The term heart disease refers to several different conditions that affect the heart. Research has indicated that people with psoriatic arthritis (PsA) have an increased risk of developing heart disease — particularly coronary artery disease (CAD). This condition is characterized by a buildup of plaque in the arteries. Over time, this plaque buildup can restrict blood flow in the body, eventually causing heart attacks and even heart failure.
It’s easy to feel anxious after a diagnosis of psoriatic arthritis. Thinking about how psoriatic arthritis can affect the body beyond the joints can be overwhelming. However, it’s important to understand how psoriatic arthritis affects the whole body. You and your health care team can determine the right treatments and preventive measures to help you stay healthy and minimize your risk of heart disease.
Research has found that the incidence of heart disease is higher in people with inflammatory conditions, including psoriasis and PsA. People diagnosed with psoriatic arthritis may be 43 percent more likely to develop heart disease than the general population. People with PsA may also have a greater than 10 percent chance of developing cardiovascular disease within 10 years of being diagnosed with psoriatic arthritis.
Although it is generally accepted that certain aspects of psoriatic arthritis put a person at a higher risk of developing heart disease, some studies contradict this conclusion. One study seemed to show that risk factors for heart disease did not develop in people diagnosed with psoriatic arthritis, indicating that the risk factors may have been present before diagnosis. Another study showed the need for more research before determining exactly how high the risk of developing heart disease is after a diagnosis of psoriatic arthritis.
Inflammation raises a person’s risk of developing heart disease. Heart disease, in particular, involves inflammation in the endothelium — the innermost layer of cells in a blood vessel.
Endothelial dysfunction is an early indicator of atherosclerosis — a disease in which the arteries thicken and become stiff, which can lead to coronary artery disease. When the endothelial cells are not functioning properly, fats, cholesterol, and other substances can build up inside the arteries. This buildup (called plaque) indicates a diagnosis of atherosclerosis. Over time, plaque can slow down blood flow, block arteries, or even cause arteries to burst.
Because psoriatic arthritis is an inflammatory arthritis, most medical specialists believe that it triggers inflammation in the endothelium. This inflammation can, in turn, bring on atherosclerosis and result in heart disease.
Being diagnosed with psoriatic arthritis seems to be a risk factor for developing heart disease. Beyond that, men who are over 55 years old and who have been diagnosed with psoriatic arthritis for a long time are more likely to develop plaques associated with heart problems.
Many medical experts recommend that all people diagnosed with psoriatic arthritis get screened for cardiovascular risk factors that may lead to heart disease. Your doctor or other health care professional may perform blood tests that screen for high blood pressure (hypertension), high cholesterol levels, high blood sugar (hyperglycemia), and high triglycerides. They may also look at your weight, diet, activity levels, and whether you are a smoker. If you are found to have any risk factors for heart disease, your doctor may recommend taking steps to modify your lifestyle or habits to reduce your risk.
Your health care team may also recommend taking medications to manage your risk factors or changing the medications you take for psoriatic arthritis.
It is important to work with a rheumatologist to make sure that your psoriatic arthritis medications are not raising your risk of heart disease and related conditions. Steroids can sometimes raise cholesterol and lower your sensitivity to insulin, increasing your likelihood of developing diabetes. Nonsteroidal anti-inflammatory drugs (NSAIDs) may raise your risk of blood clots and heart failure. The risk of these side effects needs to be balanced with the benefit of these medications, however. For most people, the benefit outweighs the risk.
Biologics and disease-modifying antirheumatic drugs (DMARDs) have been shown to improve heart health. Treating your psoriatic arthritis effectively may also lower your risk of developing heart disease. Lowering the levels of inflammation in your body can reduce inflammation in your endothelium as well, thus lowering your risk of heart disease.
Your health care provider may recommend that you work to change lifestyle factors that add to your risk of heart disease.
Experts recommend trying a plant-based diet, eating more fish, and lowering your sugar intake to reduce your risk of developing heart disease.
Learn more about an anti-inflammatory diet for psoriasis.
Being overweight makes it more likely that you will develop inflammation of all types, and obesity is associated with many of the risk factors for cardiovascular disease.
The number on the scale is not the only indicator of health. If you make other changes but don’t experience weight loss, you may still help reduce your risk of heart disease.
Regular exercise can be hard when you’re aching from psoriatic arthritis, but it can help keep your heart healthy. You can work with an expert, such as a physical therapist, to determine what types of exercise will likely work best for you.
Quitting smoking and reducing your alcohol intake are two of the most powerful things you can do to reduce your overall risk of heart disease.
Work with your doctor to decide whether to use medications such as statins to treat your heart disease risk factors. These medications should not interfere with your psoriatic arthritis treatments, and they may help keep your heart healthy.
If you develop heart disease alongside psoriatic arthritis, there are several ways of treating and managing heart disease. In general, the treatments for heart disease are the same as the preventive measures outlined above: get moving, change your diet, stop smoking, and reduce your alcohol intake.
If these steps don’t help, your doctor may prescribe medications to treat heart disease. Depending on the health of your heart and your arteries, you may also need to have surgery. The specific procedure depends on the damage to your heart.
If you or someone you love has been diagnosed with psoriatic arthritis, it’s time to get the support you need.
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