Cardiovascular risk in psoriasis patients

Introduction: It is well established that moderate to severe psoriasis increases cardiovascular mortality and its risk factors including dyslipidaemia, high blood pressure (BP) and diabetes1. Despite this association, treatment goals and management plans do not explicitly include cardiovascular parameters. Difference in BP between arms is known to correspond to the presence or increased risk of cardiovascular disease, chronic renal disease, hypertension and peripheral vascular disease. Clark et al2 demonstrated that measuring BP in both arms was a reliable measure for predicting cardiovascular risk in the primary care setting. This study aims to prospectively identify the cardiovascular risk in psoriasis patients in a multi-site cohort study using inter-arm blood pressure.
Method: Patients with psoriasis were approached during their usual dermatology appointments and asked to fill out a survey and have blood pressures measured on both arms. Data was collected regarding patients’ demographic information, CV co-morbidities and psoriasis severity and treatment.
Results: Interim data included 157 patients. The mean age was 52-years and 55.4% were male. 32.5% of patients had a PASI >10 and 53.6% were on oral or biologic treatment. In regards to CV risk factors, 84.7% of participants had a waist-to-height ratio (WHtR) >0.5 (normal <0.5) and 19.1% had BP >140/80. Having a WHtR >0.5 was significantly associated with being male (p=0.003) and increased age (p<0.001). An Inter-arm systolic BP difference of >10mmHg and >15mmHg was evident in 25.5% and 4.5% of patients, respectively; an inter-arm diastolic difference of >10mmHg was associated with a WHtR of >0.5 (p=0.03).
1. Samarasekera, E. J., Neilson, J. M., Warren, R. B., Parnham, J., & Smith, C. H. (2013). Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis. The Journal of Investigative Dermatology, 133(10), 2340–2346.
2. Clark CE, Taylor RS, Shore AC, Campbell JL. The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ. 2012; 344: 1327.

Dr. Philippa Dickison