By Warren R. Heymann, MD
Head, Division of Dermatology, Cooper University Hospital
It has been almost half a century since the world was introduced to the advertising campaign for Tegrin to treat “the heartbreak of psoriasis.” Who could have imagined at that time that patients would need to be vigilant about the health of their heart when dealing with the red, scaly lesions of psoriasis?
Psoriasis is a common skin disease that affects approximately 2 percent of the population. The characteristic feature is the presence of raised plaques with redness and scaling. Lesions usually affect the scalp, elbows and knees, although any part of the body may be affected. In severe cases, practically the whole body surface area may be involved. While patients are usually well, many often have associated arthritic complaints. The effect on a patient’s quality of life may be profound, indeed resulting in “heartbreak” for many affected individuals.
Much has been learned about the cause of psoriasis, although the precise mechanism that leads to the disease remains to be defined. It is now considered to be due to abnormalities of the immune system in genetically predisposed patients. The disease may be triggered by stress, certain medications, or following infections such as a streptococcal sore throat.
Psoriasis has been in the news because of what have been called “co-morbidities” – other conditions that may be associated in patients with psoriasis. Severe psoriasis has been linked with obesity, smoking, diabetes, hypertension (high blood pressure), hyperlipidemia (high concentration of fats [lipids] in the blood), coronary artery disease, and stroke.
The basis of risk for cardiovascular events is presumably due to the effect of chronic, ongoing inflammation. Any such inflammatory process may be a predisposing factor for what is called a “hypercoagulable” state, which leads to an increased chance of clotting.
Are patients with psoriasis really at risk for cardiovascular events such as a stroke or heart attack? A sense of perspective is necessary. First, most of these studies only demonstrate a risk for those patients with severe psoriasis (those patients with disease involving a large portion of the body surface area who require systemic treatments to get the disease under control). The latest studies suggest about a 6 percent chance of these events. It must be emphasized that a relative risk is that alone–a risk, not an inevitable event. Patients with psoriasis should not stress about these risks, as stress itself may aggravate psoriasis.
The most important recommendation for patients with psoriasis is to try to live a healthy lifestyle by discontinuing smoking, maintaining a normal weight, and exercising. Patients should speak with their primary doctor about being screened for diabetes, hypertension, and hyperlipidemia.
It remains to be determined whether treating psoriasis will have any effect on decreasing the risk of a cardiovascular event. What is clear, however, is that by controlling as many known cardiovascular risk factors as possible, the chance of developing a life-threatening heart attack or stroke will be much less likely.
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This article first appeared in the Courier-Post.
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