The first thing you notice about psoriasis is the telltale skin rash, but the effects of this autoimmune disease are far from being only skin deep. Psoriasis has body-wide effects that can put your overall health at risk in many ways. Chief among them is cardiovascular disease (CVD). Here’s what you need to know and how you can protect yourself.
The psoriasis-CVD link
Though psoriasis was first identified in the 1800s, its effect on the cardiovascular system is a relatively recent discovery. While scientists suspected a link between psoriasis and CVD, proof came from studies using advanced imaging tests that detected vascular inflammation, the starting point for the kind of plaque that develops along artery walls. Think of it this way: Angry plaques on the outside represent systemic inflammation on the inside.
CVD includes heart disease, heart attack, and stroke. There is emerging evidence that psoriasis can also increase the risk of heart failure, peripheral artery disease (PAD), heart valve problems, and atrial fibrillation. What’s more, the more severe your psoriasis, the more severe—and the more accelerated—your CVD risk. Dr. Mehta’s research has found that these health problems start to develop as early as one’s 40s, a decade sooner than they do in people without psoriasis.
There is also a convincing body of evidence that chronic inflammation in the skin can increase the risk for metabolic syndrome, a condition characterized by high blood pressure, high blood sugar, and belly fat. All are independent, additional risk factors for heart disease. It’s worth noting that psoriasis has also been linked to depression, inflammatory bowel disease, and even certain cancers. In view of this, other inflammatory diseases, such as atopic dermatitis, are now also being recognized as whole-body diseases.
By the numbers
Compared with people without psoriasis, those with severe psoriasis and its complication psoriatic arthritis have a 1.5 to two times higher risk of heart attack and 1.5 times higher risk of stroke, PAD, and other forms of CVD.
Severe psoriasis is when just 10 percent of your skin surface has plaques. The palm of your hand is a good visual representation of 1 percent. Up to 3 percent is considered mild and between 3 and 10 percent is moderate. That being said, recent research suggests that even one skin plaque might be enough to drive inflammation.
The good news? Treating psoriasis helps: Clear the plaques on your skin and you can limit the plaque in your arteries.
Get treated for psoriasis
If you have (or suspect you have) psoriasis but haven’t seen a doctor, your first step is to be evaluated and treated, if needed. Many people still don’t appreciate that psoriasis is more than cosmetic. Nearly three-fourths of patients with severe psoriasis are untreated or undertreated and, in turn, underdiagnosed for cardiovascular risk factors.
Psoriasis treatment is based on severity and usually starts with a topical medication, if mild, or methotrexate, if moderate. Stronger psoriasis drugs, such as a TNF inhibitor and doctor-directed UVB phototherapy, improve psoriasis and also have profound impacts on inﬂammation in the blood, which should improve cardiovascular risk over time. TNF inhibitors may also improve insulin sensitivity and lower your diabetes risk. Phototherapy has also been shown to improve good cholesterol levels.
Get screened for CVD risks
If you’ve been diagnosed with psoriasis but haven’t been evaluated for CVD risk factors, get screened and get appropriate treatment. You may need to advocate for yourself: Encourage your health-care provider to consider psoriasis as the equivalent of diabetes when calculating your 10-year CVD risk.
After more than a decade of work by Dr. Mehta’s team and others, a 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline recognized psoriasis as a driver of inflammation and an independent risk factor for CVD for people with an intermediate 10-year risk.
In particular, you want to be checked for the “3 Bs”:
Blood pressure. High blood pressure must be taken seriously. Rsearch shows that despite having higher risks for cardiovascular diseases overall, people with psoriasis are less likely to have their blood pressure adequately controlled.
Blood tests. Both high cholesterol and high blood glucose need to be managed. The ACC/AHA guideline states that having psoriasis warrants the early initiation of a statin for adults ages 40 to 75 without diabetes and 10-year intermediate risk of CVD.
Body mass index. Obesity drives CVD and diabetes. Separately, psoriasis is often worse in people who are overweight.
Your goals for the three Bs may be stricter than for someone without psoriasis to help mitigate their effects.
The underlying message is that you can clear your psoriasis and protect your heart health in the process.
Help Yourself: Lifestyle Steps
You can lower your CVD risk over time by monitoring your diet and exercise. Let having psoriasis be a reminder to aim for these tried-and-true health goals:
- Exercise. Try to meet the weekly benchmark of 150 minutes by walking and/or swimming.
- Eat smart. Follow an AHA-approved diet with moderate carbohydrates, low fat, and low cholesterol.
- Keep a healthy body weight. When you lose weight, and fat in particular, psoriasis gets better. The catch-22 is that it can be very difficult to lose weight in a state of inflammation—work with your doctor to get your inflammation under control to make weight loss easier.