Do Patients with Psoriasis Have Greater Asymptomatic Coronary Atherosclerosis Markers?
Psoriasis is linked with cardiovascular disease and appears to be an independent risk factor for coronary artery disease (CAD), myocardial infarction, cerebrovascular disease, stroke, peripheral vascular disease, and cardiovascular mortality. Despite substantial data for this correlation, patients with psoriasis are not actively educated, counseled, or screened for cardiovascular disease because data has been limited by the retrospective nature of population-based studies and the limited power of prospective studies using novel imaging methods. Therefore, surrogate markers, specifically coronary artery calcium (CAC) assessment, are widely accepted as a true measure of the total burden of atherosclerosis and for screening the risk of a future cardiac event.
While three studies found an association between moderate to severe psoriasis and increased CAC, cardiovascular risk stratification for patients with psoriasis remains the same as the general population despite the evidence to support the fact that this would increase cardiovascular risk. On the other hand, type 2 diabetes mellitus is an example of an established, high-risk disease associated with increased cardiovascular risk. As a result, the American College of Cardiology/ American Heart Association guidelines recommend computed tomography for CAC assessment to improve cardiovascular risk stratification in asymptomatic patients 40 years or older with type 2 diabetes.
In a recent study, researchers sought to determine how the burden of asymptomatic coronary atherosclerosis, as measured by CAC score, compared between patients with moderate to severe psoriasis, patients with type 2 diabetes and healthy controls. Patients with psoriasis have atherogenic lipoprotein and adipokine profiles similar to those in patients with type 2 diabetes. The authors report four salient findings: (1) cardiovascular risk factor profiles were similar in patients with psoriasis and type 2 diabetes when compared with age- and sex-matched controls; (2) the prevalence of moderate to severe coronary calcification was similar between patients with psoriasis and type 2 diabetes and approximately 5 times greater than controls; (3) coronary calcium in patients with moderate to severe psoriasis demonstrated a similar association with known cardiovascular and cardiometabolic risk factors when compared with type 2 diabetes; and (4) the presence of CAC in patients with psoriasis persisted independent of BMI, which was not observed in patients with type 2 diabetes.
The authors conclude that psoriasis and type 2 diabetes share similar cardiovascular risk profiles. They note that their findings warrant early cardiovascular risk assessment and aggressive risk factor modification in those with moderate to severe psoriasis. CAC assessment may be considered in patients with psoriasis who have 2 or more traditional cardiovascular risk factors.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: January 30, 2017
Source: JAMA Dermatology
Adapted from the original article.