Education initiatives designed for health-care providers who treat patients with psoriasis are needed to help them better manage cardiovascular and metabolic risks in their patients, according to an editorial published recently in the Annals of the Rheumatic Diseases.
The subject of the editorial, written by Søren Lund Kristensen, MD, PhD, and colleagues, was a study by Alexis Ogdie-Beatty, MD, MSCE, and colleagues that reported associations between psoriasis, psoriatic arthritis (PsA), and an increased risk of major adverse cardiovascular events such as myocardial infarction, stroke and cardiovascular death.
This association was also noted in patients with rheumatoid arthritis (RA), and the level of severity varied among the three conditions. Closer monitoring for cardiovascular risks is needed in these patients, concluded the investigators.
However, Kristensen and colleagues questioned whether the data reported in the the recent study were sufficient to start using a cardiovascular risk multiplier in psoriasis or PsA. Instead, they suggested that educational programs may improve cardiovascular and metabolic risk management in patients.
“Such education, which does not need to be onerous, will help lessen cardiovascular risks further in their patients,” wrote the researchers.
Kristensen is with the BHF Cardiovascular Research Centre at the University of Glasgow, Glasgow, United Kingdom, and the department of cardiology at Gentofte Hospital, Copenhagen, Denmark.
The Ogdie study was the first to provide a simultaneous comparison to risk levels in RA. If the results are accepted as valid, cardiovascular risk appears to be elevated by approximately 40% to 50% for patients with RA or severe psoriasis, compared with a risk of approximately 20% for patients with PsA.
According to the editorial, severe psoriasis as an independent cardiovascular risk factor could reasonably be considered for inclusion in the update of the European League Against Rheumatism (EULAR) recommendations on cardiovascular risk, along with the optimal/pragmatic criteria for demarcating such patients.
However, the absolute number of events among patients with PsA was low, which makes it difficult to conclude the need for a risk multiplier for such patients. Additional studies are needed to determine the relative contributions of the skin disorder versus arthralgia to vascular risk.