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Cardiovascular Mortality in Psoriasis and Psoriatic Arthritis: Epidemiology, Pathomechanisms, Therapeutic Implications, and Perspectives

  • PSORIATIC ARTHRITIS (O FITZGERALD AND P HELLIWELL, SECTION EDITORS)
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Abstract

Psoriasis and psoriatic arthritis are associated with an increased cardiovascular mortality. Although the underlying pathogenesis is not yet fully understood, it is clear that these seemingly organ-specific disorders cause a systemic inflammatory burden as mirrored by elevated biomarkers in the patients’ blood. Emerging evidence points toward insulin resistance and endothelial dysfunction as direct consequences; these in turn drive the process of atherosclerosis. As psoriasis and psoriatic arthritis therefore represent cardiovascular risk factors, they must be taken into account by primary care physicians when defining treatment goals for the comorbidities of the respective patients (e.g., arterial hypertension or dyslipidemia). Secondary and tertiary care physicians need to consider a more comprehensive treatment approach, including aspects of lifestyle intervention. Finally, effective long-term anti-inflammatory, disease-modifying therapy may contribute to reducing patients’ cardiovascular risk.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Schön MP, Boehncke WH. Psoriasis. New Engl J Med. 2005;352:1899–912.

    Article  PubMed  Google Scholar 

  2. • Suárez-Fariña M, Fuentes-Duculan J, Lowes MA, Krueger JG. Resolved psoriasis lesions retain expression of a subset of disease-related genes. J Invest Dermatol. 2011;131:391–400. This study documented abnormal genetic expression in psoriatic skin after successful treatment, turning it clinically normal. It therefore provides evidence for a “molecular scar” after clearance of a psoriatic plaque..

    Article  Google Scholar 

  3. Abuabara K, Azfar RS, Shin DB, et al. Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K. Br J Dermatol. 2010;163:586–92.

    Article  PubMed  CAS  Google Scholar 

  4. Roifman I, Beck PL, Eisenberg MJ, Genest J. Chronic inflammatory diseases and cardiovascular risk: a systematic review. Can J Cardiol. 2011;27:174–82.

    Article  PubMed  Google Scholar 

  5. Gladman DD, Farewell VT, Wong K, Husted J. Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death. Arthritis Rheum. 1998;41:1101–3.

    Article  Google Scholar 

  6. Prey S, Paul C, Bronsard V, et al. Cardiovascular risk factors in patients with psoriasis: a systematic review of epidemiological studies. J Eur Acad Dermatol Venereol. 2010;24 Suppl 2:23–30.

    Article  PubMed  Google Scholar 

  7. Mallbris L, Akre O, Granath F, et al. Increased cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol. 2004;9:225–30.

    Google Scholar 

  8. Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735–41.

    Article  PubMed  CAS  Google Scholar 

  9. Ludwig RJ, Herzog C, Rostock A, et al. Psoriasis: a possible risk factor for development of coronary artery calcification. Br J Dermatol. 2007;156:271–6.

    Article  PubMed  CAS  Google Scholar 

  10. • Brauchli YB, Jick SS, Miret M, Meier CR. Psoriasis and risk of incident myocardial infarction, stroke or transient ischemic attack: an inception cohort study with a nested case–control analysis. Br J Dermatol. 2009;160:1048–56. This study, together with the study by Prodanovich et al. [11•], allows us to estimate the OR for cardiovascular disease in patients with PSO; their risk is increased by more than 50 %..

    Article  PubMed  CAS  Google Scholar 

  11. • Prodanovich S, Kirsner RS, Kravetz JD, et al. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009;145:700–3. This study, together with the study by Brauchli et al. [10•], allows us to estimate the OR for cardiovascular disease in patients with PSO; their risk is increased by more than 50 %..

    Article  PubMed  Google Scholar 

  12. Wakkee M, Herings RM, Nijsten T. Psoriasis may not be an independent risk factor for acute ischemic heart disease hospitalizations: results of a large population-based Dutch cohort. J Invest Dermatol. 2010;130:962–7.

    Article  PubMed  CAS  Google Scholar 

  13. Gladman DD, Ang M, Su L, et al. Cardiovascular mortality in psoriatic arthritis. Ann Rheum Dis. 2009;68:1131–5.

    Article  PubMed  CAS  Google Scholar 

  14. Costa L, Caso F, D’Elia L, et al. Psoriatic arthritis is associated with increased arterial stiffness in the absence of known cardiovascular risk factors: a case control study. Clin Rheumatol. 2011. doi:10.1007/s10067-011-1892-1.

