SEVERE psoriasis is associated with an increased cardiovascular risk, specifically asymptomatic coronary microvascular dysfunction (CMD). CMD is characterised by an abnormal regulation of the coronary microcirculation, and is known to predict a poor cardiovascular prognosis in the general population. The presence of CMD is clinically measured through the evaluation of a patient’s coronary flow reserve (CFR), with lower values indicating a higher risk of myocardial infarction and death.
As patients with psoriasis are at a heightened risk for cardiovascular disease, the research team, based at the University of Padua, Italy, aimed to assess the prevalence and predictors of CMD in a large cohort of patients with psoriasis without cardiovascular disease.
A total of 448 patients (mean age: 45 years; 69% male) were included in the study and underwent transthoracic Doppler echocardiography to assess coronary microcirculation. Almost one-third of patients (31.5%) with psoriasis had a CFR of 2.5 or less, indicating CMD. A further 12.9% had a CFR of 2.0 or less, and 5.1% had a ‘severely reduced’ CFR of less than 1.5. When comparing these results with a cohort without CMD, participants with CMD had a longer psoriatic disease duration (18.91±13.53 versus 12.38±10.86; p<0.001), hypertension ( 34.0% versus 19.5%; p<0.001), and psoriatic arthritis (43.3% versus 26.7%; p<0.001). Furthermore, for every additional year of psoriasis duration, patients experienced a 5.8% and 4.6% increased risk for CMD.
Overall, Stefano Piaserico, department of medicine, University of Padua, concluded: “Our findings extend the observations of earlier small studies by showing a high prevalence of coronary microvascular dysfunction in asymptomatic patients with severe psoriasis and by showing that the excess microvascular dysfunction is independently associated with the severity and duration of psoriasis.” The research team suggest that dermatologists should diagnose and actively search for microvascular dysfunction in patients with psoriasis due to the high risk of these populations.
