Analyzing Psoriasis and its Association with Coronary Microvascular Dysfunction

A recent prospective study has revealed that almost a third of patients with severe psoriasis have echocardiographic evidence of asymptomatic coronary microvascular dysfunction (CMD) (Piaserico et al., 2021). This finding provides a potential explanation for the well-established association between psoriasis and cardiovascular disease. The study, conducted by Stefano Piaserico and colleagues at the University of Padua in Italy, showed that 31.5% of the 448 patients with psoriasis included in the study had CMD detected through Doppler echocardiography.

The presence of CMD in patients with psoriasis is significantly correlated with the severity and duration of the skin disease. For every 1-point increase in the Psoriasis Area and Severity Index (PASI) score and 1-year increase in psoriasis duration, there is a 5% to 6% increase in the risk of CMD. These findings highlight the importance of diagnosing and actively searching for microvascular dysfunction in patients with psoriasis, as this population is particularly susceptible to cardiovascular risk (Piaserico et al., 2021).

Despite the well-established association between psoriasis and cardiovascular risk, patients with psoriasis often remain undertreated for cardiovascular risk factors. Studies have shown that a significant proportion of psoriasis patients with treated cardiovascular risk factors fail to achieve guideline-recommended goals (Piaserico et al., 2021). Moreover, many patients with psoriasis have untreated diabetes, hypertension, or hyperlipidemia. This underdiagnosis and undertreatment of cardiovascular risk factors in psoriasis patients may contribute to the elevated morbidity and mortality observed in this population.

Psoriasis-induced inflammation is believed to be a key contributor to atherosclerosis and coronary microvascular dysfunction. The systemic inflammation associated with psoriasis can affect atherosclerotic plaque formation and impair coronary microcirculation. This study by Piaserico and colleagues further supports this mechanistic link by demonstrating a significant association between the severity of psoriasis, psoriatic arthritis, and the duration of disease with lower coronary flow reserve (CFR) (Piaserico et al., 2021).

The study suggests that CFR could serve as a reliable and noninvasive tool for identifying early cardiovascular dysfunction in patients with psoriasis (Piaserico et al., 2021). Monitoring CFR during psoriasis therapy may help evaluate the effectiveness of treatment in improving vascular function and reducing the risk of subsequent cardiovascular events. Preliminary studies have shown marked improvements in CFR after treatment with TNF-alpha inhibitors, ustekinumab, or secukinumab (Piaserico et al., 2021).

The findings of this study shed light on the relationship between psoriasis and cardiovascular disease. The presence of asymptomatic coronary microvascular dysfunction in patients with severe psoriasis emphasizes the need for early diagnosis and comprehensive cardiovascular risk assessment in this population. By understanding the mechanistic link between psoriasis-induced inflammation and cardiovascular dysfunction, we can potentially develop targeted interventions to reduce the burden of cardiovascular disease in patients with psoriasis. Further research is needed to explore the therapeutic implications of improving coronary microvascular function through psoriasis treatment.

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