Heart Disease Risk May be Nearly Doubled in People with Psoriatic Arthritis

Doctors have long known that heart disease is more common in people who have inflammatory conditions such asrheumatoid arthritis(RA) and psoriasis. But they weren’t sure if this applied topsoriatic arthritis(PsA), which is more complex and not nearly as well studied. Then, in 2016, Canadian researchers published a meta-analysis of studies evaluating cardiovascular disease risk and PsA in the journalArthritis Care & Research. The results suggested that people with PsA were 43 percent more likely to have or develop heart disease compared with the general population. PsA patients also had a 22 percent increased risk of cerebrovascular disease – conditions such as stroke that affect blood flow to the brain.

Alexis Ogdie-Beatty医学博士是费城宾夕法尼亚大学医院的助理教授，也是宾夕法尼亚银屑病关节炎诊所的主任，他说尽管研究中有一些偏见，“每个人都认为PsA有很大的心血管风险。”

Double Jeopardy

People with psoriasis and PsA actually have what amounts to a doubled cardiovascular risk, says John M. Davis III, MD, a researcher in the Cardio-Rheumatology Clinic at Mayo Clinic in Minnesota. They’re more likely to have traditional risk factors for heart disease, such as obesity and diabetes. And they experience the risk factor of ongoing, body-wide inflammation, which is known to damage blood vessels as well as the skin, joints and other organs.

Dr. Davis explains that in heart disease, inflammation affects the endothelium, the innermost layer of blood vessels. This can lead to atherosclerosis – the buildup of fats, cholesterol and cellular debris within blood vessel walls. Known as plaques, these fatty deposits narrow arteries, raising blood pressure and reducing the flow of blood to the heart and other organs. Some plaques can break down, causing a clot that may trigger a heart attack or stroke.

Are You at Risk?

A way to check for early atherosclerosis is to measure the thickness of the two inner layers of the carotid arteries — the major blood vessels leading to the brain. A study published in 2016 in theInternational Journal of Angiologyfound that PsA patients had increased arterial thickening even after other known cardiovascular risk factors were excluded. According to Dr. Ogdie-Beatty, current cardiovascular risk assessments, which use medical history and lifestyle information to predict a person’s chance of having a heart attack, were developed for the general population and aren’t very useful in PsA because they don’t factor in the effects of inflammation. Until a better way to assess risk is found, Dr. Ogdie- Beatty says all PsA patients should be screened for factors that put them at risk of heart disease, such as diabetes, high cholesterol and high blood pressure. She notes that many patients with psoriatic disease are underdiagnosed and untreated for traditional cardiovascular risk factors by their primary care doctors.

Protecting Your Heart

患有银屑病关节炎并不意味着你会患上心脏病。大多数危险因素——肥胖、糖尿病、缺乏运动、高胆固醇、高血压和吸烟——都可以得到改善或控制。实现和保持健康的体重尤其重要，因为肥胖与许多其他心血管风险因素有关，包括高血压和糖尿病。脂肪细胞还会释放一种叫做细胞因子的炎性蛋白，这种蛋白会导致导致动脉粥样硬化的慢性低级别炎症。

Elinor Mody, MD, an assistant professor at Harvard Medical School and director of the Women’s Orthopedic and Joint Disease Program at Brigham and Women’s Hospital, both in Boston, says obesity is such a powerful inflammation-promoter that psoriasis symptoms sometimes clear with weight loss alone. Dr. Mody also stresses the importance of physical activity, which is essential for heart and joint health as well as weight loss.

If you smoke, try to quit. In addition to promoting inflammation, smoking likely reduces treatment response in patients with PsA, according to Dafna Gladman, MD, a professor of rheumatology at the University of Toronto, Canada. Also, watch your medications. Some drugs, especiallynonsteroidal anti-inflammatory drugs(NSAIDs) like ibuprofen or naproxen, areknown to raise the risk of heart attack, stroke and heart failure在一般人群中，即使服用的时间很短。Ogdie-Beatty医生非常谨慎地给已有心脏病的病人开这种药。她说，医生和患者需要了解PsA的心血管风险，患者应该感到有权力询问治疗方案，包括药物。

Linda Rath for the Arthritis Foundation