Bridging the Gap Between Psoriasis and Cardiovascular Disease Risk

In his presentation at Dermatology Week 2025, Joel M. Gelfand, MD, MSCE, tackled the critical but often overlooked connection between psoriasis and cardiovascular disease (CVD), emphasizing the need for dermatologists to consider cardiometabolic health when managing patients with moderate-to-severe psoriasis.

Dr Gelfand opened with a reflection on his 2-decade-long research journey, noting the rapid growth in published studies linking psoriasis with CVD. He presented evidence from Mendelian randomization studies suggesting a bi-directional relationship: genetic risk factors for coronary artery disease appear to increase the likelihood of developing psoriasis, and vice versa.

Obesity emerged as a central theme, both as a causal risk factor and disease modifier. “The average BMI among psoriasis patients in dermatology practices is 30—clinically obese,” Dr Gelfand said. He explained that obesity not only increases psoriasis severity but also impairs treatment response, particularly to biologics, and raises the risk for psoriatic arthritis.

Dr Gelfand highlighted GLP-1 receptor agonists as a promising intervention. These drugs, widely used for diabetes and weight loss, may also directly reduce psoriasis inflammation by modulating IL-17 and tumor necrosis factor (TNF) pathways. Preliminary evidence from observational studies and small randomized trials shows improvements in skin disease and systemic inflammation with agents like semaglutide.

Turning to long-term outcomes, Dr Gelfand reviewed data showing higher rates of cardiovascular events, diabetes, and mortality in patients with psoriasis, particularly those with extensive skin involvement. For every 10% increase in body surface area affected, the risk of mortality rises by 80%, he noted, independent of traditional risk factors.

He then reviewed the mixed evidence on whether systemic therapies reduce cardiovascular risk. While some observational data suggest methotrexate and TNF inhibitors may be protective, randomized controlled trials have not shown consistent benefit. For example, ustekinumab transiently lowered aortic vascular inflammation, but the effect did not persist at 1 year. Other agents showed limited impact on key biomarkers like IL-6 and glucose metabolism.

Phototherapy, particularly UVB light, may offer unexpected cardiovascular benefits, as recent animal model data show reduced atherosclerotic plaque burden. Dr Gelfand cautioned against over-restricting sun exposure, advocating for a balanced approach that recognizes the potential cardioprotective effects of UV light.

He closed by reviewing guideline-based recommendations from the American Academy of Dermatology and the National Psoriasis Foundation, which call for cardiovascular risk screening and education in all patients with psoriasis, with intensified efforts for those with moderate-to-severe disease.

“Psoriasis is not just a skin disease,” Dr Gelfand concluded. “It’s a systemic condition that intersects with major public health issues like heart disease, obesity, and diabetes. As dermatologists, we have a role to play in reducing those risks.”

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Reference
Gelfand J. Psoriasis and heart health: bridging the gap in risk assessment and management. Presented at: Dermatology Week; May 14–16, 2025; Virtual