Photo Credit: Alena Butusava
In lieu of a universal consensus, researchers provided guidance on how often to screen for cardiovascular comorbidities in patients with psoriasis.
Authors of a review published in Vascular Health and Risk Management explored the association between psoriasis and cardiovascular diseases (CVD), updating clinicians on the latest data regarding patient risk profiles, screening, and preventive strategies.
“Despite the well-established association, the assessment of cardiovascular (CV) risk in patients with psoriasis frequently lacks comprehensiveness,” wrote Hitaishi Mehta, MD, DNB, MRCP, and colleagues. “Multiple questionnaire-based studies have revealed that surveyed physicians, including dermatologists, rheumatologists, cardiologists, and primary care physicians, often [do not] conduct comprehensive screenings for hypertension, dyslipidemia, smoking, and diabetes mellitus.”
To address the intricate relationship between psoriasis and CVD, the review authors shared guidance for screening mode and frequency and emphasized integrated clinical approaches that include dermatology, rheumatology, and cardiology.
CV Risk Profiles
Beyond traditional CVD risk factors like hypertension and hyperlipidemia, psoriasis contributes to an independent CV risk profile due to unique genetic links, immune pathways, and adipose tissue dysfunction.
According to the authors, conventional CV risk scores often underestimate the risk in patients with psoriasis. This has led to European and American guidelines recognizing psoriasis as a CV risk multiplier, especially in adults aged 40 to 75 who do not have diabetes but fall within an intermediate CV risk category.
“Furthermore, the collaborative guidelines from the Joint American Academy of Dermatology and National Psoriasis Foundation (NPF) underscore the importance of advising patients about their heightened CV risk. The guidelines recommend referral to primary care physicians or cardiologists for further management,” Dr. Mehta and coauthors wrote.
Psoriasis has been identified as an independent risk factor for myocardial infarction, with young patients with severe psoriasis having the highest risk. Studies have shown elevated risks for major cardiovascular events (MACE), including myocardial infarction and stroke, and CV mortality in patients with severe psoriasis. Moreover, longer disease duration correlates with higher MACE risk.
Patients with psoriasis also exhibit a higher prevalence of hypertension, diabetes, hyperlipidemia, obesity, and metabolic dysfunction-associated steatotic liver disease (MASLD). A meta-analysis of 24 studies revealed higher odds ratios for hypertension and metabolic syndrome in patients with psoriasis compared with controls, underscoring the need for regular monitoring. Additionally, patients with psoriasis who have MASLD appear to have a higher rate of subclinical atherosclerosis.
Screening and Preventive Strategies
“There is no universal consensus regarding the optimal frequency of monitoring CV risk factors in patients with psoriasis,” Dr. Mehta and colleagues wrote. “The NPF suggests adhering to regional guidelines for screening, emphasizing early and frequent monitoring for individuals with moderate to severe psoriasis.”
The review authors provided guidance on how often clinicians should assess patients for CV comorbidities and associated risk factors, including CVD, hypertension, heart rate, type 2 diabetes, dyslipidemia, and obesity (Table).
Studies have suggested that several biomarkers may be CV risk factors for patients with psoriasis. These include elevated neutrophil-to-lymphocyte ratio, triglyceride-to-glucose ratio, and monocyte-to-HDL ratio. However, there is still debate over the reliability and accuracy of these markers.
Lifestyle modifications, including a hypocaloric diet and smoking cessation, are fundamental strategies to reduce CVD risk. The authors also emphasized stress management through yoga, relaxation techniques, and exercise.
“Effectively managing stress is crucial in the intricate relationship between stress, psoriasis, and CVD. Stress exacerbates both conditions,” the authors wrote.
The researchers also advised that collaborative care models involving dermatologists, rheumatologists, and cardiologists are essential for comprehensive management. Without care coordination, dermatologists can still integrate CV risk screening during routine exams with patients with psoriasis.
“While advancements in therapeutic options… hold promise for managing both psoriasis and its CV comorbidities, ongoing research and collaboration between dermatologists, rheumatologists, and cardiologists is the need of the hour,” the researchers concluded.
