Joel M. Gelfand, MD
Joel M. Gelfand, MD, associate professor of dermatology and epidemiology at Perelman School of Medicine, University of Pennsylvania, Philadelphia. He was senior author of a study published in Archives of Dermatology.
Earlier this year, I wrote about a study demonstrating that people with psoriasis are at higher risk for heart attack (see Daily Health News, March 6, 2007). Now another study has linked psoriasis to diabetes and atherosclerosis, the hardening and narrowing of the arteries that can lead to heart disease. According to Daily Health News contributing medical editor Andrew L. Rubman, ND, this has been seen anecdotically for years — but now there’s research to back it up.
Researchers in Israel conducted a case-controlled study that compared 46,095 patients with psoriasis with 1,579,037 patients without psoriasis. They found a significantly higher proportion of diabetes and atherosclerosis in psoriasis patients compared with the control group, even after adjusting for their age since that can be a factor. The study supports previous research that demonstrated an association between psoriasis and these medical conditions.
Does this study mean that people who have psoriasis should worry about diabetes and heart disease? Does psoriasis actually cause diabetes and heart disease, or vice versa? I asked Joel M. Gelfand, MD, MSCE, assistant professor of dermatology and medical director of the Clinical Studies Unit at the University of Pennsylvania Health System — and he said the cause/effect relationship isn’t yet clear. “Psoriasis is a classic model of an immune-mediated disease,” he said, adding that “the type of inflammation that leads to psoriasis is the same type that occurs in blood vessels leading to clogged arteries and heart attack, and also the type that leads to insulin resistance and diabetes.”
In other words, psoriasis is a visible manifestation of the same process — it’s on the skin, where you can see it, rather than in the blood vessels, where you can’t.
Even though it isn’t shown that psoriasis causes diabetes or heart disease, those with psoriasis, particularly if it is severe, should be aware of their potential increased risk for diabetes and heart disease and alert to the symptoms of these diseases. Since psoriasis is usually treated as a skin problem and many dermatologists do not screen for these medical conditions, it is important to see your primary care physician to evaluate your risk and monitor cardiovascular health.
Psoriasis is a complicated illness. And, like so many diseases, lifestyle is a factor. “Psoriasis sufferers ought to take a look at their risk factors that are modifiable,” said Dr. Gelfand. “Smoking and obesity are important risk factors for heart disease and diabetes. Many people who have psoriasis also smoke and become overweight over time, due to the burden of coping with the disease.”
A healthful lifestyle is the best way to reduce your risk for heart disease and diabetes, and it can also combat inflammation, notes Dr. Rubman. His advice on natural strategies: Get regular exercise and eat a nutritious diet that includes lots of fruits and vegetables and foods high in omega-3 fatty acids such as fish, borage or flaxseed oil, and avoid all foods that contain trans fats.
You may also benefit from relaxation techniques that reduce stress, such as meditation, yoga, deep breathing or listening to soothing music. “There is some data that shows that stress exacerbates psoriasis, but this may be a chicken and egg situation because having psoriasis can be very stressful,” said Dr. Gelfand. “Some studies show that relaxation techniques such as meditation not only help patients feel better, but also improve patients’ response to psoriasis treatments.”