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Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Ischemic cardiovascular involvement in psoriasis: a systematic review
Susanna Mosca1, Paola Gargiulo2, Nicola Balato3
1Department of Advanced Biomedical Sciences, Section of Cardiology, "Federico II" University, Naples, Italy.
Insights
Psoriasis patients face higher cardiovascular risk due to inflammation, increasing the likelihood of heart events. Further research is needed to manage cardiovascular risk factors and assess treatment impacts in this population.
Area of Science:
- Cardiology
- Dermatology
- Rheumatology
Background:
- Psoriasis is linked to reduced life expectancy, primarily due to cardiovascular events.
- Psoriatic patients exhibit increased prevalence and incidence of cardiovascular risk factors for atherosclerosis.
- Chronic systemic inflammation in psoriasis likely contributes independently to elevated cardiovascular risk.
Purpose of the Study:
- To review ischemic cardiovascular involvement in psoriasis.
- To summarize cardiovascular risk factors, events, atherosclerosis mechanisms, and anti-inflammatory therapy effects in psoriatic patients.
- To identify gaps in current research regarding cardiovascular risk management in psoriasis.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Quality assessment of drug treatment studies using the Detsky score.
- Literature evaluation of prevalence, incidence, mechanisms, and therapeutic effects.
Main Results:
- Psoriatic patients have a significantly increased cardiovascular risk.
- This elevated risk is associated with a higher prevalence and incidence of cardiovascular risk factors and systemic inflammation.
- Preliminary evidence suggests anti-inflammatory therapies may improve vascular health and reduce cardiovascular morbidity.
Conclusions:
- Psoriasis is an independent risk factor for cardiovascular disease, driven by chronic inflammation.
- Current literature lacks studies defining optimal cardiovascular risk factor targets and assessing the clinical value of screening and disease-modifying therapies in psoriatic patients.
- Increased awareness of cardiovascular risk in psoriasis should stimulate further research to address these knowledge gaps.
Abstract:
Epidemiologic studies demonstrate that psoriasis is associated with shorter life expectancy, most frequently attributable to cardiovascular (CV) events. Although increased prevalence and incidence of CV risk factors for atherosclerosis have been reported in psoriatic patients, psoriasis likely plays an independent role in the increased cardiovascular risk, presumably linked to the chronic systemic inflammatory state. Consistently, preliminary investigations suggest that anti-inflammatory therapies may improve early subclinical vascular alterations and reduce cardiovascular morbidity and mortality. This review will focus on ischemic CV involvement in psoriatic patients, summarizing the prevalence and incidence of CV risk factors and CV events, as well as evidence on mechanisms of premature atherosclerosis and on effects of systemic anti-inflammatory therapies on CV risk profile. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and evaluated the quality of studies comparing drug treatments using Detsky score. Our review documented that psoriatic patients are at increased CV risk, related to raised prevalence and incidence of CV risk factor and to inflammatory status. However, available literature lacks of studies that establish appropriate targets for CV risk factors and assess the clinical value of screening for subclinical organ damage and the impact of disease-modifying therapies on CV risk profile in psoriatic patients. Awareness of raised CV risk in psoriatic patients should foster further research aimed at elucidating these aspects.
