Bridging Specialties for Better Care: The Cardiovascular-Dermatology Interface

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In an era when the complexity of inflammatory skin diseases intersects with the rising burden of comorbidities, particularly cardiovascular disease (CVD), the need for interdisciplinary education has never been more urgent. At Masterclasses in Dermatology, our commitment to bringing together world-class educators across specialties has created a platform for forward-thinking, clinically impactful education. This year’s sessions exemplify that mission—perhaps none more so than our newest collaboration with cardiologist-immunologist Dr Brittany Weber.

Dr Weber, a distinguished faculty member at Harvard and director of the Cardio-Rheumatology Clinic at Brigham and Women’s Hospital, will soon be joining UT Southwestern to lead a ground-breaking cardio-dermatology and cardio-rheumatology program. She joined our Masterclass this year to deliver a high-impact, practical talk titled “A Practical Approach to Cardiovascular Prevention in Dermatology.” Her insights underscore a fundamental truth: Dermatologists are on the front lines of chronic inflammatory disease, and we can—and must—play a greater role in cardiovascular prevention.

Why Cardiovascular Risk Matters in Dermatology

The cardiovascular implications of chronic inflammatory skin diseases are no longer theoretical. Robust data confirm that conditions such as psoriasis, hidradenitis suppurativa (HS), atopic dermatitis, and even alopecia areata confer increased risk of cardiovascular disease. These diseases amplify traditional CVD risk factors, contribute to systemic inflammation, and intersect with metabolic syndromes like obesity, hypertension, and dyslipidemia. Psoriasis, in particular, is a well-established risk enhancer for CVD. As Dr Weber highlighted, severe psoriasis independently raises the risk of myocardial infarction and other atherosclerotic events. The increased burden of traditional risk factors, from dyslipidemia to obesity, correlates closely with disease severity and duration. Unfortunately, clear guidelines for cardiovascular screening and prevention in these patient populations remain sparse. That is where a collaborative model, and education through forums like Masterclasses, becomes critical.

The Emerging Discipline of Cardio-Dermatology

Dr Weber is helping lead an emerging field: cardio-dermatology and cardio-rheumatology. Her clinic integrates cardiology, rheumatology, and now dermatology in a unified care model that focuses on early cardiovascular risk recognition and prevention in patients with autoimmune inflammatory diseases. One of the key messages from her talk was that while dermatologists may not be expected to manage hypertension or initiate lipid-lowering therapies, we are ideally positioned to identify high-risk patients early and collaborate with cardiology or primary care in risk stratification and preventive strategies. This “ABCDE” approach to CVD prevention in inflammatory disease includes:

• A: Assess cardiovascular risk early
• B: Blood pressure management
• C: Cholesterol control and statin initiation where appropriate
• D: Diabetes and weight management
• E: Encourage lifestyle modification

Dermatologists often develop longitudinal, trusting relationships with patients—a unique opportunity to insert prevention-focused dialogue into routine care.

Monitoring for Cardiovascular Effects of Dermatologic Therapies

The therapeutic armamentarium in dermatology is rapidly evolving. With biologics, Janus kinase (JAK) inhibitors, and small molecules now central to our management of inflammatory disease, it is crucial to understand their cardiovascular implications. Dr Weber shared a sobering meta-analysis demonstrating that JAK inhibitors can increase lipid levels and may carry a heightened risk of major adverse cardiovascular events and venous thromboembolism. Agents like cyclosporine and tumor necrosis factor (TNF) inhibitors, while effective, have dose-related risks for hypertension, nephrotoxicity, and potential heart failure. Even minoxidil, a commonly used dermatologic agent, has potential cardiovascular side effects, including orthostatic hypotension and fluid retention.

Understanding these associations and discussing them with our patients empowers shared decision-making. It also highlights the need for cardiovascular monitoring protocols in our specialty, particularly when initiating systemic therapy in high-risk patients.

