Cardiovascular Journal of Africa: Vol 29 No 3 (May/Junel 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018

AFRICA

189

Review Article

Double trouble: psoriasis and cardiometabolic disorders

Nasrin Goolam Mahyoodeen, Nigel J Crowther, Mohammed Tikly

Abstract

Psoriasis (PsO) is a chronic immune-mediated inflammatory

skin disorder associated with numerous co-morbidities. This

descriptive review focuses on the cardiometabolic co-morbid-

ities of PsO with reference to the epidemiology and pathoge-

netic mechanisms linking PsO and cardiometabolic disease

(CMD). Registry-based studies have shown PsO to be associ-

ated with an increased risk of cardiovascular morbidity and

mortality. Factors linking PsO and CMD include: chronic

inflammation, obesity, classic cardiovascular risk factors, and

the effects of systemic therapy used to treat PsO. Chronic

inflammation is associated with PsO itself, and with obesity.

Adipose tissue is responsible for the secretion of various

adipokines, which together with pro-inflammatory cytokines

arising from the psoriatic plaque, contribute to the pro-

inflammatory and pro-atherogenic environment. Systemic

therapy aimed at decreasing inflammation has been shown

to improve CMD in PsO. Screening for and treating CMD

and initiating lifestyle modifications will remain the most

important interventions until further data emerge regarding

the effect of systemic therapy on CMD progression.

Keywords:

psoriasis, cardiovascular disease, cardiometabolic

disease, co-morbidities, metabolic syndrome, obesity

Submitted 26/6/17, accepted 6/12/17

Published online 13/12/17

Cardiovasc J Afr

2018;

: 189–194

www.cvja.co.za

DOI: 10.5830/CVJA-2017-055

Psoriasis (PsO) is a complex, chronic, immune-mediated

inflammatory skin disorder, which has a global prevalence

ranging between 0.91 and 8.5%.

It is recognised by the World

Health Organisation as a major global health challenge,

and

is associated with impaired psychological quality of life, which

exceeds that observed in several chronic conditions including

malignancy and heart failure.

A wide range of co-morbidities

are associated with PsO, ranging from chronic inflammatory

disorders such as inflammatory arthritis, [often referred to as

psoriatic arthritis (PsA)],

Crohn’s disease,

neuropsychiatric

disorders such as Parkinsonism,

psychiatric disease,

6,7

malignancies,

4,8

as well as cardiometabolic diseases

9-13

(Table 1).

In this descriptive review, we examine the epidemiological

and pathological evidence linking PsO and cardiometabolic

disorders, with a particular focus on cardiovascular disease

(CVD). We conducted a PubMed search using the term

‘psoriasis’ in combination with the terms ‘cardiovascular disease’,

‘co-morbidities’, ‘diabetes’, ‘metabolic syndrome’, ‘obesity’,

‘hypertension’, ‘dyslipidaemia’, ‘non-alcoholic fatty liver disease’

and ‘inflammation’. Our search was limited to articles published

in English.

Immunopathogenesis of psoriasis

The interplay between genetic factors and environmental triggers

results in the classic psoriatic plaque, characterised histologically

by epidermal hyperplasia, vascular hyperproliferation and

chronic inflammation.

Common triggers for the disease are

local skin trauma (Koebner phenomenon), stress,

Streptococcus

pyogenes,

infection and smoking.

About a third of patients have

a family history of PsO and genome-wide analysis studies have

shown the

PSORS1

gene, located on chromosome 6p, accounts

for between 35 and 50% of the heritability of PsO.

Department of Internal Medicine, Chris Hani Baragwanath

Academic Hospital, Faculty of Health Sciences, University

of the Witwatersrand, Johannesburg, South Africa

Nasrin Goolam Mahyoodeen, MB ChB, FCP (SA), Cert Endocrinol

Metab (SA),

mahyoodeen@yahoo.com

Mohammed Tikly, FRCP,

PhD

Department of Chemical Pathology, National Health

Laboratory Services and University of the Witwatersrand,

Johannesburg, South Africa

Nigel J Crowther, PhD

Table 1. Co-morbidities associated with psoriasis

• Psoriatic arthritis

• Crohn’s disease

• Parkinson’s disease

• Psychiatric disease

–– Major depression

–– Alcohol abuse

• Malignancy

4,8

• Chronic kidney disease

• Cardiometabolic diseases

–– Obesity

–– Metabolic syndrome

13,16

»» Type 2 diabetes

»» Hypertension

»» Dyslipidaemia

–– Myocardial Infarction

–– Stroke

19,20

–– Abdominal aortic aneurysms

–– Non-alcoholic fatty liver disease

• Hyperuricaemia and gout