Psoriasis Disease Duration and Cardiovascular Risk
Psoriasis vulgaris is associated with systemic comorbid conditions, including diabetes, metabolic syndrome, coronary artery disease, and myocardial infarction (MI).[1] This has led to the concept of the "psoriatic march,"—psoriasis as a chronic inflammatory condition driving cardiovascular disease (CVD).[2,3] Furthermore, patients with moderate-to-severe psoriasis treated with tumor necrosis factor (TNF)-alpha inhibitors showed reductions in the proinflammatory marker C-reactive protein level and arterial intima-media thickness[4,5]—both surrogate markers for CVD.
Because vascular inflammation in patients with psoriasis correlates with disease severity,[6] it stands to reason that it might also correlate with disease duration. In this context, Egeberg and colleagues[7] hypothesized a relationship between psoriasis vulgaris duration, vascular inflammation, and major adverse cardiovascular events (MACE) such as MI, ischemic stroke, or death due to CVD. They investigated this link with two approaches:
A National Institutes of Health (NIH) human imaging study (18-fluorodeoxyglucose PET/CT scan; n=190 patients with mild-to-moderate psoriasis) to assess vascular inflammation; and
A Danish population-based study of CVD events in patients with moderate-to-severe psoriasis(n = 87,161) vs a control group (n = 4,321,964). The primary outcome measure in this cohort was the first occurrence of a MACE.
Both the imaging study and population-based cohort analysis showed that patients with psoriasis had an increased prevalence of CVD risk and that this risk worsened with disease duration.
