Systemic Inflammation and Cardiovascular Comorbidity in Psoriasis Patients: Causes and Consequences

Abstract

Psoriasis is a common inflammatory skin disease characterized by the appearance of red scaly plaques that can affect any part of the body. High prevalence, chronicity, disfiguration, disability, and associated comorbidity make it a challenge for clinicians of multiple specialties. Likewise, its complex pathogenesis, comprising inflammation, hyperproliferation, and angioneogenesis, intrigues numerous scientific disciplines, namely, immunology. From a clinical perspective, the severity of psoriasis is highlighted by its increased mortality, with cardiovascular diseases contributing the highest excess risk. From a scientific point of view, psoriasis has to be considered a systemic inflammatory condition, as blood biomarkers of inflammation are elevated and imaging techniques document sites of inflammation beyond the skin. While the association of psoriasis with cardiovascular diseases is now widely accepted, causes and consequences of this association are controversially discussed. This review comments on epidemiologic, genetic, and mechanistic studies that analyzed the relation between psoriasis and cardiovascular comorbidity. The hypothesis of psoriasis potentially being an independent cardiovascular risk factor, driving atherosclerosis via inflammation-induced endothelial dysfunction, will be discussed. Finally, consequences for the management of psoriasis with the objective to reduce the patients’ excess cardiovascular risk will be pointed out.

Effects of secukinumab on metabolic and liver parameters in plaque psoriasis patients

“…Psoriasis is associated with cardiovascular and metabolic comorbidities including atherosclerosis, obesity, diabetes, hyperuricemia, NAFLD and MetS . Genetic studies suggest only a modest association between psoriasis and cardiovascular or metabolic diseases .…”

“…Psoriasis is associated with a range of inflammatory and metabolic comorbidities, including obesity, diabetes, dyslipidemia, hyperuricemia and psychiatric conditions, and is associated with increased cardiovascular risk . The exact aetiology of comorbidity in psoriasis remains a topic of current research, but a state of systemic low‐grade inflammation induced by dysregulated Th1 and Th17 activation may contribute to the development of (pre)diabetes, obesity, non‐alcoholic fatty liver disease (NAFLD) and atherosclerosis …”

“…1 The exact aetiology of comorbidity in psoriasis remains a topic of current research, but a state of systemic low-grade inflammation induced by dysregulated Th1 and Th17 activation may contribute to the development of (pre)diabetes, obesity, non-alcoholic fatty liver disease (NAFLD) and atherosclerosis. [2][3][4][5][6] Psoriasis is linked to obesity, and a reduction of body weight is known to improve skin symptoms and response to systemic treatment. 7 Psoriasis patients are also at increased risk of metabolic syndrome (MetS), which may be related to an increase in circulating adipocytokines, 8,9 mediating systemic pro-inflammatory effects.…”

IL‐17 and its role in inflammatory, autoimmune, and oncological skin diseases: state of art

“…16,17 Recently, the central role of IL-17 in systemic inflammation and cardiovascular comorbidity in psoriasis patients has also been highlighted. [18][19][20] Finally, the evidence of the role of IL-17 in the pathogenesis of psoriasis has been supported by the proven efficacy of the treatment with anti-IL-17 in psoriatic patients. 8,21,22 In particular, the biological agent brodalumab proved its efficacy and safety in generalized pustular psoriasis.…”

“…Different authors have studied the correlation between serum levels of IL‐17 or its tissue expression and the clinical subtype of psoriasis or disease state . Recently, the central role of IL‐17 in systemic inflammation and cardiovascular comorbidity in psoriasis patients has also been highlighted …”