Psoriasis: a Skin Disease Associated With Increased Cardiovascular Risk

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González-Vela, C. González-Juanatey" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "González-Gay" "email" => array:1 [ 0 => "miguelaggay@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "González-Vela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "González-Juanatey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Dermatopatología, Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Psoriasis: una enfermedad cutánea relacionada con riesgo cardiovascular elevado" ] ] "textoCompleto" => "Psoriasis is a chronic inflammatory skin disease that affects between 1% and 3% of the population, with the highest prevalence in the white population.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The authors of a study carried out in the United States estimated the prevalence of heart disease in patients with psoriasis to be 14.3%, somewhat higher than in the general population (11.3%).<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This difference could be attributed to the higher incidence of metabolic syndrome and other traditional cardiovascular risk factors in these patients. However, the higher prevalence of heart disease in patients with psoriasis has been shown to be independent of body mass index, and in a recent study obesity was not an independent risk factor for acute myocardial infarction in this setting.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Psoriasis is now thought to be an independent risk factor for coronary artery disease and acute myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The risk of developing ischemic heart disease and cerebrovascular disease has been reported to be higher in patients with moderate to severe psoriasis than in the general population.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Using the Framingham risk score, Kimball et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> estimated the 10-year risk of coronary heart disease and stroke in 1591 patients with moderate to severe psoriasis. In the patients with a PASI score between 10 and 20, the 10-year risk of coronary heart disease and stroke was 12.3% and 8.3%, respectively, and the corresponding figures in patients with a PASI score greater than 20 were 12.2% and 8.7%, respectively. While the level of risk did not differ greatly according to the PASI score, estimated cardiovascular risk was significantly higher in both groups of patients than in the general population, with a risk that was 28% greater risk for coronary heart disease and 11.8% greater for stroke. In another study the presence of psoriasis, even in mild forms but especially in severe cases, was found to be an independent risk factor for stroke.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The hypothesis that the severity of psoriasis is a significant factor in the development of cardiovascular disease is also supported by the evidence of a correlation between PASI scores and insulin secretion.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Insulin resistance is a hallmark of metabolic syndrome, and a statistically significant correlation has been observed in patients with psoriasis between PASI scores and serum levels of resistin (a cytokine known to be increased in insulin resistance).<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The implications of these findings are that the more severe the psoriasis the higher the risk of cardiovascular complications and that a chronic inflammatory state is of pathogenic importance in the development of vascular disease in these patients.Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis that affects 0.3% to 1% of the population.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In 85% of patients with PsA, joint involvement is preceded by psoriatic skin lesions. Patients with PsA are usually seronegative for rheumatoid factor, a finding that can serve to differentiate between PsA and rheumatoid arthritis. PsA is currently classified as a rheumatic disease and included in the group of spondyloarthropathies.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> As in rheumatoid arthritis, which is the prototype of a chronic inflammatory disease associated with accelerated atherosclerosis and a high incidence of cardiovascular disease,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> higher mortality has been observed in PsA than in the general population primarily owing to the increased risk of cardiovascular disease in these patients.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> In a study that compared 3066 patients with PsA and a matched group of controls (1:4 ratio), Han et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> observed a higher prevalence of peripheral vascular disease, congestive heart failure, atherosclerosis, ischemic heart disease, and cerebrovascular disease in patients with PsA compared to the control group. The same authors also observed an increased incidence of the traditional cardiovascular risk factors, such as hypertension, diabetes mellitus, and dyslipidemia, in the patients with PsA.It has been observed that the high cardiovascular mortality in rheumatoid arthritis is due to the concurrence of traditional cardiovascular risk factors,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> a chronic inflammatory state,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and certain genetic factors.