Martyn-Simmons CL, Ranawaka RR, Chowienczyk P et al. Br J Dermatol 2011;164:26–32.
Patients with psoriasis are known to be at an increased risk of cardiovascular (CV) morbidity and mortality. Although this risk can be partially attributed to traditional CV risk factors in these patients, there is evidence that not all of the risk can be attributed to these factors. Here, the authors demonstrate that psoriasis per se is not a risk factor for CV disease.
There is compelling epidemiological evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular (CV) comorbidities such as myocardial infarction and stroke. The risk, although low in absolute terms, is significantly increased in these patients, especially in younger individuals. Interestingly, in older patients (age >50 years) the relative risk of CV morbidity attributable to psoriasis is negligible, probably because of a much larger contribution of traditional risk factors, including age itself. Further support for the notion that the autoinflammatory process in patients with psoriasis directly affects blood vessels arose from studies assessing endothelial function. It has been well documented that atherosclerosis is initiated by the damage to the endothelium and that very early atherosclerosis can be identified by measurement of flow-mediated artery dilation (FMAD). FMAD was previously found to be impaired in patients with psoriasis, indicating a direct effect of psoriasis on endothelial function.