Psoriasis, a chronic inflammatory immune-mediated illness affecting approximately 1-3% of the global population, has long been associated with various health challenges. In the largest investigation of its kind, researchers have uncovered a strong link between severe psoriasis and a heightened risk of heart disease, specifically coronary microvascular dysfunction.
The study, published in Elsevier’s Journal of Investigative Dermatology, involved 503 psoriasis patients with no prior clinical cardiovascular issues. These individuals underwent transthoracic Doppler echocardiography to evaluate their coronary microcirculation. Astonishingly, more than 30% of asymptomatic patients in the study cohort exhibited signs of coronary microvascular dysfunction.
Lead investigator, Dr. Stefano Piaserico of the Dermatology Unit at the University of Padova, emphasized the significance of their findings. “Prior research has shown that individuals with severe psoriasis face an increased risk of cardiovascular morbidity and mortality. However, there has been limited research on the specific mechanisms behind this elevated risk, particularly concerning coronary microvascular dysfunction.”
The study revealed that psoriasis severity, as measured by the Psoriasis Area Severity Index (PASI) score, and the duration of the disease were independently associated with lower coronary flow reserve (CFR). Additionally, the presence of psoriatic arthritis was linked to reduced CFR. Surprisingly, conventional cardiovascular risk factors like tobacco use, hyperlipidemia, and diabetes mellitus were not independently associated with decreased CFR in severe psoriasis patients.
These findings underscore the importance of considering inflammation and psoriasis-related factors when assessing cardiovascular risk in individuals with severe psoriasis. The research sheds light on a potential mechanism through which psoriasis elevates the risk of cardiovascular complications, aligning with previous studies on chronic inflammatory conditions such as rheumatoid arthritis and systemic lupus erythematosus.
Dr. Piaserico urged healthcare providers to actively screen for microvascular dysfunction in psoriasis patients, particularly those with severe forms of the condition. “Early and effective treatment of psoriasis may restore microvascular function and potentially reduce the risk of myocardial infarction and heart failure associated with it,” he noted. While preliminary studies have indicated that certain treatments like biologics may restore coronary microvascular function, prospective studies are required to confirm these findings and their impact on cardiovascular events.
This study highlights the critical need for proactive diagnosis and treatment to mitigate the heightened cardiovascular risks faced by individuals with severe psoriasis. Understanding the role of inflammation and its implications for heart health is a vital step in improving the overall well-being of psoriasis patients.