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> It is therefore conceivable that the same factors may be responsible for the high cardiovascular morbidity and mortality observed in patients with PsA.Subclinical atherosclerosis—diagnosed on the basis of increased intima-media thickness in the common carotid artery—has also been reported in association with the following chronic inflammatory rheumatic diseases: ankylosing spondylitis<a class="elsevierStyleCrossRef" href="#bib0075">15</a> (a spondyloarthropathy like PsA), psoriasis without joint involvement,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and PsA.<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> Patients with all these diseases were found to have increased carotid artery intima-media thickness compared to control groups matched for age, sex, and traditional cardiovascular risk factors.This association may provide very significant prognostic information in patients with these chronic inflammatory diseases since, as previously noted, a direct correlation has been found between common carotid artery intima-media thickness and the development of cardiovascular complications in both the general population and in patients with rheumatoid arthritis.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>A correlation has also been reported in PsA between common carotid artery intima-media thickness and the presence of traditional risk factors for atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Two studies in the past decade in patients with PsA with no clinical evidence of cardiovascular disease and no traditional cardiovascular risk factors have confirmed the increased prevalence of subclinical atherosclerosis in this population. Subclinical disease was manifest by the presence of endothelial dysfunction, a condition that represents the initial phase in the development of atherosclerosis,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> or by increased carotid intima-media thickness.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> However, no association has been observed between the severity of joint involvement in PsA and subclinical atherosclerosis<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a> or cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> This lack of evidence would appear to be an indication that, in PsA, the severity of the patient's skin condition may be more predictive of the development of vascular disease than the joint involvement.In line with the studies showing a correlation between the severity of psoriasis and cardiovascular events,<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Gladman et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> found in patients with PsA that, in addition to known risk factors for atherosclerosis, the severity of skin involvement was predictive of cardiovascular disease.The implication of the evidence discussed above is that chronic inflammation may play a key role in the accelerated development of atherosclerosis in patients with psoriasis and PsA. However, while chronic inflammation itself may be the key factor in the development of cardiovascular disease, we should not forget the additive effect in this process of traditional cardiovascular risk factors.In view of this evidence, clinicians treating patients with psoriasis and PsA should routinely take active steps to reduce cardiovascular risk in these patients, and the first step in this process should be to determine cardiovascular risk in every patient. Unfortunately, there are at present no guidelines dealing specifically with the management of cardiovascular risk in these patients. We should, therefore, envisage the future development of comprehensive cardiovascular risk charts specifically adapted to these diseases. Given the close correlation between the severity of skin disease and the development of cardiovascular events, these tables should take into account the clinical assessment of the patient's psoriasis and the treatments prescribed as well as the traditional risk factors.From the dermatological standpoint, a treatment aimed at reducing the severity of skin disease would also reduce the inflammatory burden. In these patients, it is also important to monitor known modifiable cardiovascular risk factors, such as obesity, hypertension, and dyslipidemia, and to check blood sugar levels regularly because of the increased risk of diabetes mellitus. Proper control of these factors may be of greater importance in patients with a long history of psoriasis or PsA in whom the presence of sustained chronic inflammation in conjunction with poor control of cardiovascular risk factors could lead to a higher atherogenic burden. In this regard, a direct correlation between the duration of PsA and the presence of an abnormally thick common carotid artery intima-media was detected in a recent study.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>If, once again, we take rheumatoid arthritis as a model for chronic inflammatory disease, we find that a consensus group of European experts has recommended stratifying cardiovascular risk in patients with rheumatoid arthritis using the Systematic Coronary Risk Evaluation (SCORE) risk charts.