MedWire News: Patients with moderate to severe psoriasis should be informed of their increased vascular risk and thoroughly assessed for risk factors, says an expert panel of dermatologists and cardiologists.
The consensus document is published in the current edition of the American Journal of Cardiology (AJC).
Cardiologist and AJC assistant editor Vincent Friedewald (University of Notre Dame, Indiana, USA) said: “It is a particularly interesting and unique document in that it bridges current knowledge from two medical disciplines – dermatology and cardiology – that rarely interrelate.”
The expert panel reviewed current evidence from the dermatology and cardiology fields, and produced a series of recommendations. It notes that a link between psoriasis and cardiovascular risk was first proposed in 1961, and that many subsequent studies have reinforced the link. The paper lists a number of possible mediating factors, giving particular attention to systemic inflammation.
The panelists recommend alerting patients to their raised vascular risk if they have moderate to severe psoriasis or mild psoriasis plus a recognized vascular risk factor, such as abdominal obesity or hypertension. Such patients should undergo thorough and regular vascular risk assessments.
The document sets out current treatment guidelines for vascular risk factors such as hyperlipidemia and hypertension. It also lays out which psoriasis therapies may increase vascular risk, and thus require careful monitoring. It includes the advice that anti-tumor necrosis factor drugs should be used “with caution” in patients with congestive heart failure.
Finally, the panelists detail their recommendations for future research.
“This consensus statement… calls for a new standard of care for patients with moderate to severe psoriasis,” commented dermatologist Joel Gelfand (University of Pennsylvania, Philadelphia, USA).
“Based on the evolving science, we recommend that patients with moderate to severe psoriasis be educated about the association of psoriasis and cardiovascular disease and that these patients receive appropriate screening and treatment of modifiable cardiovascular risk factors.”
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