The Role of Inflammatory Diseases on Cardiovascular Risk
On Saturday, April 28, Joel Gelfand, MD, MSCE, professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania, presented “New Advances in the Impact of Anti-Inflammatory Treatment on Cardiovascular (CV) Risk” at the Interdisciplinary Autoimmune Summit (IAS).
Dr Gelfand’s presentation covered the role of chronic inflammation on CV risk among patients with immune-mediated inflammatory diseases, mainly focusing on psoriasis. According to Dr Gelfand, the pathophysiology of psoriasis includes the activation of TH1/TH17-associated inflammation and is similar to the inflammatory mechanisms that cause atherosclerosis, thrombosis, and lipid metabolism. Along with inflammation, environmental and genetic factors, such as obesity and the ApoE4 gene, are involved in the risk for developing not only psoriasis but also diabetes and CV diseases (figure 1).
Psoriasis is associated with a similar risk for major cardiovascular events (MACE) as diabetes. The 10-year risk for MACE due to more severe psoriasis is 6%, Dr Geldfand said. This risk is associated with a 5-year decrease in life expectancy.
In addition, Dr Gelfand covered some of his and others’ research on the association between inflammatory diseases, including rheumatoid arthritis and inflammatory bowel disease, and CV risk. This included the study he and his colleagues published in 2013 titled “Psoriasis Severity and the Prevalence of Major Medical Comorbidity,” which demonstrated that body surface area (BSA) was a predictor of mortality independent of other risk factors. One of the frustrations of this finding, Dr Gelfand expressed during his presentation, was that Aristoteles had written similar conclusions in 320 BC saying that “somewhere along the way” dermatologists had lost this understanding of the link between skin and internal systems. Another study presented by Dr Gelfand showed that for every 10% increase in psoriasis-affected BSA there was a 20% increase in diabetes risk.
New therapies that target the immune pathways related to psoriasis were also showing some benefits on CV risk, according to Dr Gelfand. A recent study, Dr Gelfand said, showed ustekinumab (Stelara), which blocks Interleukin (IL)-12 and IL-23, was associated with statistically significant improvements in aortic inflammation that was similar to what is seen among patients on statin therapy. However, more studies are needed to confirm the benefits of these therapies, as well as to fully understand the mechanisms associated with this reduction in CV risk.
Dr Gelfand concluded his presentation on how dermatologists, rheumatologists, and others treating patients with psoriasis could help lower this risk. He noted the standard screening recommendations from the United States Preventive Task Force should be considered. A common theme throughout the talks at IAS was how specialists are sometimes the only doctor a patient will see because some do not have a primary care provider. In light of this, Dr Gelfand stressed that checking a patient’s blood pressure, assessing their hemoglobin levels, as well as asking patients about other risk factors could significantly improve patients’ quality of life and clinical outcomes.