Suffering from severe psoriasis? You are at higher risk of heart disease

Psoriasis, an autoimmune disease that causes a rash with itchy, scaly patches – most commonly on the knees, elbows, trunk, and scalp – is suffered by some 125 million people worldwide (two or three percent) of the global population). In severe cases, the skin around the joints may crack and bleed.

The patient’s body thinks its own tissues are foreign invaders that must be attacked. Unlike a simple rash, sufferers can’t get rid of it with an over-the-counter skin treatment, and it is usually an incurable, lifelong illness that often runs in families, but it doesn’t spread to other people. 

Attacks can be triggered by stress, tobacco, heavy drinking of alcohol, infections like strep throat, cold and dry weather, bad sunburn, and some medications including lithium, prednisone, and hydroxychloroquine.

As if this were not enough with which to cope, research at Italy’s University of Padova just published in the Journal of Investigative Dermatology has found that patients with severe psoriasis are at a higher risk for a decreased coronary flow and heart disease. The study was entitled “Coronary microvascular dysfunction in asymptomatic patients with severe psoriasis.”

The condition can be eased by applying a special cream or moisturizer or taking certain medications, and maintaining one’s overall health will also help improve symptoms. 

Why is the heart affected?

Lead investigator and dermatologist Dr. Stefano Piaserico explained: “Previous studies have shown that patients with severe psoriasis have an increased cardiovascular morbidity and mortality. However, there has been limited research on the specific mechanisms underlying this increased risk, particularly regarding coronary microvascular dysfunction.”

In the new study, 503 patients with psoriasis and without clinical cardiovascular disease underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation. Investigators uncovered a high prevalence of coronary microvascular dysfunction in 31.5% of asymptomatic patients within the study population.

“We wanted to further investigate the prevalence of coronary microvascular dysfunction, as assessed by coronary flow reserve (CFR), in a large cohort of patients with severe psoriasis and its association with psoriasis severity and duration, as well as other patient characteristics. Patients with a reduced CFR underwent angio-CT to exclude a stenosis of the coronary arteries, and no patients showed coronary artery disease.

Therefore, all patients with an impaired CFR in our cohort were affected by coronary microvascular dysfunction.”

Results from the study showed that conventional cardiovascular risk factors – such as tobacco use, hyperlipidemia, and Type-2 diabetes were not independently associated with reduced CFR in patients with severe psoriasis. These findings emphasize the importance of considering inflammation and psoriasis-related factors in assessing cardiovascular risk in patients with severe psoriasis.

Piaserico commented that “we should diagnose and actively search for microvascular dysfunction in patients with psoriasis, as this population is at particularly high risk. We might hypothesize that an early and effective treatment of psoriasis would restore the dysfunction and eventually prevent the future risk of myocardial infarction and heart failure associated with it. In keeping with this, some preliminary studies showed that coronary microvascular dysfunction is restored after a treatment with biologics. Nevertheless, prospective studies are needed to confirm whether these findings translate into reductions in cardiovascular events.”