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Psoriasis, Psoriatic Arthritis, and Heart Disease: Understanding the Connection

Posted on December 20, 2021
Article written by
Joan Grossman

Psoriasis and psoriatic arthritis (PsA) are associated with an increased risk of heart disease. People with either of these conditions are between 1.5 and 2 times more likely than the general population to develop heart disease. The risk is highest for people with severe psoriasis or PsA. Heart disease is a significant comorbidity — or a disease that occurs alongside another disease — for people with psoriasis and PsA.

Psoriasis is an autoimmune skin disease caused by an overactive immune system. Psoriasis causes inflammation of the skin, with symptoms such as dry, scaly, and thickened patches of skin that may be itchy, discolored, or infected during flare-ups. About one-third of people with psoriasis develop PsA, which causes painful joints and swollen fingers and toes, among other symptoms. Psoriasis and PsA can also affect other organs. Uveitis, an inflammation of the middle layer of the eye, is an example.

Heart disease, also called cardiovascular disease, comes in many forms. Some types of heart disease include:

  • High blood pressure (hypertension)
  • Coronary artery disease (blocked blood vessels or atherosclerosis)
  • Heart valve disease
  • Arrhythmia (heart rhythm disorder)
  • Heart muscle disease

Heart disease is linked to life-threatening complications like heart attacks, heart failure, and strokes.

Recognizing the connections between psoriasis and heart disease can help you take action to improve your health and well-being.

Causes and Risk Factors

The connection between heart disease and psoriasis is not fully understood, but it is believed to be related to chronic inflammation that is associated with both conditions. Research shows that a buildup of cholesterol in arteries may trigger proinflammatory proteins in the immune system that contribute to the development of heart disease.

Psoriasis is also a chronic inflammatory disease. Psoriasis is a hereditary condition that causes dysfunction in the immune system, primarily affecting the skin barrier. People with psoriasis are prone to flare-ups caused by injury or irritation to the skin, psychological stress, and bacterial infection.

Heart disease can be hereditary, or it may be caused by cardiovascular risk factors. Some of these risk factors include:

  • Family history of early-onset heart disease
  • Tobacco use
  • Environmental factors, such as pollution
  • Diabetes
  • Chronic inflammatory diseases like psoriasis, rheumatoid arthritis, and other types of rheumatic diseases and inflammatory arthritis
  • High cholesterol
  • Obesity
  • Sedentary lifestyle
  • Consumption of too much sugar, salt, fat, or alcohol

Metabolic Syndrome and Heart Disease

Psoriasis and PsA are associated with many comorbidities, including heart disease. Metabolic syndrome, inflammatory bowel disease, osteoporosis, fibromyalgia, and depression are all considered comorbidities of psoriasis.

Studies have shown that people with psoriasis have an especially high prevalence of developing metabolic syndrome, a condition that causes systemic inflammation. Metabolic syndrome is associated with high blood pressure, obesity, liver disease, diabetes, and high levels of lipids (fat) in the bloodstream — all of which can increase the risk for cardiovascular disease.

Risk factors for metabolic syndrome include:

  • High blood sugar
  • High levels of triglycerides
  • Low levels of HDL cholesterol
  • Hypertension
  • Belly fat and a large waist

People with psoriasis have a 22 percent to 98 percent higher risk of developing metabolic syndrome, depending on the severity of their psoriasis. Regular blood tests can screen for signs of metabolic syndrome.

Living With Heart Disease and Psoriasis

Research has shown that people with moderate or severe psoriasis and PsA can reduce the incidence of stroke, heart attack, and heart-related death by maintaining their treatment plans for psoriasis and PsA.

Certain disease-modifying drugs that are used in the treatment of psoriasis may help reduce the risk of cardiovascular disease. Methotrexate (a disease-modifying antirheumatic drug) and biologics (such as tumor necrosis factor inhibitors and interleukin inhibitors) have been shown in some situations to provide heart protection.

