Psoriasis and Cardiovascular disease

The concept of “psoriatic march” proposes that chronic cutaneous inflammation leads to systemic inflammation that in conjunction with increased oxidative stress triggers a cascade of events including oxidative stress, dyslipidemia, endothelial dysfunction and insulin resistance leading to metabolic syndrome or its individual components and increased risk of cardiovascular complications in psoriatics. A rise in plasma lipid and lipoprotein levels with disturbances in oxidation of triglycerides and cholesterol levels, particularly low-density lipoprotein favors atherosclerotic plaque formation predisposes psoriasis patients more for atherosclerosis compared to controls. The oxidative stress also contributes to inflammatory process leading to increased oxidant load, cell damage and lipid peroxidation of cell membranes. Thus, severe psoriasis appears to be an independent risk factor for cardiovascular disease and major adverse cardiac outcomes such as myocardial infarction, stroke and cardiovascular mortality. Framingham risk score predicts chances of having a heart attack in the next 10 years in adults aged 20 years and older who do not have heart disease or diabetes.