Psoriasis and Cardiometabolic Disease: A Brief, Focused, Educational Intervention on Cardiometabolic Risks

October 2016 | Volume 15 | Issue 10 | Original Article | 1176 | Copyright © 2016

Courtney J. Burnett BS, Dennis P. West PhD, Alfred W. Rademaker PhD, and Roopal V. Kundu MD

Northwestern University Feinberg School of Medicine, Chicago, IL

Abstract

BACKGROUND: To assess baseline knowledge and awareness of cardiometabolic comorbidities in subjects with psoriasis. To determine the impact of a verbal scripted educational intervention. METHODS: Fifty-six adults with a clinical diagnosis of moderate to severe psoriasis completed a 12-item questionnaire about psoriasis comorbidity awareness and knowledge at 2 time points: pre-intervention (PR-I) and post-intervention (PO-I). The PR-I questionnaire collected information on history of psoriasis and cardiometabolic disease. A 5-minute scripted educational intervention was administered during a single study visit to subjects immediately after PR-I but prior to PO-I questionnaires. Subjects also completed a final questionnaire at 2 months follow-up (2-MF). Responses were statistically analyzed using McNemar’s test. RESULTS: Fifty-six subjects (26 females, 30 males, mean age 51 years, range 21 to 83 years) participated in the PR-I and PO-I and 46 (82%) participated in 2-MF. Significant improvements were noted for 10 of 11 questions between PR-I and PO-I, and 8 of the scores remained significantly improved (compared with baseline) at 2-MF (P<0.05). At 2-MF, 65% of subjects had seen a primary care physician within the 2-month interval from PO-I to 2-MF, and another 26% planned to visit a primary care physician in the near future. Furthermore, 85% had checked their blood pressure in the past 2 months. CONCLUSIONS: Measures of knowledge and awareness of psoriasis and cardiometabolic comorbidities were significantly improved at PO-I and retained for most measures at 2-MF. An educational intervention, as utilized in this study, warrants consideration to enhance cardiometabolic-based knowledge and awareness in patients with psoriasis.

J Drugs Dermatol. 2016;15(10):1176-1180.

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INTRODUCTION

Psoriasis is a chronic, systemic inflammatory disease primarily associated with erythematous scaly skin plaques. It is considered an immune-mediated inflammatory disorder that is associated with a broad range of comorbidities, including those historically associated with psoriasis such as psoriatic arthritis and pustular dermatoses, and including those related to systemic inflammation, such as metabolic syndrome, cardiovascular disease, hypertension, diabetes mellitus, peripheral artery disease, ischemic stroke, and coronary artery disease, among others.1-7 Of these comorbidities, hypertension, insulin resistance, impaired glucose tolerance, dyslipidemia, and obesity (specifically, intra-abdominal) are collectively termed cardiometabolic syndrome.8 Cardiometabolic syndrome and its individual components are additional risk factors for cardiovascular disease, including coronary heart disease, myocardial infarction, and stroke, along with insulin resistance leading to raised fasting plasma glucose and diabetes mellitus.9Although historically psoriasis was thought to affect only the skin, it is now widely accepted that psoriasis is a systemic inflammatory disorder associated with an elevated risk of cardiometabolic disease compared to the general population.4,5,7,10,11These comorbidities are more prevalent among those with severe psoriasis, defined for the purpose of this study as psoriasis affecting a body surface area (BSA) >10% or necessitating systemic treatment. A meta-analyses described by Shahwan et al7 reported that patients with severe psoriasis were 2.23 times more likely to be obese than controls (whereas those with mild psoriasis were 1.46 times more likely), more likely to have hypertension, more likely to have diabetes mellitus (OR of 1.53 for mild and OR of 1.97 for severe psoriasis), and more likely to have coronary artery disease and myocardial infarction. Psoriasis is also reported to be associated with a higher prevalence of smoking, alcohol consumption, depression, anxiety, and otherpsychological comorbidities that may be expected to contribute to increased risk of cardiometabolic disease.4Pathophysiologically, psoriasis shares mechanisms with other chronic inflammatory states, such as atherosclerosis, partially explaining the increased rate of cardiometabolic comorbidities for patients with psoriasis compared to the general population. Both conditions share similar inflammatory processes7 (T helper cells, Th17, cytokine dysregulation) as well as systemic inflammation, and environmental factors such as smoking and alcohol use can lead to additional inflammation and complications.The well-described connection between psoriasis and cardiometabolic disorders informs the need for heightened.

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