Atherosclerosis—the buildup of plaque inside the arteries—is often silent, showing no symptoms until blood flow is severely narrowed or, worse, blocked completely. In fact, many people don’t know they have it until they experience a heart attack or a stroke.
For that reason, doctors often warn patients that chronic conditions associated with atherosclerosis, like diabetes, may affect their heart.
However, despite substantial evidence of the effects of psoriasis on heart health—it has been linked to coronary artery disease, heart attack, stroke, and more—people with psoriasis aren’t regularly advised about its link, nor are they screened for heart disease.
But research published in the November 2016 issue of JAMA Dermatology helps establish psoriasis as a predictor of atherosclerosis.
“Our study suggests that psoriasis should be considered just as seriously as diabetes when it comes to heart-health risks,” says Jeffrey Schussler, M.D., a cardiologist at Baylor University Medical Center at Dallas and one of the study’s authors. “Treating atherosclerosis in the early stages can help people avoid serious complications, like a heart attack.”
A cardiac risk factor
A chronic autoimmune disease, psoriasis appears as patches, or plaques, of thick, red skin lesions covered with silvery scales that flake off easily. These itchy patches are typically found on the legs, lower back, elbows, scalp, and face, although they can appear in other areas, too.
Exactly how and why psoriasis increases heart risks remains unclear, but scientists think the condition’s chronic inflammation is more than skin deep: It may lessen the body’s ability to regulate blood sugar and cholesterol levels and affect the function of the blood vessels’ inner lining.
The connection between diabetes and heart disease has been well established. The American College of Cardiology and the American Heart Association say that for people over 40 who have type 2 diabetes and are judged to be at intermediate cardiovascular risk, a coronary artery calcium (CAC) scan is a "reasonable" option to further assess their risk. The CAC screening measures calcium in the arteries, which can indicate atherosclerosis that could trigger a heart attack.
Like diabetes, psoriasis is associated with heart disease. Until now, CAC levels had never been compared in patients with diabetes and psoriasis. Specifically, the study compared the CAC levels of 258 people who had either type 2 diabetes or psoriasis and no other inflammatory diseases.
A third control group of 129 healthy individuals also had their CAC levels measured. More than 90 percent of the participants were white men and women with no history of coronary artery disease. Average ages in each group were 52, 51, and 52, respectively.
The study results are compelling: Not only was the amount of calcification similar between people with psoriasis and those with diabetes, but the presence of psoriasis, even when well controlled, was an equally strong predictor of coronary calcification. In fact, the prevalence of coronary calcification was five times higher in people in the diabetes and psoriasis groups than in the healthy group.
“The findings suggest that people with psoriasis have high rates of what we call ‘subclinical’ atherosclerosis, in which the person doesn’t experience any symptoms,” Schussler says. “We believe that the findings warrant education, early heart-risk assessment, and aggressive risk-factor modification in people who have moderate to severe psoriasis.”
The study didn’t establish a cause-and-effect relationship between psoriasis and atherosclerosis. Additionally, because the participants in the study controlled their psoriasis well for several years before the study, it’s possible that atherosclerosis was underestimated and would be even more prevalent among a group that included people with less well-controlled psoriasis.
The bottom line
If you have psoriasis, ask your doctor about your heart-health risk factors. If you have two or more traditional cardiac risk factors, such as high blood pressure, a large waistline, or tobacco use, a coronary calcium scan may be appropriate.
The calcium score can give you a clearer picture of your future heart attack risk. From there, you and your doctor can decide whether you need a daily aspirin or a statin to prevent blood clots, for example, or if you should make certain lifestyle changes. Many insurance plans don’t cover the test, however, and the cost can range from $100 to $400.