  15. Hürlimann D, Forster A, Noll G, et al. Anti-tumor necrosis factor-alpha treatment improves endothelial function in patients with rheumatoid arthritis. Circulation. 2002;106:2184–7.

    Article  PubMed  Google Scholar 

  16. Popa C, van Tits LJ, Barrera P, et al. Anti-inflammatory therapy with tumour necrosis factor alpha inhibitors improves high-density lipoprotein cholesterol antioxidative capacity in rheumatoid arthritis patients. Ann Rheum Dis. 2009;68:868–72.

    Article  PubMed  CAS  Google Scholar 

  17. Gisondi P, Tessari G, Conti A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case–control study. Br J Dermatol. 2007;157:68–73.

    Article  PubMed  CAS  Google Scholar 

  18. •• Boehncke WH, Boehncke S, Schoen MP. Managing comorbid disease in patients with psoriasis. BMJ. 2010;340:b5666. doi:10.1136/bmj.b5666. This paper summarizes action items to provide a more comprehensive approach to managing patients suffering from PSO/PsA, considering their comorbidities and comedication..

    Article  PubMed  Google Scholar 

  19. • Boehncke W-H, Boehncke S, Tobin A-M, Kirby B. The “psoriatic march”: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011;20:303–7. This is a comprehensive review on studies focusing on pathogenetic links between PSO and cardiovascular disease, putting all these findings together into a concept. It clearly defines aspects that are up for debate and summarizes the current research agenda in the field..

    Article  PubMed  Google Scholar 

  20. Coimbra S, Oliveira H, Reis F, et al. C-reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. J Eur Acad Dermatol. 2010;24:789–96.

    Article  CAS  Google Scholar 

  21. Detmar M, Brown LF, Claffey KP, et al. Overexpression of vascular permability factor/vascular endothelail growth factor and its receptors in psoriasis. J Exp Med. 1994;180:1141–6.

    Article  PubMed  CAS  Google Scholar 

  22. Ludwig RJ, Schultz JE, Boehncke WH, et al. Activated, not resting, platelets increase leukocyte rolling in murine skin utilizing distinct sets of adhesion molecules. J Invest Dermatol. 2004;122:830–6.

    Article  PubMed  CAS  Google Scholar 

  23. Garbaraviciene J, Diehl S, Varwig D, et al. Platelet P-selectin reflects a state of cutaneous inflammation: possible application to monitor treatment efficacy in psoriasis. Exp Dermatol. 2010;19:736–41.

    Article  PubMed  CAS  Google Scholar 

  24. Boehncke S, Thaci D, Beschmann H, et al. Psoriasis patients show signs of insulin resistance. Br J Dermatol. 2007;157:1249–51.

    Article  PubMed  CAS  Google Scholar 

  25. Cerman AA, Bozkrut S, Sav A, et al. Serum leptin levels, skin leptin and leptin receptor expression in psoriasis. Br J Dermatol. 2008;159:820–6.

    Article  PubMed  CAS  Google Scholar 

  26. Ucak S, Ekmekci TR, Basat O, et al. Comparison of various insulin sensitivity indices in psoriasis patients and their relationship with type of psoriasis. J Eur Acad Dermatol Venerol. 2006;20:517–22.

    Article  CAS  Google Scholar 

  27. Ursini F, Succurro E, Grembiale A, et al. Sudden progression from impaired glucose tolerance to type 2 diabetes after discontinuation of administration of anti-tumor necrosis factor-alpha antibody infliximab. Int J Immunopathol Pharmacol. 2010;23:961–3.

    PubMed  CAS  Google Scholar 

  28. Scherrer U, Randin D, Vollenweider P, et al. Nitric oxide release accounts for insulin’s vascular effects in humans. J Clin Invest. 1994;94:2511–5.

    Article  PubMed  CAS  Google Scholar 

  29. Dandona P, Aljada A, O’Donnell A, Dhinsda S, Garg R. Insulin is an anti-inflammatory and anti-atherosclerotic hormone. Metab Syndr Relat Disord. 2004;2:137–42.

    Article  PubMed  CAS  Google Scholar 

  30. Lago R, Gómez R, Lago F, Gómez-Reino J, Gualillo O. Leptin beyond body weight regulation—current concepts concerning its role in immune function and inflammation. Cell Immunol. 2008;252:139–45.

