Patients with severe psoriasis at higher risk of heart disease

In what is claimed to be the largest study to date exploring the relationship between severe psoriasis and coronary microvascular dysfunction, Greek and Italian researchers have found further evidence that patients with severe psoriasis are at higher cardiovascular risk. Their results have been published in the Journal of Investigative Dermatology.

“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,” said Dr Stefano Piaserico from the University of Padova, lead investigator on the new study. “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.”

The study saw a total of 503 patients with psoriasis, and without clinical cardiovascular disease, undergo transthoracic Doppler echocardiography to evaluate coronary microcirculation. The investigators uncovered a high prevalence of coronary microvascular dysfunction in more than 30% of asymptomatic patients within the study population.

“Patients with a reduced CFR underwent angio-CT to exclude a stenosis of the coronary arteries, and no patients showed coronary artery disease,” Piaserico said. “Therefore, all patients with an impaired CFR in our cohort were affected by coronary microvascular dysfunction.”

The study revealed that psoriasis severity, assessed by the Psoriasis Area Severity Index (PASI) score, and the duration of the disease were independently associated with lower CFR, along with the presence of psoriatic arthritis. Furthermore, conventional cardiovascular risk factors such as tobacco use, hyperlipidemia and diabetes mellitus, were not independently associated with reduced CFR in patients with severe psoriasis. These findings emphasise the importance of considering inflammation and psoriasis-related factors in assessing cardiovascular risk in patients with severe psoriasis.

The findings shed light on the potential mechanism by which psoriasis increases the risk of cardiovascular complications in affected individuals, in agreement with previous studies on chronic inflammatory conditions such as rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. The study supports the role of systemic inflammation in the development of coronary microvascular dysfunction.

“We should diagnose and actively search for microvascular dysfunction in patients with psoriasis, as this population is at particularly high risk,” Piaserico said. “We might hypothesise 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.”

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