Addressing Cardiovascular Risks in Psoriasis: Guidance for Clinical Practice

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Addressing Cardiovascular Risks in Psoriasis: Guidance for Clinical Practice

Psoriasis can be associated with cardiovascular disorders.

Mounting evidence shows that psoriasis is frequently comorbid with cardiovascular (CV) disorders, and some studies have shown a dose-response effect between the 2 diseases.1The more severe the psoriasis, the likelier a patient is to have CV concerns. Now, recent evidence from a population cohort study has shown a dose-response effect for psoriasis severity and mortality risk.2

Using the United Kingdom’s Health Improvement Network database of 8760 men and women with psoriasis and 87,600 adults without psoriasis, Noe and colleagues found that patients with psoriasis covering >10% of their body surface area were 1.79 times more likely to die compared with their healthy counterparts, even after adjusting for body mass index and alcohol and tobacco use.2 People with psoriasis tended to have higher incidence of chronic kidney disease, chronic obstructive pulmonary disease, diabetes, and myocardial infarction.2

“Physicians should be aware that patients with psoriasis have an increased risk of major CV events and mortality independent of traditional risk factors,” noted Joel M. Gelfand, MD, MSCE, professor of dermatology and epidemiology and director of the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania Perelman School of Medicine in Philadelphia. “This risk is most clinically important in psoriasis patients who require treatment with systemic or phototherapy or who have more than 10% of the body surface area affected by psoriasis.”

Do Biologics Protect Psoriasis Patients From CV Risk?

A recent study suggests that treating patients for psoriasis with biologics may reduce their risk for CV events. Wu and colleagues found that patients with psoriasis who were treated with tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors; n=11,410) had fewer CV events compared with those who received phototherapy (n=12,433).3 At 4 months after treatment initiation, patients who received TNF inhibitors had a statistically significant difference in CV events vs those who received phototherapy (adjusted hazard ratio 0.77; 95% CI, 0.60-0.99; =.046).3 For each 6-month exposure to TNF inhibitors, patients had an 11% risk reduction of CV events vs those treated with phototherapy (<.05).3

In early biologics trials, preliminary evidence suggested that biologics could be harmful to patients with psoriasis at high risk for CV events.4 Yet 1 early meta-analysis of 22 randomized control trials with 10,183 patients did not demonstrate that biologics prevented major adverse CV events (MACEs), defined as a myocardial infarction, cerebrovascular incident, or CV death. There was no significant difference in MACE rates for patients who received therapy with anti-interleukin (IL)-12/IL-23 antibodies or anti-TNF-alpha agents.4

Read on: Addressing Cardiovascular Risks in Psoriasis: Guidance for Clinical Practice

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