Cardiovascular mortality in psoriasis and psoriatic arthritis: epidemiology, pathomechanisms, therapeutic implications, and perspectives

Abstract

Psoriasis and psoriatic arthritis are associated with an increased cardiovascular mortality. Although the underlying pathogenesis is not yet fully understood, it is clear that these seemingly organ-specific disorders cause a systemic inflammatory burden as mirrored by elevated biomarkers in the patients' blood. Emerging evidence points toward insulin resistance and endothelial dysfunction as direct consequences; these in turn drive the process of atherosclerosis. As psoriasis and psoriatic arthritis therefore represent cardiovascular risk factors, they must be taken into account by primary care physicians when defining treatment goals for the comorbidities of the respective patients (e.g., arterial hypertension or dyslipidemia). Secondary and tertiary care physicians need to consider a more comprehensive treatment approach, including aspects of lifestyle intervention. Finally, effective long-term anti-inflammatory, disease-modifying therapy may contribute to reducing patients' cardiovascular risk.