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> On the basis of the available evidence, the 2 key aspects of the management of cardiovascular risk in rheumatoid arthritis are the use of SCORE risk charts adapted to each population group and clinical assessment of disease severity. It is very possible that this approach could also prove useful for the management of cardiovascular risk in patients with psoriasis and PsA. However, its usefulness has not yet been demonstrated and no consensus has been reached on clinical guidelines relating to this important aspect of the management of these patients.In view of the higher incidence of dyslipidemia and hypertension in patients with psoriasis and PsA, treatment with statins and/or antihypertensive agents should be considered in accordance with the Spanish guidelines on the management of cardiovascular risk based on the SCORE risk chart, adapted to a southern European population, as a guide. The Third European Joint Task Force on cardiovascular prevention in clinical practice recommended the SCORE model as a tool for predicting cardiovascular risk. The model predicts cardiovascular mortality at 10 years on the basis of age, sex, systolic blood pressure, total cholesterol, and smoking status. In view of the geographical variability of cardiovascular risk in Europe, 2 SCORE models have been developed: 1 for high-risk and 1 for low-risk countries. The main difference between the SCORE risk function and the Framingham-DORICA model is that the SCORE chart estimates risk for all atherothrombotic cardiovascular manifestations, including stroke, heart failure, and peripheral arterial disease, and not just coronary heart disease. Moreover, several studies have suggested that the Framingham-DORICA tables tend to underestimate cardiovascular risk in Spain, especially in hypertensive patients with other cardiovascular risk factors; the SCORE risk charts are, therefore, the recommended instrument for use in this country.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>Given that the prevalence of cardiovascular disease in patients with psoriasis and PsA is high, cardiovascular risk should be assessed in these patients by identifying factors inherent in these chronic inflammatory diseases that have been shown to be associated with the development of accelerated atherogenesis and cardiovascular events. We would therefore consider the presence of a PASI > 10 to be a prognostic factor signaling the need for more rigorous management of the skin symptoms on the part of the dermatologist.As a first step, clinicians who assess patients with psoriasis or PsA should also define a primary cardiovascular risk prevention strategy, based initially on making general recommendations to the patient regarding lifestyle, such as the need for regular moderate physical activity, a heart healthy diet, weight and blood pressure control, as well as tobacco cessation when appropriate. Furthermore, in accordance with the SCORE guidelines, treatment with statins and/or antihypertensive drugs should be initiated in patients with high cardiovascular risk (SCORE≥5%).In summary, the risk of cardiovascular morbidity and mortality is higher in patients with psoriasis and PsA than in the population in general. The presence of severe psoriasis is a significant predictor of cardiovascular risk in these patients. In addition to treating the cutaneous manifestations in patients with psoriasis and the rheumatic process in patients with PsA, clinicians must also monitor and appropriately manage the traditional risk factors for atherogenesis.Conflicts of InterestThe authors declare that they have no conflicts of interest." 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Alongside classic risk factors for atherosclerosis, the severity of psoriatic skin disease also influences cardiovascular risk in these patients. In both cases, endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease. Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients. Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La psoriasis y la artritis psoriásica se asocian con un mayor riesgo de eventos cardiovasculares y de mortalidad cardiovascular. Además de los factores clásicos de aterosclerosis, la gravedad de la afección cutánea influye en el aumento del riesgo cardiovascular en estos pacientes. En ambos procesos se observa la presencia de disfunción endotelial y un grosor aumentado de la íntima-media de la arteria carótida, como expresión de enfermedad cardiovascular subclínica. El tratamiento activo de la enfermedad y el manejo de los factores de riesgo cardiovascular clásicos son fundamentales para disminuir la morbilidad cardiovascular en estos pacientes. El establecimiento de guías clínicas para el manejo del riesgo cardiovascular abrirá, en el futuro, un nuevo abordaje clínico integral del paciente con psoriasis y la artritis psoriásica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González-Gay MA, González-Vela C, González-Juanatey C. Psoriasis: una enfermedad cutánea relacionada con riesgo cardiovascular elevado. 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Novelties in Dermatology

