PsoriasisNet Article
Psoriasis Increases Risk of Heart Attack
Now Researchers Believe They Know Why

After several studies found that psoriasis might increase a person’s risk of having a heart attack, researchers wanted to know why. Do people living with psoriasis just have more risk factors for heart disease? Studies have shown this. Or, is it the psoriasis itself?

To find out, a multi-year study followed more than 600,000 patients. Of these patients, 130,976 had psoriasis and 556,995 did not. Including patients without psoriasis allowed researchers to study whether or not psoriasis is a risk factor for heart disease. Patients’ ages ranged from 20 to 90 years.

What researchers discovered suggests that psoriasis itself is a risk factor for heart disease. One finding in particular supports this conclusion. The younger patients with severe psoriasis had a slightly higher risk of coronary artery disease (CAD) than young people without psoriasis. CAD develops when arteries that supply blood to the heart harden and narrow, which reduces blood flow to the heart.

While CAD is a risk factor for a heart attack, the risk of a young person — with or without psoriasis — having a heart attack is low. The risk for heart disease universally increases with age.

Why Psoriasis seems to be a Risk Factor
For psoriasis to develop, the person’s immune system must overreact and send faulty signals. This leads to inflammation throughout the body. Studies suggest that inflammation contributes to atherosclerosis (ath-uh-roh-skleh-RO-sis), which occurs when plaque builds up in the blood. The plaque that builds up in the blood is made up of fat, cholesterol, and other substances found in the blood. As the plaque builds, arteries narrow. This reduces blood flow to the heart.

Inflammation also seems to be the reason that people living with rheumatoid arthritis have an increased risk of developing cardiovascular disease. Like psoriasis, rheumatoid arthritis is an autoimmune condition that causes inflammation within the body. Research shows that the more severe the rheumatoid arthritis, the greater the risk of dying from heart disease.

Dermatologists caution that these findings should certainly not alarm people living with psoriasis. While inflammation appears to increase the risk of a heart attack, researchers do not have all the facts. Quite possibly other risk factors for heart disease are needed to trigger a heart attack. Many of these risk factors for a heart attack can be controlled.

Risk Factors Within Our Control
The following lists actions we can take to reduce our risk factors for heart disease. How many changes could you make to reduce your risk?

	Quit smoking
	Reduce total cholesterol levels below 240 mg/dL
	Lower blood pressure below 120/80
	Lead a physically active lifestyle
	Diet and exercise so that you are not obese or overweight
	Control diabetes mellitus
	Limit alcohol consumption (Men should limit consumption to two drinks per day; women should not have more than one drink per day. One drink equals 1 ounce of liquor, 5 ounces of wine, or 12 ounces of beer.)
	Learn and practice healthy ways of coping with stress (Unhealthy ways of coping include overeating, smoking, and turning to alcohol for stress relief.)

Identifying one’s risk factors is the first step to gaining control. If you have checked off several actions, the changes needed to reduce your risk may seem overwhelming. Sharing the results with your dermatologist or primary care physician may be a good place to begin. Working together with your doctor, the two of you may be able to develop a plan for lowering your overall risk.

References:
Gelfand et al. “Risk of Myocardial Infarction in Patients with Psoriasis.” Journal of the American Medical Association. 2006. October 11;296(14):1735-41.

Mayo Clinic. “Heart attack: Risk factors.” Last accessed March 7, 2007 at www.mayoclinic.com/health/heart-attack/DS00094/DSECTION=4.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.