Many studies over the past 10 years have highlighted the important relationship between psoriasis and cardiovascular disease including heart attack and stroke. A study published in 2018 demonstrated that patients with greater than 10% of their body covered with psoriasis have an 80% increase risk in mortality even when taking into account other risk factors. This relationship is thought to be related to common inflammatory pathways between the two conditions. Patients are becoming increasingly aware of this and rightfully are concerned.
Thankfully, the treatment of psoriasis is a rapidly expanding and changing field with many options. However, with more options can come choice overload. All of the alternatives can be overwhelming to evaluate. Dermatologists and scientists are now devoting more time and research to which treatments might reduce the risk of heart attack, stroke, and ultimately an untimely death.
A recent article from the esteemed Journal of the American Academy of Dermatology from July 2018 compared the effect of treatment with Tumor Necrosis Factor alpha inhibiting drugs compared to phototherapy on heart attack, stroke, transient ischemic events and unstable angina. It was a robust study with over 23,000 patients. There were a few findings that stood out:
TNFα inhibitors showed a decrease in cardiovascular events when compared to phototherapy starting at 4 months of treatment.
161 patients would need to be treated with TNFα inhibitors to reduce 1 cardiovascular event in this study.
Each incremental 6 months of continued treatment with a TNFα inhibitor further decreased the risk of cardiovascular events by an additional 11%.
There are many factors to consider when formulating the best treatment plan for psoriasis. It is important to discuss your risk factors and concerns for cardiac events with your Dermatologist prior to selecting a treatment strategy. TNFα inhibiting drugs should be considered as potential treatments for those patients at high risk for heart attack and stroke.
More studies are needed to continue to answer this challenging question. To review this study you, we have provided the information below.
Wu Jashin et al. The risk of cardiovascular events in psoriasis patients treated with tumor necrosis factor-α inhibitors versus phototherapy: An observational cohort study. JAAD. 2018;79:60-68.
Gelfand, Joel M. Commentary: Does biologic treatment of psoriasis lower the risk of cardiovascular events and mortality? A critical question that we are only just beginning to answer. JAAD. 2018;79:69-70.