Kaiser Hannah, Näslund-Koch Charlotte, Kvist-Hansen Amanda, Skov Lone
Department of Dermatology and Allergy, University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Dermatol Ther (Heidelb). 2024 Feb;14(2):303-321. doi: 10.1007/s13555-024-01098-z. Epub 2024 Jan 30.
Psoriasis is an immune-mediated inflammatory disease associated with an increased risk of cardiovascular disease (CVD). The risk of CVD increases with the severity of psoriasis, and exposure to systemic inflammation may partly explain the increased risk of CVD in these patients. This raises the question of whether anti-psoriatic treatment, in addition to treating the skin lesions, also lowers the risk of developing CVD. Different types of studies have examined the impact of systemic anti-psoriatic treatments on the risk of CVD in patients with psoriasis and epidemiological observational studies with, e.g., myocardial infarction and stroke as outcomes, and clinical studies investigating circulating inflammatory biomarkers in the blood indicate that anti-psoriatic therapy has a protective effect; however, no randomized controlled trial (RCT) has examined the impact of systemic anti-psoriatic treatment on future hard cardiovascular endpoints. This narrative review provides an overview of the clinical cardiovascular imaging studies examining the effect of systemic anti-psoriatic treatment on the risk of subclinical CVD in patients with psoriasis. We found a total of 24 clinical imaging studies, where 16 of these were observational cohort studies and eight were RCTs. The observational studies suggest an improvement in the risk of subclinical CVD based on different cardiovascular imaging biomarkers; however, the RCTs showed inconsistent results and mainly included vascular inflammation as the outcome. Future RCTs including other imaging biomarkers as surrogates for subclinical CVD, with longer follow-up and with hard cardiovascular endpoints are warranted to address whether systemic anti-psoriatic treatments reduce the risk of CVD.
银屑病是一种免疫介导的炎症性疾病，与心血管疾病（CVD）风险增加相关。CVD风险随银屑病严重程度增加而升高，全身性炎症暴露可能部分解释了这些患者CVD风险增加的原因。这就引出了一个问题，即抗银屑病治疗除了治疗皮肤病变外，是否还能降低发生CVD的风险。不同类型的研究已经考察了全身性抗银屑病治疗对银屑病患者CVD风险的影响，以心肌梗死和中风等为结局的流行病学观察性研究，以及调查血液中循环炎症生物标志物的临床研究表明，抗银屑病治疗具有保护作用；然而，尚无随机对照试验（RCT）考察全身性抗银屑病治疗对未来严重心血管终点事件的影响。这篇叙述性综述概述了临床心血管成像研究，这些研究考察了全身性抗银屑病治疗对银屑病患者亚临床CVD风险的影响。我们共找到24项临床成像研究，其中16项为观察性队列研究，8项为RCT。观察性研究表明，基于不同的心血管成像生物标志物，亚临床CVD风险有所改善；然而，RCT结果不一致，主要将血管炎症作为结局。未来有必要开展包括其他成像生物标志物作为亚临床CVD替代指标、随访时间更长且以严重心血管终点事件为考察对象的RCT，以确定全身性抗银屑病治疗是否能降低CVD风险。
