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- Presentation
Psoriasis and Cardiovascular Risk: Screening, Inflammation, and Comprehensive Care
Description
The talk emphasized that psoriasis is a systemic inflammatory disease associated with increased cardiovascular risk across all severities, with higher relative risk in younger patients and higher absolute risk as age increases. It reviewed evidence linking psoriasis to diabetes, mortality, diffuse arterial inflammation, and atherosclerosis, and explained that shared inflammation, genetics, and traditional risk factors likely connect psoriasis and cardiovascular disease in a bidirectional way. The speaker highlighted that while some observational studies suggest certain treatments may help, randomized trial data have not shown psoriasis therapies to reduce cardiovascular events; interleukin-1 beta and colchicine were discussed as examples from cardiology research, while methotrexate showed no benefit. The key practical message was that dermatologists should routinely educate, screen, and coordinate care by checking blood pressure, lipids, and diabetes risk, considering statins or cardiology referral when indicated, and collaborating with primary care or preventive cardiology because cardiovascular risk is often under-screened in psoriasis patients. Comprehensive care, aggressive management of modifiable risk factors, and awareness that better control of inflammation may matter for long-term health were presented as central takeaways.
View moreConclusions
- Psoriasis is associated with a higher risk of cardiovascular disease, and that risk rises with greater skin disease severity.
- Relative cardiovascular risk is greatest in younger patients with psoriasis, but the absolute event burden increases with age.
- Psoriasis appears to be a systemic inflammatory disease with diffuse arterial inflammation and atherosclerotic changes, not just a skin disorder.
- Shared inflammation, genetics, and metabolic risk factors likely explain much of the psoriasis–cardiovascular disease connection, and the relationship may be bidirectional.
- Psoriatic disease is also linked to higher risks of diabetes, hypertension, dyslipidemia, chronic kidney disease, and mortality.
- Higher body surface area and higher PASI scores are associated with worse cardiovascular and metabolic outcomes.
- Residual systemic inflammation, such as elevated CRP, predicts major cardiovascular events and mortality even when traditional risk factors are controlled.
- Current psoriasis therapies have not been proven in randomized trials to reduce cardiovascular events overall.
- Among biologics and targeted therapies, evidence is mixed, with no clear class-wide cardiovascular benefit and no basis for choosing therapy primarily to lower heart risk.
- Interleukin-1 beta inhibition and colchicine have shown cardiovascular benefit in dedicated cardiovascular trials, whereas methotrexate has not.
- Genetic data suggest cardiovascular disease may contribute to psoriasis risk more than psoriasis genetics contribute to cardiovascular disease risk.
- Preventive care for psoriasis should focus on routine screening and aggressive management of modifiable cardiovascular risk factors rather than assuming skin treatment alone lowers risk.
- Dermatologists should educate patients, check blood pressure, lipids, and diabetes risk, and collaborate with primary care or preventive cardiology.
- Cardiovascular risk is frequently under-screened in psoriasis patients, especially those with more severe disease.
- Care-coordination models can make cardiovascular screening feasible in dermatology settings and uncover previously undiagnosed risk.
- The overall recommendation is to treat psoriasis as a systemic disease and provide comprehensive, guideline-based cardiovascular risk reduction alongside skin care.
- Gelfand JM, Song WB, Langan SM, Garshick MS. Nat Rev Cardiol. 2024 Nov 13.
- Gelfand JM et al. Autoimmune diseases and cardiovascular risk. Trends Mol Med. 2022;28(12):1025-1027.#10.1016/j.molmed.2022.10.007
- Liu L et al Front Cardiovasc Med. 2022 Mar 25;9:829709.
- Svedbom A and Ståhle J Eur Acad Dermatol Venereol. 2023;37:1841–1847.
- Gelfand JM, Song WB, Langan SM, Garshick MS. Cardiodermatology: the heart of the connection between the skin and cardiovascular disease. Nat Rev Cardiol. 2024 Nov 13.#10.1038/s41569-024-01097-9
- Ridker PM et al The Lancet, Volume 401, Issue 10384, 2023, Pages 1293-1301.
- Nakamura Y and Gallo RL in the Journal of Clinical Investigation, 2024.
- Budu-Aggrey A, Paternoster L. J Invest Dermatol. 2019 Jul;139(7):1416-1421.e1.
- Suruki RY et al Rheumatology (Oxford). 2022;61(8):e236-e237.
- Geiger J, et al J Rheumatol. 2025 Nov 1; rheum.2025-0446.
- Ytterberg SR, et al., New England Journal of Medicine, 2022.
- Elmets, Leonardi, Davis, and Gelfand in JAAD 2019.
- Song, WB, Soffer, DE, Gelfand, JM. Dermatologic Clinics, 2024, https://doi.org/10.1016/j.det.2024.02.008.#10.1016/j.det.2024.02.008
- Song et al., Gelfand JM, Journal of Investigative Dermatology 2023.
- Decicco et al., American Journal of Preventive Cardiology 2023.
- Takeshita et al., JAMA Dermatology 2015.
- Neopaney et al., Gelfand JM ISID Tokyo May 2023.
- Song W et al., Gelfand JID 2024 Jan 4:S0022-202X(23)03196-2.