Beyond the Skin Plaques: Psoriasis and Its Cardiovascular Comorbidities

Abstract

Psoriasis, a widely prevalent chronic disease of the skin and joints, has long been associated with far-reaching systemic ramifications and decreased quality of life. However, psoriasis is largely underdiagnosed and insufficiently treated. Classical risk factors predisposing to cardiovascular diseases, such as hypertension, diabetes, metabolic syndrome, and dyslipidemia, have been noted in patients with mild and severe psoriasis. Furthermore, the magnitude of the cardiovascular comorbidity and the need to screen for risk factors has often been ignored while considering the management options for psoriasis. This article has reviewed the cardiovascular implications of psoriasis from the shared pathogenesis behind these two diseases to the increased incidence of cardiovascular events, such as myocardial infarction, stroke, and other causes of vascular mortality. Additionally, the therapeutic targets of common inflammatory pathways, such as those involving tumor necrosis factor α (TNF-α), interleukin-12/interleukin-23 (IL-12/IL-23), and helper T cells 17 (Th17), have been discussed with an emphasis on their efficacy in controlling psoriasis and its cardiovascular consequences.

Comorbid Psoriasis and Metabolic Syndrome: Clinical Implications and Optimal Management

“…A strong association between psoriasis and cardiovascular disease has been found in multiple studies. 16 , 18 Arterial hypertension (aHT) is a leading risk factor for cardiovascular morbidity and mortality. 20 aHT is defined as a blood pressure (BP) above 130/80 mmHg according to the ACC/AHA guidelines and 140/90 mmHg according to the ESC/ESH, NICE, and ISH guidelines.…”

“… 21 Given that psoriasis patients have an inherently increased risk of developing aHT, dermatologists need to give special consideration to this comorbidity when following up and treating psoriasis patients. 16 …”

“…Copyright© 2021, Kakarala et al This is an open access article distributed under the terms of the Creative Commons Attribution License. 16 …”

“… 11 Ultimately, these comorbidities lead to an increased risk of atherosclerosis and cardiovascular mortality in psoriasis patients. 16 Notably, psoriasis severity was identified as an independent cardiovascular risk factor.…”

“… 15 Furthermore, as in MAFLD, the IL23-Th17 axis has been identified as a crucial immunological pathway. 16 , 17 In addition, diabetes mellitus (DM), hypertension, dyslipidemia, obesity and insulin resistance share an upregulation of inflammatory cytokines like IFN-γ, IL-23 and TNF-α. 18…”