1
|
Kearney CA, Saha S, Mata Vivas MT, Gelfand JM, Garelik J, Lo Sicco KI, Garshick M. Characterization of cardiometabolic risk awareness among patients with psoriasis: A quality improvement survey study. JAAD Int 2024; 16:72-74. [PMID: 38800703 PMCID: PMC11127026 DOI: 10.1016/j.jdin.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
| | - Sreejan Saha
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Maria Teresa Mata Vivas
- Center for the Prevention of Cardiovascular Disease and Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Joel M. Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jessica Garelik
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Kristen I. Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Michael Garshick
- Center for the Prevention of Cardiovascular Disease and Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
2
|
Song WB, Soffer DE, Gelfand JM. Using Guidelines of Care to Lower Cardiovascular Risk in Patients with Psoriasis. Dermatol Clin 2024; 42:417-428. [PMID: 38796273 PMCID: PMC11128720 DOI: 10.1016/j.det.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
National guidelines define psoriasis as a risk enhancer for cardiovascular disease and recommend increased monitoring and more intense management of cardiovascular risk factors in these patients, who face an increased burden of cardiovascular disease morbidity and mortality. Screening for modifiable cardiovascular risk factors, including blood pressure, weight, cholesterol, glucose, and smoking, can be efficiently incorporated into routine dermatology clinical practice. Partnerships with primary care providers and preventive cardiologists are essential to improving management of cardiovascular risk in patients with psoriasis.
Collapse
Affiliation(s)
- William B Song
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Daniel E Soffer
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| |
Collapse
|
3
|
Song WB, Garshick MS, Barbieri JS, Shin DB, Báez S, Papadopoulos M, Neopaney A, Fitzsimmons R, Kalb RE, Mease PJ, Craig ET, Koplin J, Takeshita J, Chiesa Fuxench ZC, Armstrong AW, Mehta NN, Beidas RS, Ogdie AR, Gelfand JM. A Care Coordination Model to Prevent Cardiovascular Events in Patients with Psoriatic Disease: A Multicenter Pilot Study. J Invest Dermatol 2024; 144:1405-1409.e1. [PMID: 38184142 PMCID: PMC11116061 DOI: 10.1016/j.jid.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/08/2024]
Affiliation(s)
- William B Song
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael S Garshick
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA; Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suzette Báez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryte Papadopoulos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aakriti Neopaney
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert E Kalb
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Philip J Mease
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ethan T Craig
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joelle Koplin
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zelma C Chiesa Fuxench
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - April W Armstrong
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nehal N Mehta
- Division of Cardiology, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexis R Ogdie
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
4
|
Mehta H, Narang T, Dogra S, Handa S, Hatwal J, Batta A. Cardiovascular Considerations and Implications for Treatment in Psoriasis: An Updated Review. Vasc Health Risk Manag 2024; 20:215-229. [PMID: 38745849 PMCID: PMC11093123 DOI: 10.2147/vhrm.s464471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
Psoriasis, a prevalent chronic inflammatory skin disorder affecting 2-3% of the global population, has transcended its dermatological confines, revealing a profound association with cardiovascular diseases (CVD). This comprehensive review explores the intricate interplay between psoriasis and cardiovascular system, delving into genetic links, immune pathways, and adipose tissue dysfunction beyond conventional CVD risk factors. The pathophysiological connections unveil unique signatures, distinct from other inflammatory skin conditions, in particular psoriasis-specific genetic polymorphisms in IL-23 and TNF-α have consistently been linked to CVD. The review navigates the complex landscape of psoriasis treatments, addressing challenges and future directions in particular relevance to CVDs in psoriasis. Therapeutic interventions, including TNF inhibitors (TNFi), present promise in reducing cardiovascular risks, and methotrexate could constitute a favourable choice. Conversely, the relationship between IL-12/23 inhibitors and cardiovascular risk remains uncertain, while recent evidence indicates that Janus kinase inhibitors may not carry CVD risks. Emerging evidence supports the safety and efficacy of IL-17 and IL-23 inhibitors in patients with CVDs, hinting at evolving therapeutic paradigms. Lifestyle modifications, statins, and emerging therapies offer preventive strategies. Dedicated screening guidelines for CVD risk assessment in psoriasis are however lacking. Further, the impact of different disease phenotypes and treatment hierarchies in cardiovascular outcomes remains elusive, demanding ongoing research at the intersection of dermatology, rheumatology, and cardiology. In conclusion, unraveling the intricate connections between psoriasis and CVD provides a foundation for a holistic approach to patient care. Collaboration between specialties, advancements in screening methodologies, and a nuanced understanding of treatment impacts are essential for comprehensive cardiovascular risk management in individuals with psoriasis.
