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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.
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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
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2
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Mourino-Alvarez L, Perales-Sanchez I, Berna-Rico E, Abbad-Jaime de Aragon C, Corbacho-Alonso N, Sastre-Oliva T, Juarez-Alia C, Ballester-Martinez A, Castellanos-Gonzalez M, Llamas-Velasco M, Jaen P, Solis J, Fernandez-Friera L, Mehta NN, Gelfand JM, Barderas MG, Gonzalez-Cantero A. Association of the Complement System with Subclinical Atherosclerosis in Psoriasis: Findings from an Observational Cohort Study. J Invest Dermatol 2024; 144:1075-1087.e2. [PMID: 38036288 DOI: 10.1016/j.jid.2023.10.031] [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] [Received: 05/29/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023]
Abstract
Psoriasis is a chronic and inflammatory disease that affects the skin and joints and is associated with multiple comorbidities and cardiovascular risk factors. Consequently, patients with psoriasis have an increased risk of cardiovascular diseases such as atherosclerosis, a chronic pathology that shares common inflammatory and immune-response mechanisms with psoriasis, including vascular inflammation and complement activation. To better understand the relationship between atherosclerosis and psoriasis, a proteomics study followed by a bioinformatics analysis was carried out, with a subsequent validation step using ELISA and western blotting. When the plasma from patients with psoriasis alone was compared with that from patients with psoriasis and atherosclerosis, 31 proteins of interest related to the complement system and oxygen transport were identified. After the validation phase, 11 proteins appeared to define the presence of subclinical atherosclerosis in patients with psoriasis, indicating the importance of complement cascades in the development of atherosclerotic plaques in individuals with psoriasis. These results are a step forward in understanding the pathological pathways implicated in the cardiovascular risk associated with this population, which may represent an interesting starting point for developing predictive tools that improve the follow-up of these patients and design more effective therapies.
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Affiliation(s)
- Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain
| | - Inés Perales-Sanchez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain
| | - Emilio Berna-Rico
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Carlota Abbad-Jaime de Aragon
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain
| | - Cristina Juarez-Alia
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain
| | - Asunción Ballester-Martinez
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Pedro Jaen
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Jorge Solis
- Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain; Atria Clinic, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Leticia Fernandez-Friera
- Atria Clinic, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain
| | - Neha N Mehta
- Department of Cardiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain; Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, IDISCAM, Toledo, Spain.
| | - Alvaro Gonzalez-Cantero
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
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3
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Berna-Rico E, Abbad-Jaime de Aragon C, Ballester-Martinez A, Perez-Bootello J, Solis J, Fernandez-Friera L, Llamas-Velasco M, Castellanos-Gonzalez M, Barderas MG, Azcarraga-Llobet C, Garcia-Mouronte E, de Nicolas-Ruanes B, Naharro-Rodriguez J, Jaen-Olasolo P, Gelfand JM, Mehta NN, Gonzalez-Cantero A. Monocyte-to-High-Density Lipoprotein Ratio Is Associated with Systemic Inflammation, Insulin Resistance, and Coronary Subclinical Atherosclerosis in Psoriasis: Results from 2 Observational Cohorts. J Invest Dermatol 2024:S0022-202X(24)00174-X. [PMID: 38460808 DOI: 10.1016/j.jid.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/11/2024]
Abstract
Systemic inflammation or insulin resistance drive atherosclerosis. However, they are difficult to capture for assessing cardiovascular risk in clinical settings. The monocyte-to-high-density lipoprotein ratio (MHR) is an accessible biomarker that integrates inflammatory and metabolic information and has been associated with poorer cardiovascular outcomes. Our aim was to evaluate the association of MHR with the presence of subclinical atherosclerosis in patients with psoriasis. The study involved a European and an American cohort including 405 patients with the disease. Subclinical atherosclerosis was assessed by coronary computed tomography angiography. First, MHR correlated with insulin resistance through homeostatic model assessment for insulin resistance, with high-sensitivity CRP and with 18F-fluorodeoxyglucose uptake in spleen, liver, and bone marrow by positron emission tomography/computed tomography. MHR was associated with both the presence of coronary plaques >50% of the artery lumen and noncalcified coronary burden, beyond traditional cardiovascular risk factors (P < .05). In a noncalcified coronary burden prediction model accounting for cardiovascular risk factors, statins, and biologic treatment, MHR added value (area under the curve base model = 0.72 vs area under the curve base model plus MHR = 0.76, P = .04) within the American cohort. These results suggests that MHR may detect patients with psoriasis who have subclinical burden of cardiovascular disease and warrant more aggressive measures to reduce lifetime adverse cardiovascular outcomes.
