Underdiagnosis and undertreatment of cardiovascular risk factors in patients with moderate to severe psoriasis.
BACKGROUND
Patients with psoriasis are known to have an increased number of cardiovascular (CV) risk factors and be at increased risk for CV events.


OBJECTIVE
We sought to describe and characterize the underdiagnosis and undertreatment of CV risk factors in patients with moderate to severe psoriasis.


METHODS
Medical histories including diabetes, hypertension, and hyperlipidemia were obtained from 2899 patients in 3 phase III ustekinumab trials, a therapeutic anti-interleukin (IL)-12/IL-23p40 monoclonal antibody. Reported history was compared with measured fasting glucose, fasting lipids, and blood pressure. Ten-year Framingham risk scores and the proportion of patients achieving glycemic, lipid, and blood pressure targets were evaluated.


RESULTS
Significant risk factors existed in patients with moderate to severe psoriasis (58.6% and 28.8% of patients had ≥ 2 and ≥ 3 established CV risk factors, respectively). Based on Framingham risk score, 18.6% of patients were at high risk and 12.3% were at intermediate risk for CV events. At baseline, a small proportion of patients with diabetes (2.3%), hypertension (9.1%), or hyperlipidemia (4.9%) were previously without a diagnosis. However, 19.1%, 21.8%, and 38.6% of patients with diabetes, hypertension, or hyperlipidemia, respectively, were untreated at baseline, and the proportion at treatment goal was not ideal (hypertension 59.6% and hyperlipidemia 69.7%), especially for diabetes (36.7%).


CONCLUSIONS
Results are based on a clinical trial population and findings may not be generalizable to the general psoriasis population.


CONCLUSIONS
In this moderate to severe psoriasis population, a high prevalence of undiagnosed and undertreated CV risk factors existed, emphasizing the importance of screening patients with psoriasis for CV risk factors.
Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.
Alexa B
AB
Kimball
Philippe
P
Szapary
Ulrich
U
Mrowietz
Kristian
K
Reich
Richard G
RG
Langley
Yin
Y
You
Ming-Chun
MC
Hsu
Newman
N
Yeilding
Daniel J
DJ
Rader
Nehal N
NN
Mehta
D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications*; D012307:Risk Factors