How is Psoriatic Arthritis Linked to Cardiovascular Disease?

Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: October 2021

People with psoriatic arthritis (PsA) are at increased risk for heart disease. PsA has a higher incidence of obesity, metabolic syndrome, and diabetes, all of which are risk factors for heart disease. In addition, lifestyle factors that are known risk factors for heart disease, such as smoking, have also been found to be prevalent among people with PsA.1

C-reactive protein (CRP), a marker of systemic inflammation, is well recognized as a nontraditional risk factor for cardiovascular disease, which includes heart disease. CRP and other systemic inflammation markers are higher in people with PsA compared to healthy subjects or people with psoriasis only.2

Researchers have developed a concept called the “psoriatic march” that casually links PsA and psoriasis with an increased risk of cardiovascular disease. According to this model, psoriatic disease produces inflammation throughout the body. This inflammation causes insulin resistance and dysfunction in the lining of the blood vessels, which lead to atherosclerosis (the formation of abnormal fatty masses in the arteries) and ultimately to major cardiovascular events.2

Some studies suggest that treatment of PsA with TNF inhibitors may reduce the risk of cardiovascular disease associated with PsA. However, the data is inconclusive, and cardiovascular benefit from TNF inhibitors remains to be demonstrated in PsA.2

Ways to decrease risk of heart disease

Just as in the general population, heart disease can be decreased by managing traditional risk factors:1

  • Smoking cessation – According to the American Heart Association, smoking is the most preventable cause of premature death in the U.S. Smoking increases the risk of developing many chronic disorders, including atherosclerosis that can lead to heart disease and stroke.1,3
  • Treatment of high blood pressure – Approximately 90% of all Americans will develop hypertension, or high blood pressure, over their lifetime. Hypertension puts more stress on arteries and can cause damage over time.1,3
  • Treatment of high cholesterol – High cholesterol is one of the major controllable risk factor for heart disease. When too much LDL (“bad”) cholesterol is in the blood, it can build up in the artery walls and narrow the vessels that feed the heart and brain.1,3
  • Control of diabetesDiabetes can affect many major organs in the body, including the heart. Fortunately, diabetes is treatable and often preventable.1,3

In addition, there are several lifestyle changes that can improve the heart health of people with PsA:

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