Cardiovascular Considerations and Implications for Treatment in Psoriasis: An Updated Review

Hitaishi Mehta,1 Tarun Narang,1 Sunil Dogra,1 Sanjeev Handa,1 Juniali Hatwal,2 Akash Batta3 1Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India; 2Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India; 3Department of Cardiology, Dayanand Medical College and Hospital (DMCH), Ludhiana, 141001, IndiaCorrespondence: Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Civil Lines, Ludhiana, 141001, India, Tel +91 9815496786, Email akashbatta02@gmail.comAbstract: Psoriasis, a prevalent chronic inflammatory skin disorder affecting 2– 3% of the global population, has transcended its dermatological confines, revealing a profound association with cardiovascular diseases (CVD). This comprehensive review explores the intricate interplay between psoriasis and cardiovascular system, delving into genetic links, immune pathways, and adipose tissue dysfunction beyond conventional CVD risk factors. The pathophysiological connections unveil unique signatures, distinct from other inflammatory skin conditions, in particular psoriasis-specific genetic polymorphisms in IL-23 and TNF-α have consistently been linked to CVD. The review navigates the complex landscape of psoriasis treatments, addressing challenges and future directions in particular relevance to CVDs in psoriasis. Therapeutic interventions, including TNF inhibitors (TNFi), present promise in reducing cardiovascular risks, and methotrexate could constitute a favourable choice. Conversely, the relationship between IL-12/23 inhibitors and cardiovascular risk remains uncertain, while recent evidence indicates that Janus kinase inhibitors may not carry CVD risks. Emerging evidence supports the safety and efficacy of IL-17 and IL-23 inhibitors in patients with CVDs, hinting at evolving therapeutic paradigms. Lifestyle modifications, statins, and emerging th