04 Mar African American Patients with Psoriasis at Even Greater Risk of Atherosclerotic Heart Disease
MedicalResearch.com Interview with:
Francis Alenghat, MD, PhD
Assistant Professor of Medicine
Section of Cardiology
University of Chicago
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Psoriasis has been associated with higher rates of atherosclerotic cardiovascular disease (ASCVD), potentially due to higher-than-normal levels of systemic inflammation. Whether this association varies by race was unknown. Also, it was unclear whether patients with psoriasis have more frequent ASCVD because of higher rates of traditional cardiovascular risk factors (smoking, diabetes, hypertension, hyperlipidemia) or because of components intrinsic to psoriasis itself.
We found that, amongst a large population of patients with psoriasis, patients of both sexes and most ages had elevated ASCVD rates compared to those without psoriasis. Overall, African American patients with psoriasis had a 15% ASCVD prevalence, whereas it was 10% in white patients with psoriasis. Increased ASCVD associated with psoriasis occurred at earlier ages in African American patients compared to white patients.
Traditional cardiovascular risk factors were common in patients with psoriasis and appeared to play a large role in the driving the higher rates of ASCVD in these patients, but even in patients with psoriasis but without any documented traditional risk factors, ASCVD rates were elevated compared to patients without psoriasis.
MedicalResearch.com: What should readers take away from your report?
Response: Psoriasis is associated with higher rates of atherosclerosis in both white and African American patients. Traditional risk factors account for at least some of this association, so it would be important to screen, counsel, and treat patients for these risk factors [smoking, hypertension, hyperlipidemia, diabetes]. Evaluate for these risk factors even in young patients and note that there is more frequent premature ASCVD in African American patients. The ultimate goal would be to limit the burden of ASCVD—in the form of heart attacks, strokes, and peripheral arterial disease—for patients with psoriasis.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Identifying the cellular mechanisms linking psoriasis and ASCVD is important and could help identify more targeted approaches beyond addressing traditional cardiovascular risk factors. Molecular imaging techniques in animal models and humans can help with this type of research.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was performed as an aggregate electronic health record database query. The advantage of this approach is that it allows for study of a large number of diverse patients to detect patterns that may otherwise be hard to see. The disadvantage is that it relies on ICD coding and does not allow for individual-level analysis. There are no disclosures.
Arnold KA, Treister AD, Lio PA, Alenghat FJ. Association of Atherosclerosis Prevalence With Age, Race, and Traditional Risk Factors in Patients With Psoriasis. JAMA Dermatol. Published online February 20, 2019. doi:10.1001/jamadermatol.2018.5462
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