Unseen CV Risk Factors Common in Patients With Psoriasis

Jim Kling

October 31, 2011

October 31, 2011 — Patients with moderate to severe psoriasis have a high prevalence of undiagnosed cardiovascular (CV) risk factors, according to a study published online October 21 in the Journal of the American Academy of Dermatology.

Previous research has linked psoriasis with increased CV risk factors and with heightened risk for CV events. Associated risk factors include diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking. More severe psoriasis, such as cases that require systemic therapy, has been associated with even higher prevalence of risk factors.

One prospective study, after adjusting for CV risk factors, linked severe psoriasis to heightened risk for myocardial infarction, stroke, CV death, and overall mortality. These results suggest that psoriasis and atherosclerosis may share some biological pathways.

The researchers conducted a study to investigate the diagnosis and treatment of CV risk factors in patients with moderate to severe psoriasis. They consulted medical histories from 2899 patients who had participated in 3 phase III trials of ustekinumab, a monoclonal antibody that targets interleukin 12/interleukin 23p40.

The patient data included records on diabetes, hypertension, and hyperlipidemia, as well as fasting glucose, fasting lipids, and blood pressure values. The researchers also evaluated 10-year Framingham risk scores, as well as the number of patients who achieved glycemic, lipid, and blood pressure targets.

Of patients with moderate or severe psoriasis, 58.6% had 2 or more and 28.8% had 3 or more CV risk factors. Framingham scores indicated that 18.6% of patients were at high risk for CV events (95% confidence interval, 16.9% - 20.4%), and 12.3% (95% confidence interval, 13.2% - 16.7%) were at intermediate risk.

The researchers also found that some patients had preexisting conditions at baseline that had gone previously undiagnosed (diabetes, 2.3%; hypertension, 9.1%; hyperlipidemia, 4.9%). Other conditions, although known, were untreated at baseline (diabetes, 19.1%; hypertension, 21.8%; hyperlipidemia, 38.6%). Percentages of patients at treatment goal at the beginning of their respective studies were 59.6% for hypertension, 69.7% for hyperlipidemia, and 36.7% for diabetes.

The study was limited by the fact that it focused on participants in clinical trials, so the results may not be representative of the general population.

The study is important, says Stefan Weiss, MD, an instructor at the University of Miami School of Medicine in Florida, when asked for independent comment by Medscape Medical News. The belief underlying the research is that inflammatory processes that contribute to psoriasis may also contribute to CV risk, but that link remains to be proven, Dr. Weiss says. "The more important question is: If we decrease the inflammatory burden, using some of the newer medications, is it going to decrease the cardiovascular risk? They've done a lot of the retrospective work, but now we need to [study] it prospectively."

The study was supported by Centocor Research and Development Inc. The study authors have consulted for, received speakers' fees from, received travel reimbursement from, and/or received research funds from Abbott, Amgen, Centocor, Novartis, Idera, Pfizer, Biogen-Idec, Celgene, Forward Pharma, Janssen-Cilag, Leo Pharma, MSD, Wyeth, Basilea, Essex Pharma, Schering-Plough, UCB, Genentech, Serono, and Johnson & Johnson. Dr. Weiss has received research funding from a number of companies in the field, including Abbott, Centocor, and Amgen, and is on the medical board of the National Psoriasis Foundation.

J Am Acad Dermatol. Published online October 24, 2011. Abstract

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