Psoriasis Poses Risk of Calcium Buildup in Arteries

It may not be breaking news to hear that cardiovascular complications often come along with plaque psoriasis, but a recent study does provide new evidence that may impact treatment guidelines. While the causal link between psoriasis and cardiovascular risk is not entirely clear, it is thought that chronic inflammation plays a significant role.   Much research has been devoted to investigating this link in order to identify ways to reduce the risk of cardiovascular problems among people with psoriasis.

What does the study tell us?

A recent study published in JAMA Dermatology by Dr. Bobbak Mansouri and colleagues takes this association a step further and compares the risk and indicators of cardiovascular complications not only in plaque psoriasis but also in type 2 diabetes (T2D). It makes sense to examine inflammatory and cardiovascular responses in these two diseases in a comparative study since people with psoriasis are at heightened risk of T2D in addition to cardiovascular disease.

This research shows that people with psoriasis may be at increased risk of moderate to severe calcium buildup in their arteries, a condition called atherosclerosis. Atherosclerosis, in turn, is an indicator of heart disease.

A deeper dive...

Specifically, the study compares coronary artery calcium (CAC) scores across 387 individuals at three outpatient clinics.  129 of these individuals had psoriasis (93% with plaque psoriasis) and no T2D or other inflammatory or cardiovascular conditions, 129 individuals had type 2 diabetes and no history of plaque psoriasis or other inflammatory or cardiovascular conditions, and the final group of 129 individuals were age- and sex-matched to the psoriasis and T2D individuals (what is called a matched cohort analysis), and had no history of either condition, nor any other cardiovascular or inflammatory diseases.  The study participants were 90% white, had no history of coronary heart disease, and had a mean age of roughly 51-52 years.

Hypertension and median triglyceride levels were higher in the T2D population, whereas elevated blood cholesterol and lipids (an indicator of atherosclerosis) was more common among patients with psoriasis.  CAC scores (which indicate calcium buildup in arteries that can lead to coronary heart disease) were higher in both the T2D population and the psoriasis population, compared to the healthy control group.  This result may come as no surprise, as many of us know that cardiovascular and inflammatory conditions often accompany T2D and psoriasis, however, the most interesting finding of the study comes when the investigators further analyzed these data.

CAC scores increased in both populations with the number of cardiovascular risk factors present, another finding that seems intuitive.  However, certain cardio-metabolic and cardiovascular risk factors were more strongly correlated in the psoriasis population than in people with T2D.  These risk factors included:  waist circumference, metabolic syndrome, high-density lipoprotein cholesterol levels, blood glucose levels, hypertension, and blood pressure. CAC scores for individuals with T2D were more strongly correlated to risk factors such as current smoking, low low-density lipoprotein cholesterol levels, regular exercise, and triglycerides.

While psoriasis is linked to heart disease risk, people with psoriasis tend to have a fewer number of heart disease risk factors compared to those with diabetes. When the researchers adjusted for these differences in risk factors, such as body mass index, the link between diabetes and coronary calcium build-up was no longer significant, but the link to psoriasis remained.

What's it all mean?

This result shows that psoriasis, on its own, can be a risk factor for atherosclerosis and other cardiovascular complications.  Regardless of body mass, or other variables, people with psoriasis had a greater chance of possessing higher amounts of arterial calcium buildup and thus increased risk of heart disease.

The researchers conclude:

“Psoriasis and type 2 diabetes share similar cardiovascular risk profiles, which may predispose patients to developing coronary atherosclerosis at a relatively young age.  These findings warrant early cardiovascular risk assessment and aggressive risk factor modification in those with moderate to severe psoriasis...”

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