Psoriasis: a Skin Disease Associated With Increased Cardiovascular Risk

Psoriasis: una enfermedad cutánea relacionada con riesgo cardiovascular elevado

M.A. González-Gaya,

Corresponding author

miguelaggay@hotmail.com

Corresponding author.

, C. González-Velab, C. González-Juanateyc

a Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain

b Sección de Dermatopatología, Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain

c Servicio de Cardiología, Hospital Universitario Lucus Augusti, Lugo, Spain

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Kimball et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> estimated the 10-year risk of coronary heart disease and stroke in 1591 patients with moderate to severe psoriasis&#46; In the patients with a PASI score between 10 and 20&#44; the 10-year risk of coronary heart disease and stroke was 12&#46;3&#37; and 8&#46;3&#37;&#44; respectively&#44; and the corresponding figures in patients with a PASI score greater than 20 were 12&#46;2&#37; and 8&#46;7&#37;&#44; respectively&#46; While the level of risk did not differ greatly according to the PASI score&#44; estimated cardiovascular risk was significantly higher in both groups of patients than in the general population&#44; with a risk that was 28&#37; greater risk for coronary heart disease and 11&#46;8&#37; greater for stroke&#46; In another study the presence of psoriasis&#44; even in mild forms but especially in severe cases&#44; was found to be an independent risk factor for stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The hypothesis that the severity of psoriasis is a significant factor in the development of cardiovascular disease is also supported by the evidence of a correlation between PASI scores and insulin secretion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Insulin resistance is a hallmark of metabolic syndrome&#44; and a statistically significant correlation has been observed in patients with psoriasis between PASI scores and serum levels of resistin &#40;a cytokine known to be increased in insulin resistance&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The implications of these findings are that the more severe the psoriasis the higher the risk of cardiovascular complications and that a chronic inflammatory state is of pathogenic importance in the development of vascular disease in these patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Psoriatic arthritis &#40;PsA&#41; is a chronic inflammatory joint disease associated with psoriasis that affects 0&#46;3&#37; to 1&#37; of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In 85&#37; of patients with PsA&#44; joint involvement is preceded by psoriatic skin lesions&#46; Patients with PsA are usually seronegative for rheumatoid factor&#44; a finding that can serve to differentiate between PsA and rheumatoid arthritis&#46; PsA is currently classified as a rheumatic disease and included in the group of spondyloarthropathies&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> As in rheumatoid arthritis&#44; which is the prototype of a chronic inflammatory disease associated with accelerated atherosclerosis and a high incidence of cardiovascular disease&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> higher mortality has been observed in PsA than in the general population primarily owing to the increased risk of cardiovascular disease in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In a study that compared 3066 patients with PsA and a matched group of controls &#40;1&#58;4 ratio&#41;&#44; Han et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> observed a higher prevalence of peripheral vascular disease&#44; congestive heart failure&#44; atherosclerosis&#44; ischemic heart disease&#44; and cerebrovascular disease in patients with PsA compared to the control group&#46; The same authors also observed an increased incidence of the traditional cardiovascular risk factors&#44; such as hypertension&#44; diabetes mellitus&#44; and dyslipidemia&#44; in the patients with PsA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It has been observed that the high cardiovascular mortality in rheumatoid arthritis is due to the concurrence of traditional cardiovascular risk factors&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> a chronic inflammatory state&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and certain genetic factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> It is therefore conceivable that the same factors may be responsible for the high cardiovascular morbidity and mortality observed in patients with PsA&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Subclinical atherosclerosis&#8212;diagnosed on the basis