Cardiovascular
Psoriasis: Why severe cases can raise the risk of heart disease
Sep
- Researchers report that people with severe psoriasis have a higher risk of heart disease.
- They note that typical scans for heart disease do not show blockages in the small blood vessels.
- They say it is important for people with impaired blood flow to aggressively target heart disease risk factors.
In the most extensive study to date to look at coronary blood flow and the link between psoriasis and heart disease, scientists reported a high prevalence of coronary microvascular dysfunction in more than 30% of people with psoriasis who had no symptoms of cardiovascular disease.
Those findings were published today in the Journal of Investigative Dermatology.
The researchers specifically looked at the coronary microvascular system and examined how much the small blood vessels could expand to allow for uninterrupted blood flow, called coronary reserve flow.
They reported that inflammation seems to decrease blood flow.
For the study, 503 people with psoriasis but without a diagnosis of cardiovascular disease underwent a Doppler echocardiogram to evaluate coronary microcirculation. More than 30% of participants had undiagnosed coronary microvascular dysfunction.
Previous studies have shown that people with severe psoriasis have increased cardiovascular morbidity and mortality. Still, there has been limited research on the mechanisms underlying the increased risk.
The researchers note there is growing evidence of inflammatory diseases, including psoriasis, psoriatic arthritis, rheumatoid arthritis, and inflammatory bowel disease, with a higher prevalence of endothelial and cardiovascular microvascular dysfunction in the absence of clinically apparent cardiovascular disease.
The researchers for this study wanted to further investigate the connection between psoriasis and coronary microvascular dysfunction.
Based on the study results, they determined that systemic inflammation plays a role in the development of coronary microvascular dysfunction, but there was no association with tobacco use, hyperlipidemia, or diabetes, all of which are typical risk factors for heart disease.
They said the study shows that inflammation interferes with many bodily processes.
“In this one, the inflammatory molecules in the blood from psoriasis activity interfere with the ability of blood vessels to contract and expand,” said Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California who was not involved in the study.
“This is consistent with other information on autoimmune disorders,” Chen told Medical News Today.
“The main takeaway from this study is that severe psoriasis is associated with a high prevalence of coronary microvascular dysfunction, independent of conventional cardiovascular risk factors,” said Dr. Stefano Piaserico, an associate professor of dermatology at the University of Padua in Italy and one of the of study authors.
“Psoriasis severity, duration, and the presence of psoriatic arthritis were identified as significant predictors of reduced coronary flow reserve. This highlights the importance of considering inflammation and psoriasis-related factors when assessing cardiovascular risk in severe psoriasis patients,” Piaserico told Medical News Today.
Our blood goes through the aorta coronary arteries – the large blood vessels – and filters down to the small blood vessels, the microvascular system. After ensuring no blockage in the large blood vessels, the researchers focused on the microvascular system cells to find what caused the reduced blood flow.
“Coronary flow reserve is an integrated measure of both the coronary artery disease and the coronary microvascular dysfunction,” said Dr. Jessica Kaffenberger, a dermatologist who specializes in psoriasis at The Ohio State University Wexner Medical Center who was not involved in the study.
“If a patient has coronary artery disease with stenosis (so blood vessels obstructed), they would have a lower [coronary flow reserve],” she told Medical News Today. “Similarly, if there is a dysfunction of the coronary microcirculation (blood vessels impaired), there would be a decrease in [coronary reserve flow]. In this study, all the psoriasis patients were found to have impaired coronary microvascular function since their angio-CTs were all clear.”
Endothelial cells form a thin line in our blood vessels, regulating their relaxation and allowing them to expand and let the blood flow through.
“Endothelial cells can be damaged by psoriasis. Pro-inflammatory cytokines are released to help control inflammation in your body,” according to Dr. Michael Garshick, the director of the Cardio-Rheumatology Program, which is part of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart in New York.
“However, too many cytokines can lead to excess inflammation and cause damage and lead to psoriasis,” Garshick, who was not involved in the study, told Medical News Today.
You don’t need to rush out to find a cardiologist if you have psoriasis or another autoimmune disorder, experts say.
Although autoimmune disorders are risk factors, they do not automatically lead to heart disease, they note.
“You should get regular checkups with your primary care physician,” Chen said. “During your checkup, you should have your blood pressure tested, and your doctor could request a blood test to measure heart health markers, such as your cholesterol, which will let your doctor know if you need to see a cardiologist.”
For people with coronary microvascular dysfunction, it is essential to target all risk factors for heart disease aggressively, Garshick explained.
“Even if they are not related to [coronary microvascular dysfunction],” he said. “For example, the researchers found that smoking did not contribute to the risk. However, it is a risk factor for heart disease and you should still address it. Work with your cardiologist to aggressively target all risk factors that pertain to you.”