    Article  PubMed  CAS  Google Scholar 

  31. Verma S, Anderson T. Fundamentals of endothelial function for the clinical cardiologist. Circulation. 2002;105:546–9.

    Article  PubMed  CAS  Google Scholar 

  32. Sandvist M, Nyberg G, Hammarstedt A, et al. Low adipocyte IRS-1 protein expression is associated with an increased arterial stiffness in non-diabetic males. Atherosclerosis. 2005;180:119–25.

    Article  Google Scholar 

  33. Gisondi P, Fantin F, DelGiglio M, et al. Chronic plaque psoriasis is associated with increased arterial stiffness. Dermatology. 2009;218:110–3.

    Article  PubMed  Google Scholar 

  34. Ulusoy RE, Karabudak O, Yokusoglu M, et al. Noninvasive assessment of impaired endothelial function in psoriasis. Rheumatol Int. 2010;30:479–83.

    Article  PubMed  Google Scholar 

  35. Karadag AS, Yavoz B, Ertugrul DT, et al. Is psoriasis a pre-atherosclerotic disease? increased insulin resistance and impaired endothelial function in patients with psoriasis. Int J Dermatol. 2010;49:642–6.

    Article  PubMed  Google Scholar 

  36. Gonzales-Juanatay C, Llorca J, Miranda-Filloy JA, et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57:287–93.

    Article  Google Scholar 

  37. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.

    Article  PubMed  CAS  Google Scholar 

  38. Kimball AB, Gladman D, Gelfand JM, et al. National Psoriasis Foundation. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58:1031–42.

    Article  PubMed  Google Scholar 

  39. Friedewald VE, Cather JC, Gelfand JM, et al. AJC editor’s consensus: psoriasis and coronary artery disease. Am J Cardiol. 2008;102:1631–43.

    Article  PubMed  Google Scholar 

  40. • Dominguez P, Gladman DD, Helliwell P, et al. Development of screening tools to identify psoriatic arthritis. Curr Rheumatol Rep. 2010;12:295–9. This publication summarizes the current stage of developing questionnaires to screen for PsA. The availability of reliable, validated questionnaires is crucial to allow non-rheumatologists to serve as sentinels when it comes to the early diagnosis of this disease..

    Article  PubMed  Google Scholar 

  41. Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomini G. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque-stage psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr. 2008;88:1242–7.

    PubMed  CAS  Google Scholar 

  42. Kimball AB, Gieler U, Linder D, et al. Psoriasis: is the impairment to a patient’s life cumulative? J Eur Acad Dermatol. 2010;24:898–904.

    Google Scholar 

  43. Dixon WG, Watson KD, Lunt M, Hyrich KL, the British Society for Rheumatology Biologics Register Control Centre Consortium. Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2007;56:2905–12.

    Article  PubMed  CAS  Google Scholar 

  44. Prodanovich S, Ma F, Taylor JR, et al. Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis. J Am Acad Dermatol. 2005;52:262–7.

    Article  PubMed  Google Scholar 

  45. Strober B, Teller C, Yamauchi P, et al. Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis. Br J Dermatol. 2008;159:322–30.

    Article  PubMed  CAS  Google Scholar 

  46. •• Boehncke S, Fichtlscherer S, Salgo R, et al. Systemic therapy of plaque-type psoriasis ameliorates endothelial cell function: results of a prospective longitudinal pilot trial. Arch Dermatol Res. 2011;303:381–8. Using an invasive technique considered by many to be the gold standard to monitor cardiovascular risk, this study documents substantial improvement of endothelial function in PSO patients under continuous systemic therapy. It is the first to provide evidence from prospective observations that—similar to rheumatoid arthritis—such an approach may reduce cardiovascular mortality in PSO..

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Wolf-Henning Boehncke

  2. Department of Internal Medicine, Section of Endocrinology, Diabetes, and Metabolism, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Sandra Boehncke

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Correspondence to Wolf-Henning Boehncke.

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Boehncke, WH., Boehncke, S. Cardiovascular Mortality in Psoriasis and Psoriatic Arthritis: Epidemiology, Pathomechanisms, Therapeutic Implications, and Perspectives. Curr Rheumatol Rep 14, 343–348 (2012). https://doi.org/10.1007/s11926-012-0260-8

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  • DOI: https://doi.org/10.1007/s11926-012-0260-8

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