Stay attentive to cardiovascular disease risk in patients with psoriasis because effective treatment of psoriasis could improve their vascular risk as well, said Jeffrey M. Sobell, MD, of Tufts University in Boston.

Shared risk factors between psoriasis and cardiovascular disease may put psoriasis patients at particular risk for a major cardiac event, he said at the Caribbean Dermatology Symposium.

The metabolic syndrome and its associated cardiovascular risk of myocardial infarction and stroke is significantly more prevalent in psoriasis patients, compared with controls, Dr. Sobell said at the meeting, provided by Global Academy for Medical Education.

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A 2006 study published in the Journal of the American Academy of Dermatology showed three top cardiovascular disease risk factors – smoking, obesity, and hypertension – were prevalent in 30%, 21%, and 20%, respectively, of patients with severe psoriasis (J Am Acad Dermatol. 2006;55:829-35).

A possible reason for this link may be that the chronic inflammation associated with psoriasis leads to atherosclerosis, Dr. Sobell noted. The inflammation is evident on PET imaging with a radiolabeled glucose known as fluorodeoxyglucose positron emission tomography–computed tomography (FDG-PET/CT) The technology, first used in cancer and neuroimaging, can detect early subclinical inflammation and allows for exact measurements of inflammatory activity, and measuring inflammation of the aorta can serve as a surrogate marker for treatment, he said.

Treating skin disease appears to impact vascular disease, Dr. Sobell said. In a study published in JAMA Cardiology, researchers followed 115 patients for 1 year using FDG-PET/CT (JAMA Cardiol. 2017. doi: 10.1001/jamacardio.2017.1213)

Overall, when psoriasis improved, so did signs of vascular inflammation. “When the skin is more severe and treated more aggressively with anti-TNF therapy, the reduction in vascular disease is stronger,” Dr. Sobell said.

Dr. Jeffrey M. Sobell of Tufts University, Boston

Dr. Jeffrey M. Sobell

Data from another large study presented as a late-breaker at the American Academy of Dermatology in 2017 showed that treatment of psoriasis with tumor necrosis factor–alpha inhibitor therapy significantly reduced all-cause mortality in patients with psoriasis or psoriatic arthritis, he noted.

Psoriasis patients often are underscreened for cardiac risk factors, but identifying them can help guide treatment, Dr. Sobell said.

“Dermatologists should at minimum direct patients to primary care physicians for appropriate screening and assessment,” he emphasized.

Dr. Sobell disclosed relationships with Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Merck, Novartis, Regeneron, and Sun Pharma.

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