CVD and Psoriasis: Is One Treatment Better Than Another to Reduce Risk?
Psoriasis is a known risk factor for cardiovascular events such as myocardial infarction, coronary heart disease, stroke, and thromboembolism and mortality attributed to cardiovascular disease (CVD) increases with the severity of psoriasis. One hypothesis for how these two diseases are connected is that pro-inflammatory cytokines such as tumor necrosis factor-a (TNF-a) may be a pathogenic link between the two. Chronic activation of cytokine-mediated inflammatory pathways in patients may trigger the formation of atherosclerotic plaques. Therefore, treatment with anti-inflammatory agents may reduce risk.
A recent study looked at whether treating psoriasis patients with a TNF-a inhibitor (TNFis) may reduce risk for CVD events compared to phototherapy. The study sought to assess the overall risk of major cardiovascular events depending on treatment and to understand the effect of cumulative treatment exposure to either agent on cardiovascular event risk. The study used a retrospective design to compare two distinct cohorts of patients over a 14 year period who were either treated with phototherapy or TNFis.
The results showed that in this study, patients who were treated with TNFis had a significantly lower risk of major CV events compared to patients who were treated with phototherapy. This study also showed that a longer cumulative exposure to TNFis is associated with a risk reduction of major CV events and that the risk reduction was larger than that of patients treated with phototherapy.
The authors conclude that despite some study limitations, treating patients with TNFis will reduce risk of experiencing major CV events than treating with phototherapy.