Imaging and the Future of Risk Stratification

Beyond labs and risk calculators, Dr Weber emphasized the role of multimodality cardiovascular imaging in better understanding and managing CVD risk. Coronary computed tomography angiography (CCTA), stress positron emission tomography (PET), cardiac magnetic resonance imaging, and echocardiography are increasingly available and can provide valuable insights, especially for patients with autoimmune conditions who often fall through the cracks of standard risk assessment tools.

For example, Dr Weber cited data showing that patients with autoimmune diseases, such as lupus or psoriasis, often harbor subclinical plaque and microvascular dysfunction. A proactive approach using imaging can uncover hidden risk, enhance treatment precision, and ultimately prevent catastrophic events.

The Obesity-Inflammation Axis and GLP-1 Agonists: A New Frontier

Another key intersection shared in Dr Weber’s Masterclass talk is the link between obesity, chronic inflammation, and CVD. Associated with over 100 complications, obesity is a multisystem disease and its role in worsening both psoriasis and cardiovascular outcomes is well documented. Inflammatory cytokines, such as TNF-alpha and IL-6, create a feed-forward loop between metabolic dysfunction and immune activation.

Enter the GLP-1 receptor agonists. Originally developed for type 2 diabetes, GLP-1s, such as semaglutide and liraglutide, have demonstrated remarkable benefits across multiple domains: weight loss, glycemic control, reduction in blood pressure and inflammation, and—critically—a reduction in cardiovascular events, even in patients without diabetes.

Dr Weber walked the audience through recent trials, such as SELECT and STEP-HFpEF, where GLP-1s significantly improved cardiovascular outcomes, exercise capacity, and quality of life. She also highlighted emerging studies exploring GLP-1s in dermatologic disease, including psoriasis and HS. While still preliminary, early data suggest GLP-1s may improve Psoriasis Area and Severity Index scores, reduce HS flares, and mitigate cardiometabolic risk in these populations.

Of course, the dermatology literature remains sparse and there are challenges, including negative side effects like nausea and constipation, contraindications (medullary thyroid cancer, pancreatitis), and prescribing logistics. Still, GLP-1s represent a compelling future direction for interdisciplinary care, and dermatologists should be aware of their evolving role.

Hidradenitis Suppurativa and Cardiometabolic Disease

HS, long regarded as a dermatologic challenge, is increasingly recognized as a systemic disease with significant cardiometabolic burden. Patients with HS have higher rates of obesity, insulin resistance, dyslipidemia, and even premature atherosclerosis.

In a recent systematic review, HS was linked to elevated risk of CVD events, with some studies suggesting risk levels comparable to traditional high-risk groups. Dr Weber encouraged dermatologists to screen patients with HS more aggressively, not only for cardiometabolic comorbidities but also for mental health concerns, which further compound overall risk.

GLP-1s have also been explored in small studies in HS, showing promise in reducing flares and improving metabolic health. While larger trials are needed, this adds to the rationale for collaborative care and innovative therapeutics at the interface of dermatology and cardiology.

The Path Forward: Collaborative, Preventive, Precision Care

The key takeaway from Dr Weber’s Masterclass session is that dermatologists cannot work in silos. The cardiovascular consequences of skin inflammation are real and modifiable. Through early recognition, risk factor screening, targeted therapy, and strategic collaboration with cardiologists, we can significantly improve outcomes for our patients.

Dr Weber’s upcoming move to UT Southwestern marks an exciting chapter in the integration of cardiovascular and dermatologic care. Her vision—and ours—is a future where interdisciplinary clinics, cross-specialty training, and shared research infrastructure define how we approach complex diseases.

At Masterclasses in Dermatology, we are proud to offer a front-row seat to this evolution.

Reference of Note

Sheth S, Inestroza K, Merola JF, Weber B, Garshick M. Practical recommendations on cardiovascular risk evaluation in patients with psoriasis and psoriatic arthritis for dermatologists, rheumatologists, and primary care physicians by the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network. J Psoriasis Psoriatic Arthritis. 2025:24755303251337020. doi:10.1177/24755303251337020