Some biologic drugs associated with reducing the risk of heart disease include:

  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Secukinumab (Cosentyx)
  • Infliximab (Remicade)
  • Ustekinumab (Stelara)

Nonsteroidal anti-inflammatory drugs (NSAIDs) that may be used to treat joint pain in PsA — such as ibuprofen (Advil) and celecoxib (Celebrex) — have been shown to increase the risk for heart disease. Talk to your doctors if you are taking NSAIDs and have heart disease.

Heart Disease Drugs That May Provoke Psoriasis

Several drugs that are used to treat heart problems have been shown to cause psoriasis or make it worse in some people. These medications include:

  • Beta-blockers
  • Angiotensin-converting enzyme inhibitors
  • Clonidine (Catapres)
  • Digoxin (Digox)
  • Amiodarone (Pacerone)

If you have heart disease and psoriasis, it’s essential to discuss your medications with your cardiologist, dermatologist, and rheumatologist.

Managing Psoriasis and Heart Disease

Psoriasis and PsA are usually managed with individualized treatment plans that typically include home skin care and prescription or over-the-counter topical therapies. Treatment may also include ultraviolet phototherapy, oral medications, or biologic drugs that are taken by injection or infusion.

Adopt a Healthy Lifestyle

Lifestyle changes can help improve your heart health and reduce psoriatic disease flares. They can also improve your overall health, well-being, and quality of life. Talk to your doctors if you need advice for:

  • Maintaining a healthy weight with a well-balanced, healthy diet
  • Exercising regularly and staying physically active
  • Managing emotional stress with mindfulness training, meditation, or other relaxation techniques

Your doctors can provide referrals for a dietitian, physical therapist, or counselor. People with heart disease, psoriasis, and PsA may want to coordinate care with a multidisciplinary health care team. It’s important to advocate for the care you need and find resources that help you feel your best.

Talk With Others Who Understand

On MyHeartDiseaseTeam, the social network for people with heart disease, more than 51,000 members come together to ask questions, give advice, and share their stories with others who understand life with cardiovascular conditions.

Do you have questions about psoriasis or psoriatic arthritis and how they affect your heart condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Getting at the Heart of Psoriasis — National Psoriasis Foundation
  2. Comorbidities — Centers for Disease Control and Prevention
  3. Psoriatic Arthritis — Arthritis Foundation
  4. Uveitis — National Eye Institute
  5. Heart Disease: Symptoms and Causes — Mayo Clinic
  6. Inflammation in Heart Disease: Do Researchers Know Enough? — Nature
  7. The Genetic Basis of Psoriasis — International Journal of Molecular Sciences
  8. Cardiovascular Disease — Cleveland Clinic
  9. Comorbidities in Patients With Psoriatic Arthritis — Rambam Maimonides Medical Journal
  10. About Metabolic Syndrome — American Heart Association
  11. Psoriasis and Cardiovascular Diseases: A Literature Review To Determine the Causal Relationship — Cureus
  12. Does Treating Psoriasis Reduce the Risk of Heart Disease and Stroke? — American Academy of Dermatology Association
  13. Protective Effect of Methotrexate in Patients With Rheumatoid Arthritis and Cardiovascular Comorbidity — Therapeutic Advances in Musculoskeletal Disease
  14. Biologics May Prevent Cardiovascular Events in Rheumatoid Arthritis by Inhibiting Coronary Plaque Formation and Stabilizing High-Risk Lesions — Arthritis and Rheumatology
  15. Psoriasis Treatment: Biologics — American Academy of Dermatology Association
  16. NSAIDs: How Dangerous Are They for Your Heart? — Harvard Health Publishing
  17. Drug-Provoked Psoriasis: Is It Drug Induced or Drug Aggravated? — Journal of Clinical and Aesthetic Dermatology
  18. Stress — National Center for Complementary and Integrative Health
  19. Cardiovascular Disease and Depression in Psoriatic Arthritis: Multidimensional Comorbidities Requiring Multidisciplinary Management — Best Practice and Research Clinical Rheumatology

All updates must be accompanied by text or a picture.
Larry A. Weinrauch, MD, FACC, FACP, FAHA is an assistant professor of medicine at Harvard Medical School with a focus on cardiovascular disease and clinical outcomes research. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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