of increased intima-media thickness in the common carotid artery&#8212;has also been reported in association with the following chronic inflammatory rheumatic diseases&#58; ankylosing spondylitis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> &#40;a spondyloarthropathy like PsA&#41;&#44; psoriasis without joint involvement&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and PsA&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> Patients with all these diseases were found to have increased carotid artery intima-media thickness compared to control groups matched for age&#44; sex&#44; and traditional cardiovascular risk factors&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This association may provide very significant prognostic information in patients with these chronic inflammatory diseases since&#44; as previously noted&#44; a direct correlation has been found between common carotid artery intima-media thickness and the development of cardiovascular complications in both the general population and in patients with rheumatoid arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A correlation has also been reported in PsA between common carotid artery intima-media thickness and the presence of traditional risk factors for atherosclerosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Two studies in the past decade in patients with PsA with no clinical evidence of cardiovascular disease and no traditional cardiovascular risk factors have confirmed the increased prevalence of subclinical atherosclerosis in this population&#46; Subclinical disease was manifest by the presence of endothelial dysfunction&#44; a condition that represents the initial phase in the development of atherosclerosis&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> or by increased carotid intima-media thickness&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> However&#44; no association has been observed between the severity of joint involvement in PsA and subclinical atherosclerosis<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> or cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This lack of evidence would appear to be an indication that&#44; in PsA&#44; the severity of the patient&#39;s skin condition may be more predictive of the development of vascular disease than the joint involvement&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In line with the studies showing a correlation between the severity of psoriasis and cardiovascular events&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Gladman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> found in patients with PsA that&#44; in addition to known risk factors for atherosclerosis&#44; the severity of skin involvement was predictive of cardiovascular disease&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The implication of the evidence discussed above is that chronic inflammation may play a key role in the accelerated development of atherosclerosis in patients with psoriasis and PsA&#46; However&#44; while chronic inflammation itself may be the key factor in the development of cardiovascular disease&#44; we should not forget the additive effect in this process of traditional cardiovascular risk factors&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In view of this evidence&#44; clinicians treating patients with psoriasis and PsA should routinely take active steps to reduce cardiovascular risk in these patients&#44; and the first step in this process should be to determine cardiovascular risk in every patient&#46; Unfortunately&#44; there are at present no guidelines dealing specifically with the management of cardiovascular risk in these patients&#46; We should&#44; therefore&#44; envisage the future development of comprehensive cardiovascular risk charts specifically adapted to these diseases&#46; Given the close correlation between the severity of skin disease and the development of cardiovascular events&#44; these tables should take into account the clinical assessment of the patient&#39;s psoriasis and the treatments prescribed as well as the traditional risk factors&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">From the dermatological standpoint&#44; a treatment aimed at reducing the severity of skin disease would also reduce the inflammatory burden&#46; In these patients&#44; it is also important to monitor known modifiable cardiovascular risk factors&#44; such as obesity&#44; hypertension&#44; and dyslipidemia&#44; and to check blood sugar levels regularly because of the increased risk of diabetes mellitus&#46; Proper control of these factors may be of greater importance in patients with a long history of psoriasis or PsA in whom the presence