Management of cardiovascular disease in patients with psoriasis

ABSTRACT

Introduction: Patients with psoriasis have an increased incidence and prevalence of cardiovascular (CV) risk factors, and CV undertreatment in these patients is a well-established problem. The link between psoriasis and CV disease is present on a pathogenic level, as well as due to modifiable lifestyle factors such as smoking and alcohol abuse.

Areas covered: In this manuscript we describe the evidence associating psoriasis with CV disease, as well as the pharmacological and non-pharmacological treatment of CV risk factors including the CV effects of anti-psoriatic therapy and vice versa.

Expert opinion: Current guidelines recommend that patients with psoriasis are screened for CV risk factors, and recommend smoking cessation, reduced alcohol consumption, altering of lifestyle to move to a normal-weight body-mass index, exercising 3 times a week for 30 minutes, and monitoring and modifying cholesterol levels, respectively. While the current sum of evidence is not sufficient to recommend specific therapies for psoriasis solely based on their potential CV impact, some guidelines have suggested a 1.5 multiplication factor, in patients with severe psoriasis, to the Framingham risk score. Indeed, the importance of screening for CV risk factors and strict adherence to established primary and secondary preventive measures in these patients should be emphasized.

KEYWORDS:

• Cardiovascular disease
• inflammation
• psoriasis
• therapy

Article highlights

• Psoriasis is a systemic inflammatory skin disorder associated with a significantly increased incidence and prevalence of cardiovascular risk factors

• Traditional cardiovascular risk scores, e.g. the Framingham risk score, underestimates the cardiovascular risk in patients with psoriasis

• Pharmacological undertreatment of cardiovascular risk factors is an issue in patients with psoriasis compared with the general population

• Anti-psoriatic treatment may modify cardiovascular risk, however, results from randomized clinical trials are awaited

• The importance of screening for cardiovascular risk factors, and strict adherence to established primary and secondary preventive measures should be emphasized for physicians and patients with psoriasis

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Declaration of interest

A Egeberg has received research funding and/or salary/consultancy honoraria from Pfizer and Eli Lilly. L Skov has received consultancy and/or speaker honoraria from AbbVie, Pfizer, Janssen-Cilag, Merck Sharp & Dohme, and Leo Pharma and is a member of the advisory boards of Abbvie, Pfizer, Janssen-Cilag, Merck Sharp & Dohme, Eli Lilly, Celgene, Leo Pharma and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.