Collapse
Affiliation(s)
- Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Juniali Hatwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital (DMCH), Ludhiana, 141001, India
| |
Collapse
|
5
|
Alunno A, Carubbi F, Rodríguez-Carrio J, Gossec L, Donohoe S, Ferri C. The management of cardiovascular risk in psoriatic disease: A bridge over troubled water. Semin Arthritis Rheum 2024; 65:152389. [PMID: 38325054 DOI: 10.1016/j.semarthrit.2024.152389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
Evidence that psoriatic disease is burdened by an excess cardiovascular (CV) risk has accrued, however many questions remain unanswered. Although an interplay between traditional risk factors inflammation, disease activity and pharmacological therapies, as observed in rheumatoid arthritis (RA), may account for this increased risk, metabolic comorbidities rather than inflammation seem to have a leading role in psoriatic disease. Therefore, specific approaches, risk factors targeting and the importance of traditional risk factors and inflammation management need to be considered. The purpose of this review article is to discuss current data on CV risk in psoriatic disease, and to outline similarities and differences with RA in the light of international recommendations. Arguments in favour of developing specific guidance for CV prevention in psoriatic disease are discussed.
Collapse
Affiliation(s)
- Alessia Alunno
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
| | - Francesco Carubbi
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France; AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | | | - Claudio Ferri
- University of L'Aquila, Department of Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| |
Collapse
|
6
|
Yin S, Zhou Z, Wu J, Wang X, Lin T. Psoriasis and risk of chronic kidney diseases: A population-based cross-sectional study and Mendelian randomization analysis. Nephrology (Carlton) 2023; 28:611-619. [PMID: 37469214 DOI: 10.1111/nep.14220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Conflicting results have been reported regarding the association between psoriasis and risk of chronic kidney diseases (CKD). Furthermore, the causal nature of the possible association remains unexplored. METHODS We conducted a population-based cross-sectional study using data from National Health and Nutrition Examination Survey (NHANES). Logistic regression analyses were conducted to estimate potential association between psoriasis and CKD risk. Further, we evaluated causality by performing a Mendelian randomization analysis using large-scale genome-wide association studies of psoriasis and CKD. Inverse variance-weighted (IVW) analysis was used as the primary method. RESULTS In the observational study, 16 750 participants were included. Overall, 39 of 429 patients with psoriasis had CKD (9.1%) compared with 1481 of 16 321 without psoriasis (9.1%). In the fully adjusted model, psoriasis was not associated with CKD (OR: 0.77, 95%CI: 0.53-1.10). In the MR analysis, 36 single-nucleotide polymorphisms (SNPs) were selected as instrumental variables. The IVW analysis reported that genetically predicted psoriasis was associated with a higher risk of CKD (OR: 1.025, 95%CI: 1.001-1.049). After removing 2 SNPs associated with heterogeneity, the association remained (OR: 1.028, 95%CI: 1.006-1.050). CONCLUSION Genetically predicted psoriasis was associated with a higher risk of CKD. This association may be important for clinicians to monitor kidney function and prescribe potentially nephrotoxic drugs during psoriasis management.
Collapse
Affiliation(s)
- Saifu Yin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxia Zhou
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Ward of Nephrology and Urology, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jiapei Wu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Gonzalez-Cantero A, Boehncke WH, De Sutter J, Zamorano JL, Lambert J, Puig L. Statins and psoriasis: Position statement by the Psoriasis Task Force of the European Academy of Dermatology and Venerology. J Eur Acad Dermatol Venereol 2023; 37:1697-1705. [PMID: 37259959 DOI: 10.1111/jdv.19191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Psoriasis is associated with an increased mortality risk, with cardiovascular disease being the leading excess cause (in a dose-response manner with psoriasis severity). Statins have demonstrated a reduction in all-cause mortality with no excess of adverse events among the general population. The underuse of interventions in cardiovascular prevention, such as statins, for patients with psoriasis may be the result of an insufficient evaluation. OBJECTIVES To provide the dermatologist with a tool for systematizing the treatment of dyslipidemia in psoriasis, which generally escapes the scope of dermatological practice, and to facilitate decision-making about the referral and treatment of patients. METHODS The Psoriasis Task Force of the European Academy of Dermatology and Venereology performed this two-phase study to achieve a consensus and create recommendations on the use of statin therapy in patients with psoriasis. The first phase included a systematic review to identify a list of outline concepts and recommendations according to guidelines. The second phase consisted in a two-round Delphi study to evaluate those recommendations not literally taken from guidelines. RESULTS A list of 47 concepts and recommendations to be followed by dermatologists involved in the treatment of patients with moderate-severe psoriasis was created. It included six main concepts about cardiovascular risk and psoriasis, six items related with the role of low-density lipoprotein cholesterol (LDL-c) and the benefits of statin treatment in psoriasis patients, eight recommendations about how cardiovascular risk should be assessed, three on the role of non-invasive cardiovascular imaging, three on LDL-c thresholds, eight key points related to statin prescription, 10 on statin treatment follow-up and three on patient referral to another specialist. CONCLUSIONS The application of this position statement (close final list of concepts and recommendations) will help dermatologists to manage dyslipidemia and help psoriasis patients to reduce their cardiovascular risk.
