Treating Psoriasis to Reduce Cardiovascular Problems

INTRODUCTION
-Psoriasis is associated with metabolic syndrome which included diabetes, dyslipidamia and obesity…all of which are risk factors for cardiovascular problems (Stroke, Heart Attacks)
-But beyond the data, controversy lies whether a control of psooriasis will result in fewer cardiovascular problems.

Role of Psoriasis in Heart Atacks
-psoriasis increases the risk

Obesity
-elevated prevalence
-in a study of 7900 women, there is a link between weight gain and the skin lesions.

Depression
-psoriasis is a chronic, stigmatizing disease (recognized as such by the WHO, click HERE to read more)
-extensive cases can even lead to suicide

How often are other problems found in Psoriasis ?
-Prevalence of comorbidities overall is 58% (compared to 34% for the normal population)

Life expectancy is on average shorter:
-Life expectancy reaches 73 years old overall (vs 79 in healthy controls)
-It shorter of -3.5 years in males and -4.5 years in females.

The risk of mortality is directly linked to the severity of the disease
-Relative Risk of myocardial infarction (MI) is much higher in younger patients with psoriasis than healthy matched controls.
-At age 30 there is 3-fold increase in the risk of MI and a 2.6 fold increased risk of stroke.
-The presence of coronary plaques in young individuals is 2 times higher.

Is treatment with anti-TNFs (biologics) effective ?
-In a retrospective study of 25000 patients, a significant reduction in MI was shown when compared with topical treatments (Jashin et al,  2012).
-Anti TNFs are also indication as a second line treatment for the reduction of atherosclerosis

How does Psoriasis result in an increased risk of cardiovascular disease ?
-The Th17 and Il-17 pathway which induces cardiovascular disease. It can be targeted
-Cellular debris of cells found in psoriasis have been found in the bloodstream* the inflammation in psoriasis plays a role in atherogenesis (click HERE to read more)
-Adipocytes interact with chemokines of keratinocytes and inflammatory cells which release atherogenic factors.
-TNF increases Th17 and decreases Treg cells and it results in at atherogenesis and hypercholesterolaemia
–Il-12 promotes atherogenic plaques. Indeed Il-12 blockade in ApoE knockout mice also decreases the formation of atherogenic plaques

It also works in the other way around. Cardiologists say screening should be done and that treatment of cardiovascular risk factors should be aggressive.
CONCLUSIONS
-The evidence is based on recent studies.
-It is also a consideration of cost and efficacy. Anti TNF treatments are very expensive and the cost per avoided Major-Cardiac Adverse (MACE) effect might work, but it could also be an independent effect of other (and cheaper) ways to treat them.
-History will also tell us if the newer biologics are safe on the long term

COMMENTS
Primary mesasures includes lifestyle and associated systemic risk factors. Then medical treatment. However it remains to be seen if conventional treatment should be replaced in some cases by TNF inhibitors.
In our opinion, the real question is whether arthritis is present or not. In that case the use of Anti-TNFs is unquestionable.

 
Yes there is enough evidence Thomas Luger (Germany). CN04 – Is There Now Enough Evidence That Controlling Psoriasis Really Decreases Cardiovascular Risk? World Congress of Dermatology 2015 –  Vancouver, Canada