Positive Health Online

Abstract

HUGH and COLLEAGUES, (1)Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York, (2)Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; (3)Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey; (4)Department of Dermatology, Mount Sinai School of Medicine, New York, New York; (5)Oregon Medical Research Center, Portland, Oregon; (6)Department of Dermatology, Baylor College of Medicine, Houston, Texas; (7)Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York. jmw27@columbia.edu reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures,  outcomes and cardiovascular disease (CVD).

Background

Many studies have identified cardiovascular risk factors in patients with psoriasis. Some psoriasis therapies may increase cardiovascular disease (CVD) and others may decrease CVD. The authors reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures and outcomes.

Methodology

Results

Phototherapy has no major cardiovascular impact and may reduce levels of pro-inflammatory cytokines. Acitretin increases serum lipids and triglycerides, but has not been shown to increase cardiovascular risk. Cyclosporine A increases blood pressure, serum triglycerides, and total cholesterol. Methotrexate is associated with a decreased risk of CVD morbidity and mortality. Among the biologics, data for tumour necrosis factor inhibitors suggest an overall reduction in cardiovascular events. Most data on short-term ustekinumab use suggest no effect on major adverse cardiovascular events; however some authorities remain concerned. Nevertheless, ustekinumab use over a 4-year period shows a decrease in major adverse cardiovascular events when compared both with the general US population and with psoriatics in Great Britain. Limitations: Most studies lack the power and randomization of large clinical trials and long-term follow-up periods. In addition, the increased risk of CVD associated with psoriasis itself is a confounding factor.

Conclusion

Some therapies for moderate to severe psoriasis, including methotrexate and tumour necrosis factor inhibitors, may reduce cardiovascular events in psoriatic patients. Ustekinumab appears to be neutral but there may be a long-term benefit. Appropriate patient counselling and selection and clinical follow-up are necessary to maximize safety with these agents. Further long-term study is necessary to quantify the benefits and risks associated with biologic therapies.

References

Hugh J(1), Van Voorhees AS(2), Nijhawan RI(1), Bagel J(3), Lebwohl M(4), Blauvelt A(5), Hsu S(6), Weinberg JM(7). From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of  current therapies. J Am Acad Dermatol. 70(1):168-77. doi: 10.1016/j.jaad.2013.09.020. Epub  Nov 1 2013. Jan 2014.