title: From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies.
abstract: BACKGROUND
  Many studies have identified cardiovascular risk factors in patients with psoriasis. Some psoriasis therapies may increase cardiovascular disease (CVD) and others may decrease CVD.
  
  
  OBJECTIVE
  We reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures and outcomes.
  
  
  RESULTS
  Phototherapy has no major cardiovascular impact and may reduce levels of proinflammatory cytokines. Acitretin increases serum lipids and triglycerides, but has not been shown to increase cardiovascular risk. Cyclosporine A increases blood pressure, serum triglycerides, and total cholesterol. Methotrexate is associated with a decreased risk of CVD morbidity and mortality. Among the biologics, data for tumor necrosis factor inhibitors suggest an overall reduction in cardiovascular events. Most data on short-term ustekinumab use suggest no effect on major adverse cardiovascular events, however some authorities remain concerned. Nevertheless, ustekinumab use over a 4-year period shows a decrease in major adverse cardiovascular events when compared both with the general US population and with psoriatics in Great Britain.
  
  
  CONCLUSIONS
  Most studies lack the power and randomization of large clinical trials and long-term follow-up periods. In addition, the increased risk of CVD associated with psoriasis itself is a confounding factor.
  
  
  CONCLUSIONS
  Some therapies for moderate to severe psoriasis, including methotrexate and tumor necrosis factor inhibitors, may reduce cardiovascular events in psoriatic patients. Ustekinumab appears to be neutral but there may be a long-term benefit. Appropriate patient counseling and selection and clinical follow-up are necessary to maximize safety with these agents. Further long-term study is necessary to quantify the benefits and risks associated with biologic therapies.
authors.affiliation: Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hugh
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Van Voorhees
authors.affiliation: Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: Rajiv I
authors.initials: RI
authors.lastname: Nijhawan
authors.affiliation: Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey.
authors.forename: Jerry
authors.initials: J
authors.lastname: Bagel
authors.affiliation: Department of Dermatology, Mount Sinai School of Medicine, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
authors.affiliation: Oregon Medical Research Center, Portland, Oregon.
authors.forename: Andrew
authors.initials: A
authors.lastname: Blauvelt
authors.affiliation: Department of Dermatology, Baylor College of Medicine, Houston, Texas.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York. Electronic address: jmw27@columbia.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Weinberg
mesh_terms: D017255:Acitretin / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D001691:Biological Therapy / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000209:etiology; D016572:Cyclosporine / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007641:Keratolytic Agents / Q000009:adverse effects; D008727:Methotrexate / Q000009:adverse effects; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D011701:PUVA Therapy / Q000009:adverse effects; D011565:Psoriasis / Q000188:drug therapy* / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000069549:Ustekinumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D007641:Keratolytic Agents; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000069549:Ustekinumab; D009173:Mycophenolic Acid; D017255:Acitretin; D008727:Methotrexate
keywords: CHF; CVD; DM; HTN; IL; MACE; MI; MTX; PUVA; PsA; RA; TNF; TNFi; UV; VEGF; adalimumab; biologic therapies; cardiovascular; cardiovascular disease; congestive heart failure; cyclosporine; diabetes mellitus; etanercept; hypertension; infliximab; interleukin; major adverse cardiovascular events; methotrexate; mycophenolate mofetil; myocardial infarction; psoralen plus ultraviolet A; psoriasis; psoriatic arthritis; rheumatoid arthritis; tumor necrosis factor; tumor necrosis factor inhibitor; ultraviolet; ultraviolet therapy; ustekinumab; vascular endothelial growth factor