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Cumulative Duration of Severe Psoriasis: A Novel Cardiovascular Risk Predictor for Dermatologists
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DOI：10.1007/s13555-026-01872-1.png)
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Abstract
En 中文
The association between moderate-to-severe psoriasis and cardiovascular (CV) risk is well known. No clear link between disease activity, disease duration, and CV risk has been established thus far to identify high CV risk patients with psoriasis without CV symptoms. We aimed to investigate the relationship between moderate-to-severe psoriasis and cardiovascular disease (CVD) by introducing and determining the cutoff value for a new tool, the cumulative duration of severe psoriasis (CDSP), reflecting the total duration of severe psoriasis skin symptoms. Ninety-eight asymptomatic patients with moderate-to-severe psoriasis were enrolled in this cross-sectional study, without cardiac symptoms. CDSP was recorded using a structured questionnaire. CDSP threshold, defined as Coronary Artery Calcium Score (CACS) > 0, was determined using receiver operating characteristic curve analysis. Ultrasound (intima-media thickness (IMT) and carotid, brachial, and femoral artery plaque burden) and cardiac computed tomography (CACS, segment involvement score (SIS), and coronary artery disease-reporting and data system severity (CAD-RADS™)) were performed. Controls (n = 248) were matched for age, sex, body mass index, and, where possible, comorbidities. CACS was significantly higher in psoriasis (mean 159.02, standard deviation 365.60) compared to controls (73.12, 166.08), P = 0.029. The CDSP threshold was 60.5 months. Patients with long-CDSP (> 60.5 months) had significantly higher CACS (214.63, 430.11) than patients with short-CDSP (57.61, 162.53), P = 0.012. SIS and CAD-RADS were also significantly higher in the long-CDSP group compared to the short-CDSP group (4.50, 3.85 vs. 1.39, 2.06), P = 0.002 and (2.06, 1.63 vs. 0.71, 1.08), P = 0.003, respectively. Patients with long-CDSP showed a non-significant trend towards higher IMT and peripheral plaque burden. Patients with long-CDSP had a greater extent and severity of CVD. This innovative predictor is easily determined by dermatologists and assists in the early identification of asymptomatic high CV risk patients with psoriasis. Graphical abstract available for this article. Psoriasis is a common skin disease characterized by inflammation, resulting in itchy, red, and scaly skin lesions. The inflammation also affects the blood vessels. Therefore, patients with severe psoriasis have a higher risk of cardiovascular disease, which affects the heart and blood vessels. We propose that patients with longer periods of severe psoriasis are exposed to inflammation for longer and, consequently, are at a higher risk of cardiovascular disease than those with shorter durations of severe symptoms. This study, conducted in Hungary, aimed to investigate the relationship between cumulative duration of severe psoriasis and cardiovascular disease by performing highly sensitive heart scans and ultrasound of blood vessels. Ninety-eight patients with psoriasis were included and matched with non-psoriasis controls. Our findings showed that patients with psoriasis had a greater cardiovascular disease burden, as assessed by imaging tests. Furthermore, patients with long cumulative duration of severe psoriasis (> 60.5 months) had a greater extent and severity of cardiovascular disease than patients with short cumulative duration of severe psoriasis. In conclusion, patients with a long cumulative duration of severe psoriasis are at higher risk of cardiovascular disease. Dermatologists play a vital role in the early identification of asymptomatic high cardiovascular risk patients with psoriasis and referring them to cardiology in order to prevent potentially life-threatening complications, such as heart attacks.
Keywords:
Atherosclerosis
Cardiovascular diseases
Inflammation
Psoriasis
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