of sustained chronic inflammation in conjunction with poor control of cardiovascular risk factors could lead to a higher atherogenic burden&#46; In this regard&#44; a direct correlation between the duration of PsA and the presence of an abnormally thick common carotid artery intima-media was detected in a recent study&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">If&#44; once again&#44; we take rheumatoid arthritis as a model for chronic inflammatory disease&#44; we find that a consensus group of European experts has recommended stratifying cardiovascular risk in patients with rheumatoid arthritis using the Systematic Coronary Risk Evaluation &#40;SCORE&#41; risk charts&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> On the basis of the available evidence&#44; the 2 key aspects of the management of cardiovascular risk in rheumatoid arthritis are the use of SCORE risk charts adapted to each population group and clinical assessment of disease severity&#46; It is very possible that this approach could also prove useful for the management of cardiovascular risk in patients with psoriasis and PsA&#46; However&#44; its usefulness has not yet been demonstrated and no consensus has been reached on clinical guidelines relating to this important aspect of the management of these patients&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In view of the higher incidence of dyslipidemia and hypertension in patients with psoriasis and PsA&#44; treatment with statins and&#47;or antihypertensive agents should be considered in accordance with the Spanish guidelines on the management of cardiovascular risk based on the SCORE risk chart&#44; adapted to a southern European population&#44; as a guide&#46; The Third European Joint Task Force on cardiovascular prevention in clinical practice recommended the SCORE model as a tool for predicting cardiovascular risk&#46; The model predicts cardiovascular mortality at 10 years on the basis of age&#44; sex&#44; systolic blood pressure&#44; total cholesterol&#44; and smoking status&#46; In view of the geographical variability of cardiovascular risk in Europe&#44; 2 SCORE models have been developed&#58; 1 for high-risk and 1 for low-risk countries&#46; The main difference between the SCORE risk function and the Framingham-DORICA model is that the SCORE chart estimates risk for all atherothrombotic cardiovascular manifestations&#44; including stroke&#44; heart failure&#44; and peripheral arterial disease&#44; and not just coronary heart disease&#46; Moreover&#44; several studies have suggested that the Framingham-DORICA tables tend to underestimate cardiovascular risk in Spain&#44; especially in hypertensive patients with other cardiovascular risk factors&#59; the SCORE risk charts are&#44; therefore&#44; the recommended instrument for use in this country&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Given that the prevalence of cardiovascular disease in patients with psoriasis and PsA is high&#44; cardiovascular risk should be assessed in these patients by identifying factors inherent in these chronic inflammatory diseases that have been shown to be associated with the development of accelerated atherogenesis and cardiovascular events&#46; We would therefore consider the presence of a PASI&#160;&#62;&#160;10 to be a prognostic factor signaling the need for more rigorous management of the skin symptoms on the part of the dermatologist&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As a first step&#44; clinicians who assess patients with psoriasis or PsA should also define a primary cardiovascular risk prevention strategy&#44; based initially on making general recommendations to the patient regarding lifestyle&#44; such as the need for regular moderate physical activity&#44; a heart healthy diet&#44; weight and blood pressure control&#44; as well as tobacco cessation when appropriate&#46; Furthermore&#44; in accordance with the SCORE guidelines&#44; treatment with statins and&#47;or antihypertensive drugs should be initiated in patients with high cardiovascular risk &#40;SCORE<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In summary&#44; the risk of cardiovascular morbidity and mortality is higher in patients with psoriasis and PsA than in the population in general&#46; The presence of severe psoriasis is a significant predictor of cardiovascular risk in these patients&#46; In addition to treating the cutaneous manifestations in patients with psoriasis and the rheumatic process in patients with PsA&#44; clinicians must also monitor and appropriately manage the traditional risk factors for atherogenesis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres96156"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psoriasis