Patients with Severe Psoriasis Need Evaluation of Heart Disease Risk

Psoriasis is a common skin disease affecting two to three percent of the world population, including 7.5 million Americans. The most common type of psoriasis causes a scaly rash that can cover large areas of the skin; some patients develop arthritis as well. In addition, there is now strong evidence that people with psoriasis are at increased risk of CAD—narrowing of the arteries supplying the heart, which can lead to heart attack (myocardial infarction) and other complications.

A special “Editor's Consensus” article provides an update on the little-recognized link between psoriasis and heart disease. “This AJC Editor’s Consensus focuses on a large new area of evidence strengthening the connection between inflammatory processes and coronary artery disease,” comments cardiologist and lead author of the article, Vincent E. Friedewald, M.D., of the University of Notre Dame. Dr. Friedewald is also an Assistant Editor of AJC. “It is a particularly interesting and unique document in that it bridges current knowledge from two medical disciplines—dermatology and cardiology—that rarely interrelate.”

“This consensus statement, issued by an expert panel of cardiologists, dermatologists, and scientists, calls for a new standard of care for patients with moderate to severe psoriasis,” comments University of Pennsylvania dermatologist Joel M. Gelfand, M.D. “Based on the evolving science, we recommend that patients with moderate to severe psoriasis be educated about the association of psoriasis and cardiovascular disease and that these patients receive appropriate screening and treatment of modifiable cardiovascular risk factors.”

The explanation for the link between psoriasis and CAD risk is not yet clear, but a leading candidate is inflammation. Regardless of the cause, the expert panel believes that the current evidence is strong enough to recommend that doctors assess CAD risk in their patients with psoriasis. Key recommendations in the consensus statement include:

• Informing patients with moderate to severe psoriasis that they are at increased risk of CAD and performing a medical evaluation to assess cardiovascular risk. For patients with milder psoriasis, evaluation is recommended if other CAD risk factors are present, such as obesity or high blood pressure.

• Prescribing treatment to reduce high cholesterol levels and other risk factors, if present.

• Paying close attention to possible interactions or adverse effects of the medications used to treat psoriasis.