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Psoriasis is fundamentally an inflammatory disease which manifests itself in skin, joints and other body organs. There is a well-described link between psoriasis and cardiovascular disease, but the mechanism which connects skin inflammation to the cardiovascular system has, until now, been poorly understood. Now researchers in the US and in Sweden have addressed this question in a well-conducted study, using two complementary groups of patients; in the US, the Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative (PACI) and in Sweden, the Stockholm Psoriasis Cohort (SPC).1 In all, 769 patients with psoriasis were included in the study, 260 from PACI and 509 from SPC.
The researchers used an innovative blood marker of inflammation called GlycA, together with the Psoriasis Area and Severity Index (PASI), to assess the severity of disease in all patients. They then looked at cardiovascular events (heart attack or death) in the SPC patients and evidence of disease using special heart scans in the PACI group.
The findings were striking: GlycA accounted for approximately 17% of the association with evidence of disease on heart scans and 37% of the association with clinical cardiovascular events. These findings demonstrate, for the first time, that the systemic inflammation which is a key part of psoriasis, may make a substantial contribution to the onset of cardiovascular disease.
Comment
This study demonstrates the link between inflammation in the context of psoriasis and cardiovascular disease. However, the relative contribution in each patient group (17% and 37%) suggests that this is not the whole story and other mechanisms – including insulin resistance and variety of metabolic factors – are likely to be involved. Moreover, rather than skin inflammation driving cardiovascular disease, it could be that psoriasis and heart disease share common genetic pathways. Nevertheless, this study underscores the importance of viewing psoriasis as a systemic disease and strengthens the case for a multidisciplinary approach to patient care. There may also be a role for GlycA in the routine assessment of patients with psoriasis.
Reference
1 Svedbom A, Mallbris L, González-Cantero Á, et al. Skin Inflammation, Systemic Inflammation and Cardiovascular Disease in Psoriasis. JAMA Dermatol. 2025;161(1):81-86.