Psoriasis and Cardiovascular Disease: Do Biologics Help Reduce Risk?

Long believed to be a skin disorder, psoriasis is now recognized as a chronic and systemic inflammatory disorder that affects multiple organ systems. Patients with psoriasis face elevated cardiovascular disease risks, including comorbidities like hypertension, and peripheral arterial disease, metabolic syndrome, diabetes, chronic kidney disease, and obesity.^1-6 The reasons for higher rates of MI among patients with psoriasis remain unclear. Psoriasis and psoriatic arthritis appear to have similar inflammatory pathways as atherosclerosis, however.^3,4

One recently-published study found that early age of onset of psoriasis (diagnosis at age 25 years or younger), advancing age, and male sex were all significant risk factors for myocardial infarction (MI).¹ Previous studies have estimated that psoriasis could be responsible for 11,000 cardiovascular events like MI and ischemic stroke each year in the United States, and 1200 deaths.^1,2

Some researchers have emphasized that patients with psoriasis (particularly people with severe cases) should be evaluated for cardiovascular disease, and encouraged to reduce their risks by avoiding tobacco use, reducing alcohol consumption, exercising at least three times per week for 30 minutes or more, monitoring and managing cholesterol levels, and losing weight if overweight or obese.⁷ 

There is also reason to suspect that biologic agents used to treat psoriasis might themselves help to reduce MI risk for these patients.^1,5,6 A meta-analysis that pooled data from more than 220,000 patients revealed that systematic therapies were associated with a reduced risk of cardiovascular events (risk ratio [RR], 0.75; 95% CI, 0.63-0.91; P=0.003).⁵ A five-year followup analysis of 6,902 patients in Denmark bolstered that finding; the authors reported that both methotrexate and tumor necrosis factor-alpha (TNFα) inhibitors, which block TNF cytokine signaling in inflammation pathways, were each independently associated with reduced cardiovascular events (odds ratios [ORs], 0.53 and 0.46, respectively).⁶ However, ustekinumab, an anti-IL-12/23 biologic, was not associated with reduced cardiovascular event rates.⁶