Abstract
Psoriasis, a widely prevalent chronic disease of the skin and joints, has long been associated with far-reaching systemic ramifications and decreased quality of life. However, psoriasis is largely underdiagnosed and insufficiently treated. Classical risk factors predisposing to cardiovascular diseases, such as hypertension, diabetes, metabolic syndrome, and dyslipidemia, have been noted in patients with mild and severe psoriasis. Furthermore, the magnitude of the cardiovascular comorbidity and the need to screen for risk factors has often been ignored while considering the management options for psoriasis. This article has reviewed the cardiovascular implications of psoriasis from the shared pathogenesis behind these two diseases to the increased incidence of cardiovascular events, such as myocardial infarction, stroke, and other causes of vascular mortality. Additionally, the therapeutic targets of common inflammatory pathways, such as those involving tumor necrosis factor α (TNF-α), interleukin-12/interleukin-23 (IL-12/IL-23), and helper T cells 17 (Th17), have been discussed with an emphasis on their efficacy in controlling psoriasis and its cardiovascular consequences.
Highlights
BackgroundAmong the most prevalent immune-mediated disorders chronically involving the skin and joints, psoriasis manifests as symmetrical erythematous plaques with scaling [1]
Classical risk factors predisposing to cardiovascular diseases, such as hypertension, diabetes, metabolic syndrome, and dyslipidemia, have been noted in patients with mild and severe psoriasis
This study showed incidences of 3.58, 4.04, and 5.13 per 1000 person-years for controls and patients with mild and severe psoriasis, respectively [60]
Summary
Among the most prevalent immune-mediated disorders chronically involving the skin and joints, psoriasis manifests as symmetrical erythematous plaques with scaling [1]. More recent studies have shown increased prevalence rates of typical cardiovascular risk factors in patients with psoriasis, such as hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome [36]. Smoking was found to impact the clinical severity and response to treatment in many patients [52] Risk factors such as central obesity, glucose intolerance and insulin resistance, hypertension, low levels of high-density lipoprotein (HDL), and hypertriglyceridemia can be grouped into an entity called metabolic syndrome [41]. The same study showed significantly higher carotid intima-media thickness in patients with psoriasis (0.61 mm ± 0.01 mm) as compared to controls (0.37 mm ± 0.01 mm), suggesting a higher prevalence of subclinical atherosclerosis in psoriasis patients [54]
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