Collapse
Affiliation(s)
- A Gonzalez-Cantero
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - W H Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - J De Sutter
- Department of Cardiology, AZ Maria Middelares, Ghent, Belgium
| | - J L Zamorano
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - J Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Song WB, Peck GM, Neopaney A, Shin DB, Fleischer AB, Feldman SR, Gelfand JM. Regional Variation in Cardiovascular Risk Factor Screening by Dermatologists for Psoriasis Patients in the United States. J Invest Dermatol 2023; 143:1816-1819. [PMID: 36990175 DOI: 10.1016/j.jid.2023.03.1655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Affiliation(s)
- William B Song
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gabrielle M Peck
- Department of Dermatology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Aakriti Neopaney
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan B Fleischer
- Department of Dermatology, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Steven R Feldman
- Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
9
|
Schaller T, Ringen J, Fischer B, Bieler T, Perius K, Knopp T, Kommoss KS, Korn T, Heikenwälder M, Oelze M, Daiber A, Münzel T, Kramer D, Wenzel P, Wild J, Karbach S, Waisman A. Reactive oxygen species produced by myeloid cells in psoriasis as a potential biofactor contributing to the development of vascular inflammation. Biofactors 2023; 49:861-874. [PMID: 37139784 DOI: 10.1002/biof.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/04/2023] [Indexed: 05/05/2023]
Abstract
Psoriasis is an immune-mediated inflammatory skin disease driven by interleukin-17A (IL-17A) and associated with cardiovascular dysfunction. We used a severe psoriasis mouse model of keratinocyte IL-17A overexpression (K14-IL-17Aind/+ , IL-17Aind/+ control mice) to investigate the activity of neutrophils and a potential cellular interconnection between skin and vasculature. Levels of dermal reactive oxygen species (ROS) and their release by neutrophils were measured by lucigenin-/luminol-based assays, respectively. Quantitative RT-PCR determined neutrophilic activity and inflammation-related markers in skin and aorta. To track skin-derived immune cells, we used PhAM-K14-IL-17Aind/+ mice allowing us to mark all cells in the skin by photoconversion of a fluorescent protein to analyze their migration into spleen, aorta, and lymph nodes by flow cytometry. Compared to controls, K14-IL-17Aind/+ mice exhibited elevated ROS levels in the skin and a higher neutrophilic oxidative burst accompanied by the upregulation of several activation markers. In line with these results psoriatic mice displayed elevated expression of genes involved in neutrophil migration (e.g., Cxcl2 and S100a9) in skin and aorta. However, no direct immune cell migration from the psoriatic skin into the aortic vessel wall was observed. Neutrophils of psoriatic mice showed an activated phenotype, but no direct cellular migration from the skin to the vasculature was observed. This suggests that highly active vasculature-invading neutrophils must originate directly from the bone marrow. Hence, the skin-vasculature crosstalk in psoriasis is most likely based on the systemic effects of the autoimmune skin disease, emphasizing the importance of a systemic therapeutic approach for psoriasis patients.
Collapse
Affiliation(s)
- Theresa Schaller
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia Ringen
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Berenice Fischer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tabea Bieler
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Interdisciplinary Center for Scientific Computing (IWR), University of Heidelberg, Heidelberg, Germany
| | - Katharina Perius
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tanja Knopp
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Hematology and Central Hematology Laboratory, Inselspital University Hospital Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Katharina S Kommoss
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Thomas Korn
- Institute for Experimental Neuroimmunology, Technical University of Munich School of Medicine, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- The M3 Research Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Matthias Oelze
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniela Kramer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Wild
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susanne Karbach
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner Site Rhine-Main, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ari Waisman
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Research Center for Immunotherapy, Johannes Gutenberg-University Mainz, Mainz, Germany
| |
Collapse
|
10
|
Kommoss KS, Enk A, Heikenwälder M, Waisman A, Karbach S, Wild J. Cardiovascular comorbidity in psoriasis - psoriatic inflammation is more than just skin deep. J Dtsch Dermatol Ges 2023. [PMID: 37186503 DOI: 10.1111/ddg.15071] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is a growing understanding of inflammation in psoriasis beyond its dermatological manifestation, towards systemic inflammation. Management of possible comorbidities encompassing psychological, metabolic and cardiovascular disease is recommended in national and international dermatology guidelines for treatment of psoriasis patients. Vice versa, psoriasis is being recognized as a new risk factor for cardiovascular inflammation within the cardiological community. METHODS A review of the literature was conducted. Key points regarding epidemiological, mechanistic and management aspects were summarized and put into context for physicians treating psoriasis patients. RESULTS Efforts are currently being made to better understand the mechanistic underpinnings of systemic inflammation within psoriatic inflammation. Studies looking to "hit two birds with one stone" regarding specifically cardiovascular comorbidities of psoriasis patients using established systemic dermatological therapies have so far provided heterogeneous data. The diagnosis of psoriasis entails preventive and therapeutic consequences regarding concomitant diseases for the individual patient. CONCLUSIONS The knowledge of comorbidities in psoriasis calls for pronounced interdisciplinary care of psoriasis patients, to which this article highlights efforts regarding vascular inflammation and cardiovascular disease.