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Affiliation(s)
- Emilio Berna-Rico
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
| | - Carlota Abbad-Jaime de Aragon
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Asuncion Ballester-Martinez
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Javier Perez-Bootello
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jorge Solis
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Cardiology, Atria Clinic, Madrid, Spain; Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain; Facultad HM Hospitales de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernandez-Friera
- Department of Cardiology, Atria Clinic, Madrid, Spain; Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain; Facultad HM Hospitales de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, Spain
| | - Carlos Azcarraga-Llobet
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Emilio Garcia-Mouronte
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Belen de Nicolas-Ruanes
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jorge Naharro-Rodriguez
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Pedro Jaen-Olasolo
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nehal N Mehta
- Department of Cardiology, George Washington Medical Center, Washington, District of Columbia, USA
| | - Alvaro Gonzalez-Cantero
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
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4
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Mehta NN. How Much More Evidence Do We Need before Becoming Proactive about Cardiovascular Disease in Psoriasis? J Invest Dermatol 2023; 143:1859-1862. [PMID: 37739762 DOI: 10.1016/j.jid.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Nehal N Mehta
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA; Department of Medicine, Penn Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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Abbad-Jaime de Aragón C, Berna-Rico E, Ballester-Martinez MA, Jaén P, Solís J, Barderas MG, Fernández-Friera L, N Mehta N, Gelfand JM, González-Cantero Á. Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis (EDSAP): protocol for an observational, single-centre, prospective cohort study. BMJ Open 2023; 13:e072455. [PMID: 37751953 PMCID: PMC10533786 DOI: 10.1136/bmjopen-2023-072455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/16/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Life expectancy of patients with psoriasis is reduced by 4-5 years due to cardiovascular disease with an increased risk of myocardial infarction at an earlier age compared with the general population. This increased risk is independent of traditional cardiovascular risk factors and higher in moderate-to-severe forms of psoriasis. Inflammation may play a key role in the development of atherosclerosis in these patients. METHODS AND ANALYSIS A prospective cohort study, Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis (EDSAP), was initiated in January 2020 to investigate the presence and progression of subclinical atherosclerosis in patients with psoriasis. 120 patients aged 30-65 years and eligible for biological treatment have been recruited at Hospital Ramón y Cajal in Madrid, Spain. Patients undergo a baseline visit, and 1-year follow-up visit after starting biological therapy. Each visit includes: assessment of cardiovascular risk factors, screening for subclinical atherosclerosis by two-dimensional/three-dimensional ultrasound of carotid and femoral arteries, cardiac CT of coronary arteries and blood sampling. All baseline visits were completed by December 2022, and the remaining follow-up visits will be concluded by the end of 2023. The EDSAP study aims to identify new molecular and imaging markers associated with the presence of atherosclerosis and its progression in a chronic inflammatory state such as psoriasis. This has the potential to: (1) help improve primary cardiovascular prevention strategies in these patients; (2) understand the effect of biological drugs on the cardiovascular system; and (3) serve as a model for understanding atherosclerosis in other chronic inflammatory diseases. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Review Board of the Hospital Ramón y Cajal in Madrid. We will present our findings at national and international congresses, and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05858099.
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Affiliation(s)
| | | | | | - Pedro Jaén
- Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jorge Solís
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Atria Clinic, Madrid, Spain
| | - María G Barderas
- Vascular Physiopathology, Hospital Nacional de Parapléjicos, IDISCAM, Toledo, Spain
| | - Leticia Fernández-Friera
- Cardiology, Atria Clinic, Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares HM CIEC, HM Hospitales, Madrid, Spain
| | - Nehal N Mehta
- Cardiology, George Washington Medical Center, Washington, DC, USA
| | - Joel M Gelfand
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Álvaro González-Cantero
- Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Comunidad de Madrid, Spain
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6
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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.
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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
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7
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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.
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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.
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8
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:577-579. [DOI: 10.1093/eurjpc/zwac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/13/2022]
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9
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Zhou W, Dey A, Manyak G, Teklu M, Patel N, Teague H, Mehta NN. The application of molecular imaging to advance translational research in chronic inflammation. J Nucl Cardiol 2021; 28:2033-2045. [PMID: 33244675 PMCID: PMC8149483 DOI: 10.1007/s12350-020-02439-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/17/2020] [Indexed: 01/23/2023]
Abstract
Over the past several decades, molecular imaging techniques to assess cellular processes in vivo have been integral in advancing our understanding of disease pathogenesis. 18F-fluorodeoxyglucose (18-FDG) positron emission tomography (PET) imaging in particular has shaped the field of atherosclerosis research by highlighting the importance of underlying inflammatory processes that are responsible for driving disease progression. The ability to assess physiology using molecular imaging, combining it with anatomic delineation using cardiac coronary angiography (CCTA) and magnetic resonance imaging (MRI) and lab-based techniques, provides a powerful combination to advance both research and ultimately clinical care. In this review, we demonstrate how molecular imaging studies, specifically using 18-FDG PET, have revealed that early vascular disease is a systemic process with multiple, concurrent biological mechanisms using inflammatory diseases as a basis to understand early atherosclerotic mechanisms in humans.
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Affiliation(s)
- Wunan Zhou
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
- Cardiovascular Branch, NHLBI, 10 Center Drive, CRC, Room 5-5140, Bethesda, MD, 20892, USA
| | - Amit Dey
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Grigory Manyak
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Meron Teklu
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Nidhi Patel
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Heather Teague
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
- Cardiovascular Branch, NHLBI, 10 Center Drive, CRC, Room 5-5140, Bethesda, MD, 20892, USA.
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