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Heart Disease and Diabetes: Risks Related to Psoriasis Diagnosis

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Posted on March 25, 2021

Psoriasis is an autoimmune skin disease. The condition is associated with an increased risk of heart disease, diabetes, and other comorbidities such as metabolic syndrome and sleep apnea.

Compared to people without psoriasis, those living with psoriasis or psoriatic arthritis have a 40 percent and 50 percent higher chance, respectively, of having type 2 diabetes. Immune disorders like psoriasis are associated with a two- to seven-fold risk of cardiovascular problems in the future.

How Can Psoriasis Affect Heart Disease and Diabetes?

How can a skin condition like psoriasis be connected to heart disease and diabetes? The answer lies in three main factors — inflammation, smoking, and certain psoriasis treatments.

Inflammation

In psoriasis, inflammation creates havoc in the body. Inflammatory processes increase compounds that promote inflammation (such as cytokines, interleukins, tumor necrosis factor-alpha, and highly sensitive C-reactive protein) and increase levels of homocysteine, a compound that leads to cardiovascular disease and diabetes.

Systemic inflammation also results in insulin resistance. This means your body cells are no longer sensitive to circulating insulin. As a result, blood sugar cannot enter the body cells, leading to increased blood sugar levels and ultimately, diabetes.

Via inflammation, psoriasis also increases the risk of atherosclerosis, high blood pressure, coronary artery disease, obesity, and abnormal lipid levels in the blood (dyslipidemia). Each of these is a known risk factor for cardiovascular disease and diabetes.

Smoking

Smoking is a contributing factor to diabetes and cardiovascular disease. Research has found that people with psoriasis are more likely to smoke than the general population.

Psoriasis Treatments

Finally, certain psoriasis treatments may play a role. For example, cyclosporine increases blood pressure and alters the metabolism of fats. Retinoids increase the levels of triglycerides and lower the levels of high-density lipoprotein cholesterol (good cholesterol). Methotrexate may increase homocysteine levels in the blood. All of these effects can increase the risk of cardiovascular disease.

However, some treatments may have a protective effect against heart disease and diabetes. At low amounts, methotrexate has been found to protect the heart thanks to its anti-inflammatory properties. And according to an American Heart Association journal report, biologic therapy for psoriasis protects against heart disease by reducing buildup in the arteries.

Do Heart Disease and Diabetes Increase Risk of Psoriasis?

High blood pressure (hypertension) and diabetes also increase the risk of psoriasis, likely due to shared characteristics.

Research has found that people diagnosed with type 2 diabetes are more likely than controls to develop psoriasis in the following 10 years. This is probably because obesity and depression are common in those with type 2 diabetes and are also risk factors for psoriasis.

In a study, researchers found that hypertension (high blood pressure) is associated with an increased risk of psoriasis and suggested that there are several common pathways. For example, psoriasis and hypertension both have increased oxidative stress and share similar inflammatory mechanisms. There may also be a genetic component that plays similar roles in the development of hypertension and psoriasis. The use of blood pressure medications (such as beta blockers, calcium channel blockers, or thiazides) may be linked to the development or worsening of psoriasis.

Methods To Reduce the Risk of Heart Disease and Diabetes

If you are living with psoriasis, follow these tips for reducing the risk of heart disease and diabetes:

  • Quit smoking.
  • Routinely measure your blood pressure at home.
  • Follow a healthy diet and limit your intake of cholesterol, trans fats, saturated fats, and sodium.
  • Maintain a healthy weight.
  • Stay physically active.
  • Visit your primary care physician once a year for a laboratory assessment of blood sugar and cholesterol levels.
  • Manage your stress.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 90,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you have diabetes? What about heart disease? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.

References
  1. Psoriasis Management — Journal of the Dermatology Nurses’ Association
  2. Psoriasis: Classical and Emerging Comorbidities — Anais Brasileiros de Dermatologia
  3. Risk of Type 2 Diabetes and Cardiovascular Disease in an Incident Cohort of People With Psoriatic Arthritis: A Population-Based Cohort Study — Rheumatology (Oxford, England)
  4. Chronic Inflammation, Cardiometabolic Diseases and Effects of Treatment: Psoriasis as a Human Model — Trends in Cardiovascular Medicine
  5. Increased Prevalence of the Metabolic Syndrome in Patients With Moderate to Severe Psoriasis — Archives of Dermatological Research
  6. Association of Homocysteine With Type 2 Diabetes: A Meta-Analysis Implementing Mendelian Randomization Approach — BMC genomics
  7. Thickness of Carotid Artery Intima Is an Independent Risk Factor for Psoriasis — Archives of Dermatological Research
  8. Association Between Psoriasis, Diabetes Mellitus, Hypertension and Obesity — Clinical Epidemiology and Global Health.
  9. The Association Between Psoriasis, Diabetes Mellitus, and Atherosclerosis in Israel: A Case-Control study — Journal of the American Academy of Dermatology
  10. Psoriasis and Cardiovascular Disease — Dermatologic Therapy
  11. Biologic Therapy for Psoriasis May Reduce Heart Disease — American Heart Association
  12. Psoriasis and Risk for New-Onset Diabetes — Primary Care Reports
  13. Psoriasis Risk in Patients With Type 2 Diabetes in German Primary Care Practices — Primary Care Diabetes
  14. Hypertension and Risk of Psoriasis incidence: An 11-Year Nationwide Population-Based Cohort Study — PloS One
  15. Researchers Explore Psoriasis-Diabetes Link — Harvard Health Letter
  16. Heart Disease: Diagnosis and Treatment — Mayo Clinic
  17. Methotrexate — National Psoriasis Foundation
Posted on March 25, 2021
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Paz Etcheverry, Ph.D. has an M.S. in food science and nutrition from North Carolina State University and a Ph.D. in food science and technology from Cornell University. Learn more about her here.

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