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Veiny Truth of Vascular Inflammation

Veiny Truth of Vascular Inflammation

It is well known and documented that people living with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease, which includes damage to the blood vessels that can lead to heart attack or stroke. Part of the reason people with PsA are more likely to have cardiovascular disease is because they have a higher rate of the usual risk factors, such as obesity and diabetes. But even after those risk factors are taken into consideration, PsA itself seems to increase risk for cardiovascular complications. Recently, research has looked at inflammatory pathways as a commonality in both PsA and in the blood vessels.

People with PsA have noticeable inflammation in their joints, causing stiffness, pain, and possible disability that impacts many daily activities. PsA is an autoimmune disease, in which the body’s immune system gets triggered and creates chronic inflammation that causes damage to the joints. While the effects of inflammation are easily visible in the swelling and pain of the affected joints, it is also happening elsewhere in the body where it may go more unnoticed.

Understanding the risk

One study that examined the effect PsA has on cardiovascular disease was conducted at the Mayo Clinic. Researchers used the Framingham Risk Score, which looks at age, sex, smoking status, high blood pressure, diabetes, total cholesterol and high-density lipoprotein cholesterol to calculate a person’s risk of having cardiovascular disease over the next 10 years. The study followed 158 patients with PsA over 10 years. At the beginning of the study, 32 of the patients already had cardiovascular disease and 126 did not. Using the Framingham Risk Score, researchers predicted that over the 10-year period, 10 additional patients would develop cardiovascular disease. Those 10 patients were more likely to be smokers and more likely to be obese, common risk factors for both PsA and cardiovascular disease. But the Framingham Risk Score underestimated the true risk: 18 patients actually developed cardiovascular disease. While the Framingham Risk Score has proven effective in the general population, it underestimates the risk of cardiovascular disease in patients with PsA. Researchers concluded that this is due to the chronic inflammation in PsA, which may lead to damage to the inner lining of the blood vessels, arterial disease like atherosclerosis, and other downstream effects that are not accounted for by risk assessment systems. 1

Other studies have seen similar increased risk for cardiovascular disease among patients with other chronic inflammatory conditions, including psoriasis, rheumatoid arthritis, and lupus. While there are multiple inflammatory pathways that occur in the immune system, researchers continue to search for the commonalities and ways to interrupt the inflammation cascade in order to reduce the symptoms of PsA as well as reducing the risk of vascular inflammation and damage.

How to reduce risk

While researchers continue to look for ways to stop the chronic inflammation that causes damage to joints and vessels, experts agree that just as in the general population, the best ways to reduce the risk of cardiovascular disease is by managing the traditional risk factors, including quitting smoking, treating high blood pressure and high cholesterol, controlling diabetes, and managing weight. Some studies have found that treating PsA with the disease modifying anti-rheumatic drugs (DMARD) TNF inhibitors may reduce the risk of cardiovascular disease; however, other studies haven’t found a cardiovascular benefit to those treatments. The inflammatory pathways that impact PsA, cardiovascular disease, and other inflammatory conditions, such as diabetes and inflammatory bowel disease, will continue to be an area of focus for researchers. 2

  1. Ernste FC, Sánchez-Menéndez M, Wilton KM, et al. Cardiovascular risk profile at the onset of psoriatic arthritis: a population-based cohort study. Arthritis Care Res. 2015 Jul;67(7):1015-21. doi: 10.1002/acr.22536.
  2. de Vlam K, Gottlieb AB, Mease PJ. Current concepts in psoriatic arthritis: pathogenesis and management. Acta Derm Venereol. 2014 Nov;94(6):627-34.