Cardiovascular Screening Practices and Statin Prescription Habits in Patients with Psoriasis among Dermatologists, Rheumatologists and Primary Care Physicians

Abstract

Patients with psoriasis have a higher prevalence of cardiovascular risk factors. This study evaluated cardiovascular screening practices and statin prescribing habits among dermatologists, rheumatologists and primary care physicians (PCPs) through an online questionnaire, which was distributed through the Spanish scientific societies of the above-mentioned specialties. A total of 299 physicians (103 dermatologists, 94 rheumatologists and 102 PCPs) responded to the questionnaire. Of these, 74.6% reported screening for smoking, 37.8% for hypertension, 80.3% for dyslipidaemia, and 79.6% for diabetes mellitus. Notably, only 28.4% performed global screening, defined as screening for smoking, hypertension, dyslipidaemia, and diabetes mellitus by the same physician, and 24.4% reported calculating 10-year cardiovascular disease (CVD) risk, probably reflecting a lack of comprehensive cardiovascular risk assessment in these patients. This study also identified unmet needs for awareness of cardiovascular comorbidities in psoriasis and corresponding screening and treatment recommendations among PCPs. Of PCPs, 61.2% reported not being aware of the association between psoriasis and CVD and/or not being aware of its screening recommendations, and 67.6% did not consider psoriasis as a risk-enhancing factor when deciding on statin prescription. Thirteen dermatologists (12.6%) and 35 rheumatologists (37.2%) reported prescribing statins. Among those who do not prescribe, 49.7% would be willing to start their prescription.

Psoriasis and Cardiovascular Risk. Is There Any Association?

“…Health Problems of Civilization eISSN: 2354-0265, ISSN: 2353-6942 knowledge of screening recommendations in psoriasis patients [3]. This study found that more than 60% of primary care physicians were unaware of psoriasis being associated with CVD [3].…”

“…Recent studies have identified that psoriasis and CVD have various common pathogenic pathways including genetic factors, inflammatory pathways, adipokine secretion, insulin resistance, lipoproteins, angiogenesis and oxidative stress [3]. Reasons for increased CVD risk include both increased systemic inflammation caused by psoriatic lesions, usually covering large areas of the skin and the fact that psoriasis is associated with an increased incidence of modifiable cardiovascular risk factors such as obesity, smoking, hypertension, diabetes mellitus, dyslipidemia, metabolic syndrome and a sedentary lifestyle [3]. The study by Karbach et al [4] found that psoriatic patients with heart attacks were on average 5 years younger than heart attack patients without psoriasis.…”

Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis (EDSAP): protocol for an observational, single-centre, prospective cohort study

“…Traditional prediction systems based on classical CVRFs, underestimate the actual CV risk of patients with psoriasis and other chronic inflammatory states. 8 34 There is a lack of markers that allow us to adequately predict those patients who will develop CV disease. In this scenario, numerous publications have emerged recently highlighting the value of detecting subclinical atherosclerosis through various imaging tests as a tool to overcome this gap.…”

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

“…The screening for CVD risk factors among psoriasis patients is often inadequate, leading to suboptimal management. 133 This issue is compounded by dermatologists and rheumatologists’ hesitance to prescribe statins, 4 highlighting the need for better coordination and clear delineation of responsibilities among healthcare providers. A survey-based study by Barbieri et al reported optimistic views from both dermatologists and patients regarding the adoption of a care model led by dermatologists or rheumatologists for CVD prevention.…”

“… 3 Multiple questionnaire-based studies have revealed that surveyed physicians, including dermatologists, rheumatologists, cardiologists and primary care physicians, often fail to conduct comprehensive screenings for hypertension, dyslipidemia, smoking, and diabetes mellitus, with more than half of primary care physicians unaware of the connection between psoriasis and cardiovascular disease. 4 , 5 A recent Delphi consensus has affirmed the significance of cardiovascular disease as a crucial comorbidity in patients with psoriatic disease. 6 It emphasized the need for evaluation in clinical trials, marking this as an area warranting further investigation.…”