Collapse
Affiliation(s)
- Katharina S Kommoss
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ari Waisman
- Institute for Molecular Medicine, University Medical Center of Mainz, Mainz, Germany
- Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susanne Karbach
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
| | - Johannes Wild
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
| |
Collapse
|
11
|
Berna-Rico E, Abbad-Jaime de Aragon C, Garcia-Aparicio A, Palacios-Martinez D, Ballester-Martinez A, Carrascosa JM, De la Cueva P, Anton C, Azcarraga-Llobet C, Garcia-Mouronte E, De Nicolas-Ruanes B, Puig L, Jaen P, Mehta NN, Gelfand JM, Gonzalez-Cantero A. Cardiovascular Screening Practices and Statin Prescription Habits in Patients with Psoriasis among Dermatologists, Rheumatologists and Primary Care Physicians. Acta Derm Venereol 2023; 103:adv5087. [PMID: 36987537 PMCID: PMC10077140 DOI: 10.2340/actadv.v103.5087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Patients with psoriasis have a higher prevalence of cardiovascular risk factors. This study evaluated cardiovascular screening practices and statin prescribing habits among dermatologists, rheumatologists and primary care physicians (PCPs) through an online questionnaire, which was distributed through the Spanish scientific societies of the above-mentioned specialties. A total of 299 physicians (103 dermatologists, 94 rheumatologists and 102 PCPs) responded to the questionnaire. Of these, 74.6% reported screening for smoking, 37.8% for hypertension, 80.3% for dyslipidaemia, and 79.6% for diabetes mellitus. Notably, only 28.4% performed global screening, defined as screening for smoking, hypertension, dyslipidaemia, and diabetes mellitus by the same physician, and 24.4% reported calculating 10-year cardiovascular disease (CVD) risk, probably reflecting a lack of comprehensive cardiovascular risk assessment in these patients. This study also identified unmet needs for awareness of cardiovascular comorbidities in psoriasis and corresponding screening and treatment recommendations among PCPs. Of PCPs, 61.2% reported not being aware of the association between psoriasis and CVD and/or not being aware of its screening recommendations, and 67.6% did not consider psoriasis as a risk-enhancing factor when deciding on statin prescription. Thirteen dermatologists (12.6%) and 35 rheumatologists (37.2%) reported prescribing statins. Among those who do not prescribe, 49.7% would be willing to start their prescription.
Collapse
Affiliation(s)
- Emilio Berna-Rico
- Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | - Jose-M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. IGTP. Badalona, Spain
| | | | - Cristina Anton
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | | | - Lluis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Pedro Jaen
- Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Nehal N Mehta
- Laboratory of Inflammation & Cardiometabolic diseases, Cardiovascular Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Joel M Gelfand
- Department of Dermatology and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alvaro Gonzalez-Cantero
- Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
| |
Collapse
|
12
|
Terui H, Asano Y. Biologics for Reducing Cardiovascular Risk in Psoriasis Patients. J Clin Med 2023; 12:jcm12031162. [PMID: 36769825 PMCID: PMC9918118 DOI: 10.3390/jcm12031162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease with a high prevalence of cardiovascular disease (CVD), obesity, dyslipidemia, hypertension, diabetes mellitus, and metabolic syndrome. Among them, CVD is the most common cause of morbidity and mortality in psoriasis patients. Since CVD is associated with considerable morbidity and mortality, primary care clinicians are increasingly committed to reducing the risk of CVD in patients with psoriasis. Biologics targeting TNF-α, IL-12/23, and IL-17 are systemic therapies that can dramatically improve the condition of psoriasis. Recent studies have reported that these inflammatory cytokine signals may promote atherosclerosis, suggesting that biologics might be effective for improving psoriasis as well as reducing the risk of CVD. Here, we reviewed cardiovascular risk in psoriasis patients, the association between psoriatic inflammation and atherosclerosis, and the efficacy of biologics for reducing the risk of cardiovascular diseases.
Collapse
|
13
|
Mehta NN, Gelfand JM. Is It Prime Time for Statin Therapy in Psoriasis? J Invest Dermatol 2022; 142:1519-1522. [DOI: 10.1016/j.jid.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
|