Does Treatment of Psoriasis Reduce the Risk of Cardiovascular Disease?

Abstract

Psoriasis is an inflammatory disease associated with multiple comorbidities and cardiovascular risk factors. Patients with psoriasis have an increased risk of cardiovascular disease (CVD) and cardiovascular death. It has been proposed that overlapping mechanisms of systemic inflammation contribute to the link between psoriasis and cardiovascular disease. Some psoriasis treatments decrease systemic inflammation, but the effect of psoriasis treatments on heart disease is unknown. In this review of 23 original research publications, we present preliminary evidence that some psoriasis therapies improve cardiovascular biomarkers and the incidence of cardiovascular risk. Phototherapy may reduce some inflammatory cytokines, but there is little evidence for a decreased risk of CVD outcomes. Both methotrexate and tumour necrosis factor-α inhibitors improve cardiovascular inflammatory biomarkers and improve CVD outcomes. Short-term data on interleukin-12/23 inhibitors are varied, but most data suggest there is not an increase in cardiovascular events.

The effect of tumor necrosis factor inhibitor therapy on the incidence of myocardial infarction in patients with psoriasis: a retrospective study

“…Churton et al (5) reviewed twenty-three original research publications, and presented preliminary evidence that some psoriasis therapies improve cardiovascular biomarkers and the incidence of cardiovascular risk.…”

“…Introduction of the TNF-a inhibitors therapy with infliximab, etanercept and adalimumab has intensely enhanced the outcome of severe psoriasis further than that achieved with traditional systemic drugs. Both MTX and TNF-a inhibitors improve cardiovascular inflammatory biomarkers and CVD outcomes (5). A cardioprotective effect has been suggested with systemic agents such as MTX and TNF-a inhibitor agents in rheumatoid arthritis and psoriasis populations (28).…”

“…It has been associated with multiple co-morbidities including cardiovascular diseases (CVD), the metabolic syndrome, cancer, gastrointestinal diseases and chronic obstructive pulmonary diseases (COPD) (2)(3)(4). Overlapping mechanism of systemic inflammation has been proposed to contribute to the common link between psoriasis and CVD (5). Studies have found psoriasis to be an independent risk factor for diseases including diabetes, atherosclerosis, myocardial infarction and stroke, even after controlling of other well-known risk factors (6)(7)(8).…”

Antipsoriatic treatment extends beyond the skin: recovering of high‐density lipoprotein function

“…However, recent data from more than 8845 patients enrolled the Kaiser Permanente Southern California health plan suggested that treatment of psoriasis with tumor necrosis factor (TNF) inhibitors was associated with a significant reduction in myocardial infarction risk and incidence rate compared with the treatment with topical agents . Moreover, systemic treatment with methotrexate or photo(chemo)therapy, including broadband UV‐B, narrowband UV‐B or PUVA , was also associated with a significant reduction in cardiovascular risk. Interestingly, a small study demonstrated recently that treatment of psoriasis utilizing anti‐TNF therapy led to improvement in carotid intimal‐medial thickness, an established surrogate marker of cardiovascular disease .…”

The Association between Psoriasis Area and Severity Index and Cardiovascular Risk Factor in Korean Psoriasis Patients

“…Usually, the subjects were defined as having moderate to severe psoriasis if they had a history of systemic treatments. However, some psoriasis therapies may increase incidence of cardiovascular diseases while others may decrease it 1 2 . These heterogenous effects of individual drugs on cardiovascular disease may limit current practice of determining the severity according to past treatment history, in the aspect of evaluating the current cardiovascular risk factors.…”