Recent studies have shown that psoriasis is associated with atherosclerosis. 27 30 In addition, one study reviews all the recent studies regarding epidemiology and pathophysiology connecting psoriasis and metabolic syndrome. The relationship between psoriasis and other diseases has drawn increasing interest in recent years. It has been reported as an independent risk factor for coronary heart disease (CHD) in the United States and Europe. Many studies in the United States and Europe have shown that psoriasis is an independent risk factor for CHD and cardiovascular events 16 24 or cardiovascular mortality 25; however, in contrast, other studies concluded that that psoriasis is not an independent risk factor for coronary atherosclerosis and acute cardiovascular events 26 30. In Japan, the relationship between psoriasis vulgaris and CHD has almost never been studied.
Risk factors: Severe psoriasis linked with increased cardiovascular mortality. Bryony M. Mearns. A number of studies assessed MI or stroke prevalence but not incidence. All others assessed MI, stroke, or cardiovascular death independently. The baseline characteristics of each study, stratified by mild versus severe psoriasis, are shown in Tables 1 and 2. The association between psoriasis and cardiovascular disease has gained increased attention in the past 5 years. Psoriasis has been suggested to be an independent risk factor for cardiovascular disease (CVD); however, available studies have shown inconsistent results. The results were similar when coronary heart disease, stroke, and heart failure were analyzed separately.
Cardiovascular disease (CVD) remains the leading cause of death in the United States thus far. 2,3,9,18-22 It is important to note that in addition to the inflammatory dysregulation driving psoriasis and CVD, there may be shared genetic risk which contributes as well; certain heritable gene locuses have been shown to play a key role in susceptibility to psoriasis as well as diabetes and CAD. Psoriasis and psoriatic arthritis diseases illustrate that immune-mediated activated crossroads of inflammation beyond enhanced cardiovascular risk factors are the result of an interplay between different proatherogenic mediators derived from metabolic, vascular and autoimmune joint and skin inflamed target tissue. In 1995, Hansson and others established that atherosclerosis has many features of a chronic inflammatory process, giving rise to the immune-mediated hypothesis behind atherogenesis 2. Epidemiological studies show a peak in incidence between the second and third decades in life 5. Chronic inflammation has also been associated with atherosclerosis and thrombosis. (1.43, 95 CI 1.1, 1.9) psoriasis were independent risk factors for stroke.
Is psoriasis an independent risk factor for coronary artery disease? 3Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 4Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia 5Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia. One of the most clinically important aspects of recent advances in our understanding of psoriasis has been the detection of an association between this disease and an increased prevalence of cardiovascular risk factors. The introduction of biologic therapies has greatly improved the expectations of treatment as well as the long-term control of psoriasis, and there is epidemiological evidence that these therapies may lower cardiovascular risk in psoriasis as they do in rheumatoid arthritis. Other studies report ultrasound evidence of subclinical atherosclerosis24 and endothelial dysfunction in the brachial artery. Recent studies have examined the risk of cardiovascular events in patients with psoriasis according to the Framingham cardiovascular risk prediction score and documented that a high proportion of patients with psoriasis were at substantially increased risk and making them potential candidates for pharmacological cardiovascular primary prophylaxis 8. However, the explanation of the association between psoriasis and cardiovascular disease is likely to be more complex and multifactorial 10. 8 The rise in these acute phase reactants due to a high cytokine state observed in the setting of obesity, insulin resistance and other features of metabolic syndrome, has been shown in large prospective studies to correlate with increased cardiovascular risk in these patients. 31 Chronic Inflammation – The Bridge between Psoriasis, Metabolic Syndrome and Atherosclerosis? Chronic inflammation is thought to be the etiopathogenetic mechanism underlying metabolic syndrome, atherosclerosis, and psoriasis, the last being an independent risk factor for subclinical atherosclerosis and subsequent adverse cardiovascular events. Overall epidemiological data unanimously support the link between psoriasis and cardiovascular risk. 141 Psoriasis and the Risk of Cardiovascular Disease. A Prospective Study. Epidemiological studies have shown an independent association between psoriasis and atherosclerosis, stroke and coronary artery disease.