Could Psoriasis Raise the Risk of Stroke and Heart Attack?

More psoriasis on the skin may indicate more inflammation in the blood vessels, which could lead to a higher risk of stroke and heart attack, according to a new study.

“The finding that vascular inflammation is directly related to the amount of skin disease suggests that what is being observed on the skin is mirrored in the blood vessels,” says senior study author Nehal N. Mehta, MD, MSCE, chief of the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute in Bethesda, Md.
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“Furthermore, the relationship changed very little after adjustment for cardiac risk factors, suggesting that psoriasis may independently predispose to accelerated atherosclerosis,” he says.

Mehta and his colleagues examined 60 adults with psoriasis and 20 without psoriasis to determine whether the severity of this chronic inflammatory skin disease impacts inflammation in the blood vessels.

All of the study participants were at low risk for cardiovascular disease based on a traditional risk assessment. They underwent a nuclear scan that measured blood vessel inflammation, and were assessed by a dermatologist to determine the severity of their psoriasis.

Severity ranged from mild forms of psoriasis that involved only a few patches affecting less than 3% of the skin surface to severe forms where patches covered more than 10% of the skin surface. Researchers found that the most extensive forms of psoriasis were associated with a 51% increase in blood vessel inflammation.

Mehta says it’s important that health care providers be made aware of the increased risk of heart attack and stroke in psoriasis to improve preventive care.

“They should educate and screen patients with psoriasis for traditional cardiac risk factors, including measurement of a seated blood pressure, height/weight to assess for obesity, and blood tests for cholesterol and glucose,” he says. “This will provide the largest potential reduction in future events for this high-risk population.”

Mehta and his colleagues have plans to continue investigating the relationship between skin disease and vascular disease.

“This was an important initial study to demonstrate that skin disease severity directly relates to vascular disease severity,” Mehta says. “Ongoing research is focusing on assessing treatment of skin disease and potential effects on vascular diseases as well as whether very mild skin disease is associated with cardiometabolic risk.”

Researchers are currently completing the Vascular Inflammation in Psoriasis (VIP) study, an ongoing randomized clinical trial that is testing the hypothesis that aggressive treatment of skin disease may decrease blood vessel inflammation.

—Colleen Mullarkey

Reference

Naik HB, Natarajan B, Stansky E, Ahlman MA, Teague H, Salahuddin T, et al. Severity of psoriasis associates with aortic vascular inflammation detected by FDG PET/CT and neutrophil activation in a prospective observational study. Arterioscler Thromb Vasc Biol. 8 October 2015. [Epub ahead of print].