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Heart Health Special Report

The Research on Psoriasis and Cardiovascular Disease

Many doctors are starting to think of psoriasis -- an uncomfortable condition that can cause a buildup of dead skin cells and dry, itchy red patches -- as more than simply a skin disease. In fact, psoriasis, which affects about 7.5 million Americans, is now being described as an autoimmune disorder that can have a negative impact on the entire body. A new wave of research has linked it to a host of chronic medical problems, including cardiovascular disease.

Psoriasis is caused by overactivity in the immune system. This not only inflames the skin but also is associated with increased blood levels of C-reactive protein -- a marker of system-wide inflammation. Systemic inflammation has been connected to a variety of medical problems, including insulin resistance and atherosclerosis -- hardening of the arteries, which increases the risk of heart attack and stroke.

The link between psoriasis and major cardiovascular problems has been suspected for years. But researchers were unsure whether the psoriasis itself accounted for the connection or whether to pin the blame on obesity and high cholesterol levels -- since these risk factors are more prevalent among people with psoriasis.

Then in 2006, a study published in the Journal of the American Medical Association shed some light on the issue. Researchers from the University of Pennsylvania looked at medical records collected between 1987 and 2002 from approximately 127,000 people with mild psoriasis, 4,000 people with severe psoriasis, and 560,000 people without psoriasis.

After taking cardiovascular risk factors such as high blood pressure and high cholesterol into account, they found that a 60-year-old with severe psoriasis had a 36 percent higher chance of a heart attack than a 60-year-old without psoriasis. In other words, psoriasis sufferers with no other risk factors for heart disease were still more likely to experience a heart attack.

More evidence has since confirmed this link. In a 2009 study in the Archives of Dermatology, researchers compared 3,236 people (mostly men) with psoriasis with 2,500 people without the condition. They found that people with psoriasis were almost twice as likely to be diagnosed with at least one atherosclerotic disease -- including coronary heart disease (CHD) and heart attack, cerebrovascular disease (which can lead to stroke), and peripheral artery disease (narrowed arteries supplying blood to the extremities). People with psoriasis were also more likely to die of any cause.

It is not yet clear whether treating your psoriasis will protect your heart. But some research has shown that people taking the drug methotrexate -- sometimes used to treat psoriasis -- are less likely to develop CHD. Currently, some cardiologists are recommending that psoriasis patients, especially those with moderate or severe forms of the disease, be evaluated for their risk of CHD. They also recommend that these patients reduce their risk with appropriate medication and lifestyle measures.

If you have psoriasis, talk to your primary care doctor about assessing your risk of CHD. Your doctor should communicate these findings and any treatment strategies to your dermatologist (or other healthcare professional managing your psoriasis) and determine whether you need to see a cardiologist.

Posted in Heart Health on October 1, 2010


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