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Psoriasis May Up Risk of Heart Attack

Researchers Say Elevated Risk Especially Seen in Younger Patients With Severe Psoriasis

Patient Awareness Low

"Most psoriasis patients are unaware that they have an increased risk of heart attack," Horn tells WebMD. "They just haven't made the connection."

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 patients."

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 says.

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 says.

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 says.

"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 that issue.

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."

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