Psoriasis and psoriatic arthritis increase the risk of a heart attack, primarily from increased inflammation. Yesterday I discussed my wife’s auto immune disease. She has that increased risk as well and she is on optimal medical therapy with losartan, atorvastatin, metformin, and spironolactone. She takes her medication very faithfully. I take the same combination—so we don’t just talk the talk, we walk the walk. The more severe the psoriasis, the higher the risk of heart attack.
Many patients with psoriasis and other autoimmune conditions associated with increased inflammation don’t have high cholesterol, but statin treatment still lowers their risk of a heart attack by 40%. Forty milligrams of atorvastatin given to patients with psoriasis reduced vascular inflammation within two weeks. In general, only half the people eligible for statin treatment are taking them. Among those not taking a statin, in 59% it was never offered. Ten percent declined and thirty-one percent stopped the treatment. Only 35% of patients with psoriasis and a high risk of heart attack are on a statin. This is another example of the way our system fails patients with autoimmune diseases.
It also points to a larger problem. Our system is designed around the idea of organ systems and risk factors, but autoimmune diseases like my wife’s relapsing polychondritis and Phil Mickelson’s psoriasis impact the entire body. Patients with psoriasis also have an increased risk of diabetes that correlates with the severity of the psoriasis. These chronic diseases are all related.
Statins reduce the risk of heart attack in patients with psoriasis whether the cholesterol is elevated or not. We have already discussed how metformin and empagliflozin are beneficial in heart disease whether the glucose is elevated or not. Lisinopril and losartan are beneficial in chronic kidney disease in the absence of high blood pressure. Statins are beneficial in preventing heart attack in patients with psoriasis and normal cholesterol, because they are antioxidant and anti inflammatory independent of their effect on cholesterol. That is why they are beneficial in these patients. We need to move to treatment of the whole patient based on an understanding of the molecular biology underlying chronic diseases. Primary care teams focused on chronic diseases are the answer. Let me know if you want to get started. wbestermann@congruityhealth.com
Eating non- processed food, enriched with antioxidants in combination with good pharmacotherapy= optimum outcomes. A "MUST" task is physical movements. You cannot exercise your way out of a bad diet. Food is the coding that program your body to function.
Agreed!