I met a patient in the hospital where he was being treated for his coronary disease. I noticed that he had psoriasis, the inflammation and autoimmune disease that manifests itself in skin lesions.
“Are you seeing a dermatologist?” I asked the patient. “You really ought to get your psoriasis treated.”
“No, it’s not bothering me,” he said.
“You may not realize this, but the psoriasis may be making your heart disease worse,” I said.
There is a growing recognition of these “nontraditional risk factors” for heart disease. Patients may not realize it, and even many doctors may not realize it, but psoriasis is on the same cardiovascular risk list as smoking, high blood pressure, high cholesterol and obesity.
Psoriasis is not just a skin problem; it’s a systemic problem. The skin lesions are the visible signs, but that’s just what’s visible on the surface.
Dermatologists have known this for some time. Psoriasis is not just a skin problem; it’s a systemic problem. The skin lesions are the visible signs, but that’s just what’s visible on the surface. It’s an inflammatory and immune-mediated problem, and that’s the underlying condition that puts you at risk.
Research published last year made our argument much more convincing. Along with Alan Menter, MD, a dermatologist on the medical staff Baylor University Medical Center at Dallas, a group of researchers helped devise a study establishing that people with psoriasis were just as likely to have calcium buildup in their arteries as people with Type 2 diabetes, a well-known risk factor for heart disease and strokes. Both groups were five times more likely to have coronary calcification than healthy people in the same study.
Patients may not realize it, and even many doctors may not realize it, but it’s on the same cardiovascular risk list as smoking, high blood pressure, high cholesterol and obesity.
Coronary artery calcium (CAC), which is measured by a noninvasive scan, indicates whether plaque is present in the coronary arteries. Atherosclerosis, or plaque buildup, can be a silent killer because people often don’t know they have a problem until it causes a heart attack or stroke.
Related: Are you at risk for heart disease?
The study, published in the November 2016 issue of JAMA Dermatology, concluded that people with psoriasis may benefit from being screened for cardiovascular disease and treated if they have it.
For some people, that’s still a bit of a leap. Because the worse the psoriasis and the longer it’s untreated, the more a person is exposed to the risk of the inflammation. If a person is not willing to get treated because they’re not worried about how their elbows look, that’s one thing. But if they’re worried about it because they may have a heart attack, maybe there’s more incentive to treat it.
Psoriasis is just one of a number of inflammatory diseases. We are discovering that many of the inflammatory diseases (including rheumatoid arthritis and lupus) may also be associated with increased risk for cardiovascular disease.
The bottom line: Psoriasis may be thought of as a skin condition, but it’s not. If you have this, you may need to be treated by a dermatologist, not only so that you look and feel better, but because it may impact your long-term cardiovascular health.
About the author
Dr. Schussler is a general and interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas and Baylor University Medical Center. His interests include preventative cardiology, coronary stents, trans-radial (through the wrist) coronary intervention. More recently, his research has focused on non-invasive coronary imaging using CT scans, as well as robotic-assisted angioplasty. He is active on Twitter @Updock typically posting on new technologies and techniques in cardiology.