PSORIASIS AND THE HEART:
CURRENT CONCEPTS AND
CONTROVERSIES
• Psoriasis is multigenic inflammatory disease,
affecting 2–3% of the population worldwide
• More than 20 predisposition genes
have been identified
• The role of environmental factors are
important
• National Psoriasis Foundation. About Psoriasis: statistics. Available at:
http://www.psoriasis.org/about/stats. (last accessed: September 2008).
• Prey et al. Cardiovascular risk factors in patients with plaque psoriasis: a systematic review of
• The association of psoriasis with cardiovascular
disease dates back from 1961
• Recent epidemiological studies have confirmed an
association between psoriasis and an increased risk
of coronary heart disease
• Reed WB, Becker SW, Rohde R, Heiskell CL. Psoriasis and arthritis. Clinicopathologic study. Arch
Dermatol 1961; 83: 541–548.
• Gelfand JM, Neimann AL, Shin DB et al. Risk of myocardial infarction in patients with psoriasis. JAMA
• CV risk factors
(obesity, diabetes, hypertension,
hyperlipidemia, smoking)
are associated with mild /
severe psoriasis
• CV risk factors may contribute to atherogenesis
• Menter A, Griffiths CEM, Tebbey PW et al. Exploring the association between cardiovascular and other disease-related risk factors in the psoriasis population: the need for increased understanding across the medical
community. JEADV 2010, 24, 1371–1377
• Sterry W, Strober BE, Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary con- ference and review. Br J Dermatol 2007; 157: 649–655.
• Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006; 55: 829–835.
• High incidence of metabolic syndrome in psoriasis
may be explained by the chronic systemic
inflammation
• Davidovici BB, Sattar N, Prinz JC et al. Psoriasis and systemic inflam- matory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol 2010; 130: 1785–1796.
• Reich K. The concept of psoriasis as a systemic inflammation: implications for disease management. JEADV 2012, 26 (Suppl. 2), 3–11
• The relative risks of myocardial infarction (MI) and
stroke are increased in patients with psoriasis
compared with the general population
• Abuabara K, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Cause-specific mortality in patients with severe psoriasis: a population- based cohort study in the U.K. Br J Dermatol 2010; 163: 586–592.
• 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 2011; Aug 25. [Epub ahead of print].
• Mehta NN, Yu Y, Pinnelas R et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med 2011; 124: 775, e771–e776.
• This is especially the case in younger patients with
more severe disease
• Risk of CV disease and stroke may contribute to a
decrease in life expectancy in patients with severe
psoriasis
• Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735–1741.
• Kaye JA, Li L, Jick SS. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis. Br J Dermatol 2008; 159: 895–902.
• Brauchli YB, Jick SS, Miret M, Meier CR. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case–control analysis. Br J Dermatol 2009; 160: 1048– 1056.
• Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol 2009; 145: 700–703.
