psoriasis-doctor

By Denise Mann

MONDAY, June 15, 2009 (Health.com) — Leonard Kleinman, an 82-year-old retired grocer in Boynton Beach, Fla., always thought of psoriasis as a nuisance separate from his other health problems, but now he is learning that his skin condition, which causes raised, silvery plaques on his legs, may actually be related to some of his other health issues.

“My doctor told me I was at risk for diabetes, and he referred me to a cardiologist because of some blockages in my heart arteries,” says Kleinman. “It didn’t occur to me that this could be connected to my psoriasis. But he said that it could be the case and I needed to take it seriously."

Like Kleinman, about seven million Americans have psoriasis. Now, a new study suggests they are more likely to have heart attacks; strokes; blockages in the arteries of the legs, arms, and groin; and a greater risk of earlier death than those who do not have the inflammatory skin disease. The findings, published in the June issue of the Archives of Dermatology, add to a growing body of evidence that links psoriasis to a laundry list of other systemic, inflammatory diseases.

“Psoriasis is not just a skin disease, but rather a disease that appears to have diffuse manifestations throughout the body,” says study author Robert S. Kirsner, MD, PhD, a Stiefel Laboratories professor and vice chairman in the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine. “Patients with psoriasis and clinicians caring for patients with psoriasis should be aware of this association and take appropriate action to limit risk of developing these diseases.”

People with psoriasis should have regular screenings and aggressive treatments to reduce the risk of heart and blood vessel disease, he says. Some patients may need to take aspirin daily; the low-dose variety helps reduce the risk of blood clots that can cause heart attacks and strokes.

Next page: Psoriasis linked to earlier mortality

In the study, Dr. Kirsner and colleagues compared rates of heart disease, stroke-related vascular disease, peripheral artery disease (PAD), and death among 3,236 people with psoriasis (mostly men in their mid-to-late 60s) and 2,500 people without the skin condition. In PAD, blockages form in the arteries of the legs, arms, or groin, and can lead to cramping and make it difficult to walk.

Overall, people with psoriasis were nearly twice as likely to have been diagnosed with heart disease, stroke-related vascular disease, or PAD. What’s more, 19.6% of people with psoriasis died during the study, compared with 9.9% of participants who did not have psoriasis.

Dr. Kirsner says the conditions are most likely linked due to underlying inflammation. “Psoriasis is a systemic inflammatory disease similar to rheumatoid arthritis [and] the same inflammatory cytokine profile that is thought to cause psoriasis has been also shown to cause cardiovascular disease,” he says. Cytokines are inflammation-causing proteins that are released by the cells of the immune system.

People with psoriasis should be screened for diabetes, high blood pressure, abnormal cholesterol levels, and other factors linked to heart disease and stroke, Dr. Kirsner says.

Kleinman, for example, is currently taking medication to control his cholesterol, and he watches his diet to keep his blood sugar and weight in check. He is also working with his dermatologist to treat his psoriasis.

It's unclear whether aggressive treatment of the psoriasis will have an impact on heart and stroke risks, but preliminary studies suggest it might, Dr. Kirsner says.

However, the researchers aren't sure if the psoriasis came first or other health conditions. And people with psoriasis are more likely to be overweight and to smoke and lead a sedentary lifestyle than people without the inflammatory skin disease. These behaviors may play a role in the increased risk of heart and blood vessel disease.

What's more, no one knows for sure if psoriasis treatments such as topical steroids or methotrexate protect or harm the heart.

However, Mitchel P. Goldman, MD, a clinical professor of dermatology and medicine at the University of California, San Diego, says that methotrexate may decrease inflammation in the body as well as the skin.

Dr. Goldman stresses that it is important for people with psoriasis to see their primary care doctor at least once a year to be screened for cardiovascular risk factors. "I also tell people with psoriasis to make sure they have appropriate testing for heart disease and blood vessel disease,” he says.

Dr. Goldman also advises psoriasis patients to manage their risk factors for heart disease. “I make sure to tell them not to smoke, to eat properly, and get exercise,” he says.


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