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Review
. 2024 Jul;42(3):417-428.
doi: 10.1016/j.det.2024.02.008. Epub 2024 Feb 26.

Using Guidelines of Care to Lower Cardiovascular Risk in Patients with Psoriasis

William B Song  1 , Daniel E Soffer  2 , Joel M Gelfand  3
Affiliations
Review

Using Guidelines of Care to Lower Cardiovascular Risk in Patients with Psoriasis

William B Song et al. Dermatol Clin. 2024 Jul.

Abstract

National guidelines define psoriasis as a risk enhancer for cardiovascular disease and recommend increased monitoring and more intense management of cardiovascular risk factors in these patients, who face an increased burden of cardiovascular disease morbidity and mortality. Screening for modifiable cardiovascular risk factors, including blood pressure, weight, cholesterol, glucose, and smoking, can be efficiently incorporated into routine dermatology clinical practice. Partnerships with primary care providers and preventive cardiologists are essential to improving management of cardiovascular risk in patients with psoriasis.

Keywords: Biologics; Cardiovascular; Guidelines; Mortality; Myocardial infarction; Psoriasis; Psoriatic; Statin.

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Conflict of interest statement

Disclosure J.M. Gelfand served as a consultant for Abbvie, Artax (DSMB), BMS, Boehringer Ingelheim, Celldex (DSMB), FIDE (which is sponsored by multiple pharmaceutical companies) GSK, Inmagene (DSMB), Twill, Lilly (DMC), Leo, Moonlake (DSMB), Janssen Biologics, Novartis Corp, UCB (DSMB), Neuroderm (DSMB), and Veolia North America receiving honoraria; receives research grants (to the Trustees of the University of Pennsylvania) from Amgen, United States, BMS, United States, and Pfizer Inc., United States; received payment for continuing medical education work related to psoriasis that was supported indirectly by pharmaceutical sponsors; is a co-patent holder of resiquimod for the treatment of cutaneous T-cell lymphoma; is a Deputy Editor for the Journal of Investigative Dermatology receiving honoraria from the Society for Investigative Dermatology; is the Chief Medical Editor for Healio Dermatology (receiving honoraria); and is a member of the Board of Directors for the International Psoriasis Council and the Medical Dermatology Society, receiving no honoraria. D.E. Soffer has served as consultant for Akcea, Amgen, Amryt, Ionis, Novartis, and Partnership for Health Analytics Research; was an investigator for Akcea, Amgen, Amryt, Ionis, Novartis, Regeneron, and Verve Therapeutics; and did data monitoring for Amgen.

Figures

Figure 1.
Figure 1.. Example coronary artery calcium imaging study used in cardiovascular risk assessment.
Coronary artery calcium (CAC) imaging study for a 59-year-old male psoriasis patient with no clinically evident atherosclerotic cardiovascular disease and several cardiovascular risk factors, including age, smoking history, hypertension, and severe longstanding psoriasis. (A) Axial computed tomography images of the chest, heart, and coronary vessels are displayed, with plaques in three coronary vessels visualized in color. Plaques present in the left main (LM) artery are green, plaques in the left anterior descending (LAD) artery are yellow, and plaques in the left circumflex (CX) artery are cyan. (B) A total score for coronary calcium is calculated based on plaque volumes of individual coronary vessels. In this image, the total CAC score is 152.2, indicating that statin initiation is highly favored.
Figure 2.
Figure 2.. Example of online calculator for 10-year risk of developing atherosclerotic cardiovascular disease.
The American Heart Association and American College of Cardiology provide convenient online calculators for estimating risk of developing atherosclerotic cardiovascular disease (ASCVD) for patients without ASCVD. In this example, a 59-year-old, White, male patient with several risk factors and without clinically evident ASCVD has an estimated 10.7% risk of developing ASCVD in 10 years.
Figure 3.
Figure 3.. Approach to implementing guidelines-based cardiovascular risk screening for psoriasis patients in routine dermatological practice.
*The American Heart Association and American College of Cardiology provide convenient online calculators for estimating risk of developing atherosclerotic cardiovascular disease (ASCVD) for primary prevention, which are found at https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/ and are based on pooled cohort equations from Yadlowsky S, Hayward RA, Sussman JB, McClelland RL, Min YI, Basu S. Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Ann Intern Med. Jul 3 2018;169(1):20-29. doi:10.7326/M17-3011.
See this image and copyright information in PMC

References

    1. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. Aug 1 2021;157(8):940–946. doi: 10.1001/jamadermatol.2021.2007 - DOI - PMC - PubMed
    1. Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol Feb 2017;31(2):205–212. doi: 10.1111/jdv.13854 - DOI - PubMed
    1. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004. J Am Acad Dermatol. Feb 2009;60(2):218–24. - PMC - PubMed
    1. Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. Apr 2019;80(4):1073–1113. doi: 10.1016/j.jaad.2018.11.058 - DOI - PubMed
    1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. Jun 18 2019;139(25):e1082–e1143. doi: 10.1161/CIR.0000000000000625 - DOI - PMC - PubMed

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