Psoriasis May Up Risk of Heart Attack
Researchers Say Elevated Risk Especially Seen in Younger Patients With Severe Psoriasis
Patient Awareness Low
psoriasis patients are unaware that they have an increased risk of heart
attack," Horn tells WebMD. "They just haven't made the
Only in the past year has the National Psoriasis Foundation started
addressing the issue in its patient-education materials, she says.
"When something new like this study comes out, we don't want to scare
patients," Horn says. "But it's something they need to be aware of, so
it's going to be an ongoing challenge for us as a national organization to
educate our patient population and for doctors treating these
Studies show that many psoriasis patients already have multiple risk factors
for heart diseaseheart
disease. "People with psoriasis are more likely to be smokers, be
overweight, and have high blood pressurehigh blood pressure and diabetesdiabetes," Gelfand says.
So it's essential that they undergo a medical evaluation for risk factors
and receive appropriate treatment for those that can be controlled, Gelfand
How Psoriasis Increases the Risk
"Only in the last 15 years have we come to understand that psoriasis is
an autoimmune disease," Gelfand says. "Only in the past 10 years have
we learned that psoriasis is promoted by the same immune pathways that are
active in atherosclerosis." Atherosclerosis is hardening of the arteries,
which contributes to coronary artery disease and heart attack risk.
"Our study fits in with the whole paradigm of inflammation leading to
heart disease," Gelfand says. "When people have severe psoriasis,
there's a huge amount of inflammation going on."
People with severe disease also have higher blood levels of C-reactive
protein, or CRP, an inflammatory marker associated with heart disease, Gelfand
More Study Needed
"We're learning so much about psoriasis and heart disease," Horn
says. "But I don't think we understand enough about the risk to know how to
modify it. For now, the best advice we can give patients is to work with their
doctors to address the lifestyle and other risks that can be modified."
It's still unknown if psoriasis treatment -- which ranges from topically
applied steroids to potent oral medications such as methotrexate -- has any
effect on heart attack risk. "Patients should understand that," Gelfand
"It's also not clear how much skin disease you need to have before the
risk increases," Gelfand says. Because the study defined severe psoriasis
as "disease under treatment with oral medications" and mild psoriasis
as "disease receiving milder or no treatment," it could not address
Further research is needed to confirm the new study's findings, focus on
inflammatory markers common to psoriasis and atherosclerosis, explore whether
or not some psoriasis treatments can reduce the risk of heart attack, and
quantify the risk of heart attack by disease severity, Gelfand says.
"We're hoping to do that," Gelfand says. "Unfortunately, such
studies are expensive to do."