PSORIASIS and COMORBIDITIES – CEREBRAL VASCULAR AND PERIPHERAL ARTERY DISEASE

Continuing our series on Psoriasis and Comorbidities

CHART 1: Comorbidities Associated with Psoriasis 1,2,3

Metabolic Syndrome –

Cerebral Vascular Disease – stroke

Peripheral Artery Disease – PAD

Cerebral Vascular Disease – stroke

A study found that cerebral (brain) vascular disease and peripheral arterial disease was also significantly more likely to be diagnosed in patients with psoriasis than in controls. 1 Cerebral vascular diseases are conditions that are caused by problems that affect the blood supply to the brain. Including:-

  • stroke– a serious medical condition where one part of the brain is damaged by a lack of blood supply or bleeding into the brain from a burst blood vessel 
  • transient ischemic attack (TIA) – a temporary fall in the blood supply to one part of the brain, resulting in brief symptoms similar to stroke 
  • subarachnoid haemorrhage – a type of stroke where blood leaks out of the brain’s blood vessels on to the surface of the brain
  • vascular dementia – persistent impairment in mental ability resulting from stroke or other problems with blood circulation to the brain 2

The results of a study looking at the association between psoriasis and stroke found that patients with severe psoriasis have a 44% increased risk of stroke, a potentially devastating co-morbidity. The risk of stroke in patients with psoriasis could not be explained by both common and rare major risk factors for stroke as identified in routine medical practice, suggesting that psoriasis may be an independent risk factor for stroke. Patients that are classified as having mild psoriasis had a statistically significant increased risk of stroke, however, this association was very modest and of limited clinical significance for the individual patient. The data showed that a patient with mild psoriasis has an excess risk of stroke attributable to psoriasis of 1 in 4115 per year, whereas a patient with severe psoriasis has an excess risk of stroke attributable to psoriasis of 1 in 530 per year. 3

Peripheral Artery Disease – PAD

Peripheral artery disease (PAD) is a narrowing of the peripheral arteries to the legs, stomach, arms, and head which can cause symptomatic claudication (blockage) and may lead to amputation. 1

PAD_nhlbi.nih.govhealtheducationalpaddocspad_extfctsht_general_508.pdf

In patients with psoriasis the diagnosis of peripheral arterial disease was found to be greater than in patients without psoriasis but with dyslipidemia (those with abnormal amount of lipids in the blood) or in smokers.4

Several studies have shown that presence and severity Cerebral vascular diseases (CVD) are related to presence and severity of Carotid Artery Disease (CAD) and PAD. In one study, significant CAD was observed in 25.4% of patients presenting with ischemic stroke. Among this stroke group, patients had a elevenfold likelihood of CAD compared to an age-matched general population. In other studies, PAD has been reported in 20 to 36% of patients with CVD.5

The prevalence of CAD in PAD patients is particularly high. In a systematic review of PAD studies, between 1966?2005, reported that CAD coexisted in 62% of patients when detected using stress tests, and in 90% of patients if the disease was detected by coronary angiography. Another review of the existing literature confirmed these findings, showing that 50% of those presenting with PAD have symptoms of CAD or electrocardiographic abnormalities, 90% have abnormalities on coronary angiography, and 40% have duplex evidence of carotid artery disease.5

A person’s risk also increases if they are over the age of 50  and who 6 : –

  • Smoke or used to smoke – If you smoke or have a history of smoking have up to four times greater risk of P.A.D.
  • Have diabetes – One in every three people over the age of 50 with diabetes is likely to develop P.A.D. This will be further increased for psoriasis patients with diabetes.
  • Have high blood pressure – Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
  • Have high blood cholesterol – Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs.
  • Have a personal history of vascular disease, heart attack, or stroke. If you have been diagnosed with heart disease, you increase your risk of also developing PAD by 1 in 3.

The signs and symptoms of the disease include 6 :

  • Claudication (obstruction of the arteries) – causing fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity e.g. walking or climbing stairs. This pain or discomfort goes away once the activity is stopped and after resting.
  • Experiencing pain in the legs and/or feet that disturbs your sleep.
  • Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all.
  • Colour changes in the skin of the feet, including paleness or purply blueness. The purply blue colouration of psoriasis plaques is especially seen in psoriasis patients who also have diabetes.
  • A lower temperature in one leg compared to the other leg.
  • Poor nail growth and decreased hair growth on toes and legs.

To improve your general health, mobility, and in order to reduce the risk of heart attack, stroke, and/or amputation it is critical that you reduce any symptoms that you may have of PAD :-

  • Quit smoking – Consult with your health care provider to develop an effective cessation plan and ensure you stick to it. This is especially important for psoriasis patients as smoking can be an aggravating trigger for those with chemical sensitivities.
  • It is important to lower your high blood pressure, cholesterol, and blood glucose levels. Consult with your health care provider.
  • Follow a healthy eating plan. Choose foods that are low in saturated fat, trans fat, and cholesterol. Be sure to increase your vegetable intake especially green vegetables, and those fruits as identified in your consultation with our Psoriasis Eczema Clinic Practitioners.
  • Adopt a more physical lifestyle. Aim for 30 minutes of moderate-intensity activity e.g. walking at least 3-4 times per week.
  • Reduce your weight – If you are overweight or obese, work with your health care provider to develop a supervised weight loss plan.

 

REFERENCES

  • Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of Psoriasis with Coronary Artery, Cerebrovascular, and Peripheral Vascular Diseases and Mortality. Arch Dermatol. 2009;145(6):700-703. doi:10.1001/archdermatol.2009.94
  • http://www.nhs.uk/conditions/Cerebrovascular-disease/Pages/Definition.aspx
  • Gelfand JM, Dommasch E, Shin DB, et al. The Risk of Stroke in Patients with Psoriasis. The Journal of investigative dermatology. 2009;129(10):2411-2418. doi:10.1038/jid.2009.112.
  • Prodanovich S. et al.; Association of Psoriasis with Coronary Artery, Cerebrovascular, and Peripheral Vascular Diseases and Mortality; Arch Dermatol. 2009;145(6):700-703. doi:10.1001/archdermatol.2009.94
  • Shar A.M. et al.; Coronary, Peripheral and Cerebrovascular Disease: a Complex Relationship; Herz 33 · 2008 · Nr. 7 © Urban & Vogel
  • NHLBI Diseases and Conditions Index: Peripheral Arterial Disease (P.A.D.) www.nhlbi.nih.gov/health/dci/ Diseases/pad/pad_what.html