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Psoriasis and the Heart Health of Women

Psoriasis is strongly associated with an increased risk of cardiovascular disease and progression of atherosclerosis.

Psoriasis affects up to 3% of the adult population, with men and women seeming to have similar risk, [1] and it is strongly associated with an increased risk of cardiovascular disease and progression of atherosclerosis. [2]

What is Cardiovascular Disease?

Cardiovascular disease (CVD) is an umbrella term that includes heart disease and vascular disease. Amy Friedrich-Karnik, Vice President of Advocacy and Communications at WomenHeart, explains further: “Heart disease is a term used to describe a range of conditions that affect a person’s heart. It includes issues with clogged blood vessels that could lead to a heart attack, problems with heart rhythm or heart valves, or conditions of the heart muscle like heart failure,” she says. “There are 60 million women in the U.S. with heart disease; that number drops to 12 million if you exclude hypertension, i.e. high blood pressure.” Cardiovascular disease is considered to be a comorbidity of psoriasis.

Shared Risk Factors

It is well understood that risk factors of psoriasis can include (but are not limited to) lifestyle, skin injuries, as well as intrinsic factors such as genetics [3]. Interestingly, heart disease and psoriasis share some risk factors, such as genetics and lifestyle. “Family history is one of the leading risk factors for heart disease, while blood pressure, cholesterol and blood sugar levels all have a big impact on your heart health. Conditions such as diabetes and having experienced certain pregnancy complications can also be risk factors for heart disease,” says C. It is recognized that the chronic inflammation seen in patients with psoriasis is associated with a higher prevalence of cardiovascular risk factors that make up the metabolic syndrome: obesity, diabetes, hyperlipidemia, and hypertension. Furthermore, research has demonstrated that patients with psoriasis and metabolic syndrome had higher levels of systemic inflammation, prevalence of CVD risk factors and coronary plaque burden. [2]

There is evidence that psoriasis may be associated with a higher risk of CVD compared with the general population [4]. As a matter of fact, according to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol, psoriasis is considered an independent risk enhancer for individuals with an intermediate 10-year risk of CVD. [5]

Healthy lifestyle interventions, such as quitting smoking, are suggested for patients with psoriasis, patients with CVD, and patients with both. In fact, encouraging smoking cessation is recommended in the 2018 American College of Rheumatology/National Psoriasis Foundation (NPF) Guidelines for the Treatment of Psoriatic Arthritis. [6] “Diet and exercise are important to heart health. Eating a low-fat diet and watching salt intake can help [patients] prevent or manage heart disease. Load up on fresh fruits and vegetables, whole grains, fat-free or low-fat dairy products, fish, fiber and lean poultry and meat. Smoking can damage heart and blood vessels; quitting smoking dramatically cuts your risk of heart disease. Regular exercise (AHA [the American Heart Association] recommends adults should get at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week) and learning to manage stress levels is also important,” says Friedrich-Karnik. According to the CDC, moderate-intensity aerobic activity is anything that gets the heart beating faster, such as walking a dog and swimming. However, they note that it is important for people to do what they can, saying “even 5 minutes of physical activity has real health benefits.” [7]

Managing Patients

Dermatologists and rheumatologists may feel hesitation about cardiovascular risk screening and management, but are willing to be more involved, according to unpublished research by John Barbieri, M.D., MBA, related to the NPF Psoriasis Prevention Initiative (PPI). Patients with psoriatic disease are also interested in engaging with their dermatologist and/or rheumatologist about their CVD risk, with patients noting it would be convenient to work with their specialist.

For providers who may have female patients at risk of disease and/or heart attack, it is important to recognize the symptoms. Many women having a heart attack experience may present with the classic symptoms of chest pain or pressure, Friedrich-Karnik says, but she notes that some symptoms are more common in women. “They often include shortness of breath, dizziness or nausea, pressure that spreads to the shoulders, neck, upper back, jaw or arms, or unexplained fatigue,” she says. “Learn more about the signs and symptoms of a heart attack.

“Heart disease is the number one killer of women in the U.S. And yet, many people still think of heart disease as a man’s disease. That’s why WomenHeart is here – to raise awareness of the risk to women and to provide community, support, and education for women who are living with heart disease. No one should go on the journey of heart disease alone.”

Providers can visit womenheart.org to learn more about how to support their female patients who may be at risk for cardiovascular conditions. The website has fact sheets and other resources on specific heart conditions, as well as access to peer support services for women with heart disease.

To learn more about managing cardiovascular comorbidities in people with psoriasis, review the Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities published in the Journal of the American Academy of Dermatology. These guidelines cover CVD and metabolic syndrome, as well as other comorbidities such as inflammatory bowel disease, psoriatic arthritis, and mental health.

Understanding Cardiovascular Disease and Psoriasis

Listen to Nehal Mehta, M.D., of the National Heart, Lung, and Blood Institute discuss the impacts of CVD on psoriatic disease in this episode of NPF Psound Bytes CME podcast (claim 0.25 credits).

Listen now

Article References

References

[1] Psoriasis. Centers for Disease Control and Prevention. https://www.cdc.gov/psoriasis/index.htm. Published August 18, 2020. Accessed June 11, 2021.

[2] Teklu M, Zhou W, Kapoor P, et al. Metabolic Syndrome and its Factors are Associated with Non-Calcified Coronary Plaque Burden in Psoriasis: An Observational Cohort Study, Journal of the American Academy of Dermatology (2021), doi: https://doi.org/10.1016/j.jaad.2020.12.044.

[3] Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk Factors for the Development of Psoriasis. Int J Mol Sci. 2019;20(18):4347. Published 2019 Sep 5. doi:10.3390/ijms20184347

[4] Jindal S, Jindal N. Psoriasis and Cardiovascular Diseases: A Literature Review to Determine the Causal Relationship. Cureus. 2018;10(2):e2195. Published 2018 Feb 15. doi:10.7759/cureus.2195

[5] Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2019 Jun 25;73(24):3234-3237]. J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002.

[6] Singh JA, Guyatt G, Ogdie A, et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726

[7] Physical Activity Basics. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/index.htm. Last review October 7, 2020. Accessed June 11, 2021.

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