Inflammatory Skin Conditions: Prevention of Cardiovascular Disease

During the 2023 Interdisciplinary Autoimmune Summit, Joel M. Gelfand, MD, MSCE, presented his session, “Update on Prevention of Cardiovascular Disease in IMID Patients.” He discussed the impact of immune-targeted treatments in cardiovascular events and surrogate markers of cardiovascular disease, in addition to understanding how physicians can use guidelines to lower the risk of cardiovascular disease mortality in patients with immune-mediated diseases.

He started by noting that within the last decade, some models have suggested interleukin-17s may be proinflammatory and antiatherogenic. Therefore, the effects of IL-17 as a cytokine in the blood, especially in cardiovascular disease, are unclear and it is difficult to know what the impact of blocking this cytokine will be on cardiovascular events.

He continued with rheumatoid arthritis (RA), stating that there is a well-accepted connection between RA and cardiovascular events, with an overall finding of a higher risk of cardiovascular events in people with inflammatory bowel disease. He reviewed a variety of inflammatory diseases and the risk of diabetes, stroke, and coronary artery disease. He emphasized that some of the stronger relationships are with psoriasis, especially with more severe psoriasis, based on treatment patterns. Additionally, he stressed that studies have shown younger individuals have a higher relative risk of cardiovascular event than people with psoriasis or inflammatory diseases who are older.

“This is a reminder that we need to consider the importance of cardiovascular risk in people with inflammatory diseases along the lifespan,” Dr Gelfand stated.

He added that although younger individuals have a low absolute risk, the best time to start introducing healthy lifestyle behaviors and discussing cardiovascular risk factors is at a younger age. As patients get older, physicians would have to get more aggressive in trying to lower their risk by controlling their cardiovascular risk factors.

Regarding the treatment of inflammation to prevent cardiovascular disease, the problem is that the immune system can be unpredictable and have paradoxical effects. Although it is well-known that a team of inhibitors are anti-inflammatory, they could be pro-inflammatory in the central nervous system, which can cause multiple sclerosis. Additionally, they could be anti-inflammatory in guts and joints while causing psoriasis-like skin lesions and inflammation in the skin. Specifically, for the IL-17 inhibitors, they can reduce inflammation in the skin and joints, and promote inflammation in the gut through inflammatory bowel disease.

“This shows you how complicated the relationships can be when we are looking at immune pathways and cardiovascular disease,” Dr Gelfand shared.

The latter portion of his session was spent talking about how physicians can use guidelines of care to lower the risk of cardiovascular disease in people with inflammatory conditions such as psoriasis. He shared that in 2019, the American Academy of Dermatology and the National Psoriasis Foundation released guidelines including the importance of comorbidities. He stated that it is recommended to follow age-appropriate guidelines from the Centers for Disease Control and Prevention or American Heart Association on screening patients with traditional cardiovascular risk factors. He recommended his colleagues do this more frequently and intensively. Being more aggressive in managing traditional cardiovascular risk factors in those with more severe psoriasis is a team-based approach.

“We encourage a dermatologist to educate the patient and work with their primary care physician or their prevention cardiologist, so everyone is aware of the latest findings and guidelines,” Dr Gelfand concluded.

—Jessica Garlewitz

Reference
Gelfand J. Update on prevention of cardiovascular disease in IMID patients. Presented at: Interdisciplinary Autoimmune Summit; April 26–28, 2023; Virtual.