and psoriatic arthritis are associated with increased risk of cardiovascular events and cardiovascular mortality&#46; Alongside classic risk factors for atherosclerosis&#44; the severity of psoriatic skin disease also influences cardiovascular risk in these patients&#46; In both cases&#44; endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease&#46; Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients&#46; Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La psoriasis y la artritis psori&#225;sica se asocian con un mayor riesgo de eventos cardiovasculares y de mortalidad cardiovascular&#46; Adem&#225;s de los factores cl&#225;sicos de aterosclerosis&#44; la gravedad de la afecci&#243;n cut&#225;nea influye en el aumento del riesgo cardiovascular en estos pacientes&#46; En ambos procesos se observa la presencia de disfunci&#243;n endotelial y un grosor aumentado de la &#237;ntima-media de la arteria car&#243;tida&#44; como expresi&#243;n de enfermedad cardiovascular subcl&#237;nica&#46; El tratamiento activo de la enfermedad y el manejo de los factores de riesgo cardiovascular cl&#225;sicos son fundamentales para disminuir la morbilidad cardiovascular en estos pacientes&#46; El establecimiento de gu&#237;as cl&#237;nicas para el manejo del riesgo cardiovascular abrir&#225;&#44; en el futuro&#44; un nuevo abordaje cl&#237;nico integral del paciente con psoriasis y la artritis psori&#225;sica&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Gonz&#225;lez-Gay MA&#44; Gonz&#225;lez-Vela C&#44; Gonz&#225;lez-Juanatey C&#46; Psoriasis&#58; una enfermedad cut&#225;nea relacionada con riesgo cardiovascular elevado&#46; Actas Dermosifiliogr&#46;2012&#59;103&#58;595&#8211;598&#46;</p>"
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Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2012.08.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	15	11	26
2024 October	99	43	142
2024 September	95	23	118
2024 August	96	66	162
2024 July	76	22	98
2024 June	83	30	113
2024 May	67	30	97
2024 April	64	35	99
2024 March	73	31	104
2024 February	53	33	86
2024 January	48	33	81
2023 December	51	20	71
2023 November	67	33	100
2023 October	66	29	95
2023 September	62	31	93
2023 August	34	15	49
2023 July	49	32	81
2023 June	49	18	67
2023 May	45	28	73
2023 April	55	33	88
2023 March	53	26	79
2023 February	35	28	63
2023 January	33	28	61
2022 December	61	47	108
2022 November	45	28	73
2022 October	52	39	91
2022 September	32	36	68
2022 August	32	56	88
2022 July	29	49	78
2022 June	31	39	70
2022 May	44	45	89
2022 April	40	59	99
2022 March	50	64	114
2022 February	34	30	64
2022 January	31	61	92
2021 December	34	46	80
2021 November	33	51	84
2021 October	34	52	86
2021 September	28	42	70
2021 August	32	41	73
2021 July	19	28	47
2021 June	25	37	62
2021 May	44	35	79
2021 April	83	53	136
2021 March	64	45	109
2021 February	41	27	68
2021 January	55	34	89
2020 December	41	21	62
2020 November	25	22	47
2020 October	26	16	42
2020 September	22	29	51
2020 August	37	28	65
2020 July	27	12	39
2020 June	32	30	62
2020 May	20	21	41
2020 April	31	19	50
2020 March	24	17	41
2020 February	3	1	4
2019 December	2	2	4
2019 September	5	0	5
2019 June	3	2	5
2019 May	1	6	7
2019 April	0	1	1
2019 March	2	8	10
2019 January	1	0	1
2018 December	3	0	3
2018 October	3	0	3
2018 September	4	0	4
2018 March	1	0	1
2018 February	25	8	33
2018 January	35	6	41
2017 December	25	8	33
2017 November	14	10	24
2017 October	29	5	34
2017 September	25	6	31
2017 August	34	12	46
2017 July	20	5	25
2017 June	38	13	51
2017 May	27	6	33
2017 April	19	5	24
2017 March	20	7	27
2017 February	12	8	20
2017 January	15	13	28
2016 December	29	8	37
2016 November	39	7	46
2016 October	36	10	46
2016 September	36	10	46
2016 August	46	14	60
2016 July	49	24	73
2016 June	9	0	9
2016 May	7	17	24
2016 April	14	4	18
2016 March	13	0	13
2016 February	11	7	18
2016 January	12	6	18
2015 December	8	0	8
2015 November	16	6	22
2015 October	18	2	20
2015 September	7	0	7
2015 August	11	1	12
2015 July	49	6	55
2015 June	55	8	63
2015 May	69	18	87
2015 April	76	14	90
2015 March	46	12	58
2015 February	62	7	69
2015 January	40	9	49
2014 December	59	13	72
2014 November	43	11	54
2014 October	58	16	74
2014 September	45	13	58
2014 August	16	3	19
2014 July	15	8	23
2014 June	33	6	39
2014 May	32	3	35
2014 April	27	11	38
2014 March	19	11	30
2014 February	24	11	35
2014 January	31	7	38
2013 December	32	7	39
2013 November	30	16	46
2013 October	18	11	29
2013 September	7	13	20
2013 August	13	15	28
2013 July	15	21	36
2013 June	12	25	37
2013 May	14	15	29
2013 April	28	18	46
2013 March	22	20	42
2013 February	22	8	30
2013 January	28	9	37
2012 December	21	6	27
2012 November	2	6	8
2012 October	3	21	24
2012 September	0	13	13

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