Cardiovascular Considerations and Implications for Treatment in Psoriasis: An Updated Review

Figures & data

Video Abstract

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Figure 1 Pathophysiological pathways leading on to adverse cardiac effects in psoriasis.

Abbreviations: ET, endothelin; TNFa, tumor necrosis factor alpha; NO, nitric oxide; ROS, reactive oxygen species; ANS, autonomic nervous system; IL, interleukin; GLUT, insulin related glucose transfer; LDL, low density lipoprotein; HDL, high density lipoprotein; NAFLD, non-alcoholic fatty liver disease.

Figure 2 Flowchart illustrating the management approach for patients with psoriasis and psoriatic arthritis concerning their association with cardiovascular risk.

Abbreviations: CVD, cardiovascular disease; TBSA, total body surface area.

Table 1 Screening for Cardiovascular Comorbidities and Risk Factors in Psoriasis Patients. Moderate to Severe Psoriasis is Defined as Total Body Surface Area Exceeding 10%, and/or Requiring Systemic Treatment or Phototherapy

Comorbidities	Frequency of Screening	Mode of Screening
Cardiovascular disease	Risk assessment as per national guidelines using validated tools Early and frequent monitoring for patients with moderate to severe psoriasis Risk score models should be adapted by introducing a 1.5 multiplication factor in patients with moderate to severe psoriasis	Blood pressure Fasting blood glucose or HBA1c Fasting lipid profile Body mass index 10-year cardiovascular disease risk score
Hypertension	Annual screening in patients >18 years of age At every visit in patients receiving cyclosporine A	Office blood pressure monitoring Consider ambulatory blood pressure monitoring if indicated
Heart rate	At least every two years (in view of increased risk of atrial fibrillation)	Heart rate Cardiology consult and Holter monitoring for patients with tachycardia or symptomatic palpitations
Type 2 diabetes mellitus	Periodic screening as per the national guidelines, consider higher frequency of monitoring in patients with moderate to severe psoriasis	Fasting blood glucose, or HBA1c
Dyslipidemia	Periodic screening as per the national guidelines, consider higher frequency of monitoring in patients with moderate to severe psoriasis Regular monitoring if the patient is on acitretin or cyclosporine (every 3 to 6 months)	Fasting total cholesterol Low-density lipoprotein cholesterol High-density lipoprotein cholesterol Triglycerides
Obesity	Every two years for patients with normal initial body mass index Annual monitoring in patients with moderate to severe psoriasis	Height Weight Waist circumference Body mass index