Psoriasis and the Heart Health of Women

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feel hesitation about cardiovascular risk screening and management, but are willing to be more involved, according to unpublished research by John Barbieri, M.D., MBA, related to the NPF Psoriasis Prevention Initiative (PPI).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.