Patient education on heart failure risk is crucial in psoriasis
EXPERT ANALYSIS FROM SDEF LAS VEGAS DERMATOLOGY SEMINAR
As evidence supporting an association between psoriasis and cardiovascular disease continues to mount, dermatologists may be the first line of defense in lowering heart failure risk.
"The increased risk of cardiovascular disease for patients with psoriasis may be of a similar magnitude as other well-described CV risk factors, such as uncontrolled hypertension," said Dr. Bruce E. Strober of the University of Connecticut, Farmington. "Further, epidemiological studies show that psoriasis patients have a shortened life expectancy, likely as a result of their experience with CV comorbitidies."
Patient education is essential, he noted at the Skin Disease Education Foundation’s annual Las Vegas dermatology seminar. "At the very least, dermatologists should alert patients of the link between psoriasis and CV disease, and remind these patients of the necessity of having a primary care physician who monitors conventional risk factors of CV disease. Patients should be reminded that psoriasis is ‘systemic disease of inflammation’ that creates risks beyond the skin and may shorten life expectancy."
"Dermatologists who care for moderate to severe psoriasis patients should measure blood pressure and draw baseline blood tests assessing for abnormalities of cholesterol, triglycerides, kidney function, liver function, and blood glucose. Abnormalities should prompt an appropriate referral to a primary care physician," he noted.
In a population-based Dutch study presented at the annual congress of the European Society of Cardiology in September, adults with mild psoriasis developed 4.02 cases of new-onset heart failure per 1,000 person-years of follow-up, compared with 4.50/1,000 person-years in patients with severe psoriasis; both of which were significantly higher than the rate of 2.27/1,000 person-years in the general population.
Data from a 2006 study found that diabetes, hypertension, hyperlipidemia, and obesity were more prevalent in psoriasis patients, when compared with controls (J. Am. Acad. Dermatol. 2006;55:829-35). Diabetes and obesity were significantly more prevalent in patients with severe psoriasis, compared with patients with mild psoriasis.
Although the reasons for the increased cardiovascular risk in psoriasis patients remain unknown, possible causes include the use of dyslipidemic therapies, including corticosteroids, acitretin, and cyclosporine, as well as uncontrolled inflammation that could lead to endothelial dysfunction and dyslipidemia, said Dr. Strober. The prevalence of other associated and/or independent risk factors including obesity, hypertension, smoking, and alcohol misuse in psoriasis patients, also could play a role.