The following are key points to remember from this JACC review topic of the week on cardiovascular (CV) risk in patients with psoriasis:

1. Psoriasis is a chronic inflammatory skin disease that affects 2-3% of the US population.
2. The immune response in psoriasis includes enhanced activation of T cells and myeloid cells, platelet activation, and up-regulation of interferons, tumor necrosis factor-α, and interleukins (ILs) IL-23, IL-17, and IL-6, which are linked to vascular inflammation and atherosclerosis development.
3. Patients with psoriasis are up to 50% more likely to develop cardiovascular disease (CVD), and this CV risk increases with skin severity. Major society guidelines now advocate incorporating a psoriasis diagnosis into CV risk prediction and prevention strategies.
4. Cutaneous and systemic inflammation coupled with a background of traditional CV risk factors are thought to increase CV risk in psoriasis.
5. Patients with psoriasis requiring systemic therapy exhibit an absolute 10-year risk of a coronary event or stroke of 6.2%, beyond what is expected from traditional CV risk estimates.
6. The traditional modifiable CV risk factors, hypertension, diabetes, hyperlipidemia, obesity, and smoking, along with metabolic syndrome, are highly prevalent (in aggregate >50%), under-recognized, and undertreated in psoriasis.
7. Although registry data suggest that treatment targeting psoriasis skin disease reduces vascular inflammation and coronary plaque burden, and may reduce CV risk, randomized placebo-controlled trials are inconclusive to date.
8. Optimal lifestyle modification in psoriasis is a cornerstone of strategies to reduce CVD and improve skin severity. Smoking cessation should be encouraged as it reduces CVD and may also improve psoriasis skin severity.
9. Increased patient and provider awareness of the connection between atherosclerosis and psoriasis is required to facilitate and initiate conversations on CV preventive measures.
10. Finally, adequately powered randomized trials are required to define traditional CV risk factor goals, the optimal role of lipid-lowering and antiplatelet therapy, and targeted psoriasis therapies on CV risk.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Hypertension, Smoking

Keywords: Atherosclerosis, Diabetes Mellitus, Hyperlipidemias, Hypertension, Immunity, Inflammation, Interferons, Interleukins, Life Style, Lipids, Metabolic Syndrome, Myeloid Cells, Myocardial Ischemia, Obesity, Platelet Aggregation Inhibitors, Primary Prevention, Psoriasis, Risk Factors, Skin Diseases, Smoking, Smoking Cessation, Stroke, Vascular Diseases

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