Med. 2012;366(13):1181–9.
Leonardi C, Matheson R, Zachariae C, et al. Anti-interleukin-17 monoclonal antibody ixekizumab in chronic plaque psoriasis. N Engl J Med. 2012;366(13):1190–9.
Feldman SR, Ravis S, Moran WP, et al. Patients seen in a dermatology clinic have unmet preventive health care needs. J Am Acad Dermatol. 2001;44(4):706–9.
Fenerty SD, West C, Davis SA, et al. The effect of reminder systems on patients’ adherence to treatment. Patient Prefer Adherence. 2012;6:127–35.
Feldman SR, Horn EJ, Balkrishnan R, et al. Psoriasis: improving adherence to topical therapy. J Am Acad Dermatol. 2008;59(6):1009–16.
Martin SL, McGoey ST, Bebo Jr BF, et al. Patients’ educational needs about topical treatments for psoriasis. J Am Acad Dermatol. 2012. [Epub ahead of print].
The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. Ms. Tablazon, Mr. Al-Dabagh, and Mr. Davis have no conflicts of interest to disclose.
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Tablazon, I.L.D., Al-Dabagh, A., Davis, S.A. et al. Risk of Cardiovascular Disorders in Psoriasis Patients. Am J Clin Dermatol 14, 1–7 (2013). https://doi.org/10.1007/s40257-012-0005-5