Psoriasis severity predicts risk of abdominal aortic aneurysms

Characterized by inflamed red and silvery patches of skin, psoriasis is a common skin complaint.

Predominantly affecting adults, psoriasis is caused by skin cells building up too quickly in the surface layers of the skin. It is an itchy and long-lived disease endured by an estimated 2-3% of Americans.

[Medical image of aorta and kidneys]

Psoriasis is an autoimmune disease; in other words, the body’s immune system causes the symptoms by attacking healthy cells.

The aorta is a major artery that supplies blood to the abdomen, pelvis and legs. An abdominal aortic aneurysm occurs when the aorta becomes enlarged and balloons out.

In general, abdominal aortic aneurysms have no symptoms as they slowly swell over a number of years. Some of the major causes are smoking, high blood pressure, being a male and certain genetic factors.

When an abdominal aortic aneurysm ruptures, often with little warning, it becomes a medical emergency and can be fatal. Because of the lack of preceding symptoms, this makes them particularly dangerous.

Lead author Dr. Usman Khalid, at Herlev and Gentofte Hospital, Denmark, used data from Danish nationwide registers between 1997 and 2011 to investigate the links between psoriasis and this silent killer. In total, the team took information from 59,423 patients with mild versions of psoriasis and 11,566 patients with severe psoriasis.

The patients were followed until they suffered an abdominal aortic aneurysm, moved out of the country, died or the study ended. A surprisingly clear trend emerged.

Psoriasis and abdominal aortic aneurysms

In the general population, abdominal aortic aneurysms occur at a rate of 3.72 cases per 10,000 person-years. For those with mild psoriasis, the occurrence rate was seen to jump to 7.30, and for individuals with severe psoriasis, the prevalence increased to 9.87.

Dr. Khalid says of the results:

“Compared to the general population, the adjusted incidence rate ratios were significantly increased for severe psoriasis […] That’s a 67% greater risk of abdominal aortic aneurysms likelihood for severe psoriasis sufferers.

Clinicians need to educate and assist their patients with psoriasis in lifestyle and risk factor modification to facilitate cardiovascular disease risk reduction.”

Link between psoriasis and heart disease

The connection between psoriasis and heart health has been considered for some time. However, it is difficult to tease out cause and effect; people with severe psoriasis are more likely to be obese and suffer from diabetes, both risk factors forheart disease, but was it the psoriasis that encouraged the weight gain and diabetes, or did those conditions cause or exacerbate the psoriasis?

Recent studies have shown that the severity of psoriasis is related to the amount of inflammation in the blood vessels. This inflammation puts additional pressure on the heart, increasing the risk of cardiac events.

As evidence mounts for the link between cardiovascular health and psoriasis, Dr. Khalid asks whether routine screening for abdominal aortic aneurysms should be employed in psoriasis sufferers at the most severe end of the scale.

He also calls for further research into whether anti-inflammatory medication might ease the inflammation of blood vessels and reduce the risks of future circulatory problems. Dr. Khalid says:

“Psoriasis must be considered as a systemic inflammatory disease rather than an isolated skin disease. Increased awareness of heightened risk of other cardiovascular diseases, including abdominal aortic aneurysms, in patients with psoriasis is also required.”

The results add another piece to the puzzle, but only through further investigation will the best way to handle the psoriasis-cardiac interaction become clear. The connections between the disorders are given an extra layer of intrigue when added to the recent findings that asthma and psoriasis are linked, as is asthma and heart health. The picture certainly is a complex one.

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