Medical professionals have understood for some time that conditions like rheumatoid arthritis and psoriasis can be linked to a higher occurrence of heart disease. However, it was unclear if the same was true for psoriatic arthritis (PsA), given its intricate nature and less extensive research.

In 2016, a pivotal study from Canada shed light on this. The findings, published in the journal Arthritis Care & Research, indicated that individuals with PsA had a 43% higher chance of experiencing or developing heart issues compared to the broader population. Moreover, there was a 22% elevated risk of conditions impacting blood circulation to the brain for those with PsA.

Dr. Alexis Ogdie-Beatty, a respected associate professor at the Hospital of the University of Pennsylvania and head of the Penn Psoriatic Arthritis Clinic, acknowledges that while there may have been certain biases in these studies, the consensus is clear: there's a significant cardiovascular risk associated with PsA.

Double Jeopardy

Dr. John M. Davis III from Mayo Clinic in Minnesota highlights that individuals with PsA face a significantly heightened cardiovascular risk. Such individuals often exhibit common risk indicators for heart disease, including obesity and diabetes. Moreover, persistent inflammation throughout the body can harm blood vessels, skin, joints, and other organs.

Dr. Davis points out that inflammation particularly impacts the endothelium, which is the inner lining of our blood vessels. This can contribute to atherosclerosis, where fats and cholesterol accumulate in the blood vessels. These deposits, known as plaques, can constrict arteries, increase blood pressure, and limit blood flow to vital organs. Some plaques, especially unstable ones, have the potential to break open, possibly leading to heart attacks or strokes.

While traditional risk factors are significant, Dr. Davis emphasizes that a substantial portion of the risk stems from inflammation.

How to Know If You’re at Risk

Doctors often check for atherosclerosis by measuring the thickness of the inner layers of the carotid arteries, which are major blood vessels to the brain. A 2016 study in the International Journal of Angiology highlighted that individuals with PsA showed more arterial thickening, even when other heart disease risk factors were ruled out. This could mean that PsA on its own might increase the risk of heart disease. Interestingly, the study didn't find a strong link between PsA severity and the extent of atherosclerosis.

On a brighter note, this also means pinpointing those at higher risk for heart issues becomes a bit challenging. Dr. Ogdie-Beatty points out that the current methods to estimate heart attack risk, based on medical history and lifestyle, might not be as effective for PsA patients since they don't consider inflammation's impact.

To ensure the health and safety of PsA patients, Dr. Ogdie-Beatty recommends comprehensive screening for heart disease risk factors such as diabetes, high cholesterol, and high blood pressure. She emphasizes that many with psoriatic disease often don't get diagnosed or treated for these traditional risk factors by their primary care physicians.

Protecting Your Heart

Living with psoriatic arthritis doesn't necessarily mean you'll face heart disease. Many contributing factors such as obesity, diabetes, lack of exercise, high cholesterol, high blood pressure, and smoking can be managed or even changed. It's crucial to aim for a healthy weight as being overweight can bring along multiple cardiovascular risks, including diabetes and high blood pressure. Additionally, fat cells release inflammatory proteins that might lead to heart conditions.

It's interesting to note that Dr. Elinor Mody, a respected figure from Harvard Medical School and director at Brigham and Women’s Hospital in Boston, mentions that weight loss alone can sometimes alleviate psoriasis symptoms, given the strong link between obesity and inflammation. Dr. Mody always discusses diet with her patients and, if needed, refers them to a nutritionist to ensure they're following a heart-healthy regimen. She also emphasizes the benefits of regular exercise, not just for heart and weight management, but for joint health too.

Can managing PsA help lower the risk of cardiovascular issues?

It's understandable to think that medications that alleviate skin and joint inflammation might also benefit blood vessel inflammation. However, Dr. Ogdie-Beatty points out that there isn't a solid body of evidence to back this up.

The idea is that by managing systemic inflammation, one might reduce the risk of cardiovascular issues. There are hints from observational studies indicating this could be true, and that drugs like anti-TNFs might be more effective than methotrexate. But, the truth is, there isn't enough strong data on this yet. What we are sure about is the benefits of weight management and effective diabetes treatment, as they result in better health outcomes.

Regarding arthritis medications, there's evidence suggesting that NSAIDs such as ibuprofen or naproxen could increase the chances of heart complications for the general public, even if used briefly. Dr. Ogdie-Beatty is uncertain if the same risks apply to those with inflammatory arthritis, but she tends to be careful when prescribing these to patients with known heart issues.

Dr. Ogdie-Beatty emphasizes the importance of both physicians and patients being aware of the cardiovascular risks associated with PsA. Patients should be encouraged to ask questions about their treatment options, including medications. Dr. Mody concurs, stressing the need for primary care doctors and cardiologists to view PsA patients as having a higher risk and take steps to address any existing cardiovascular risk factors.

What You Can Do

Taking steps toward heart health can make a big difference. Here are some ways to support your heart:

• If you're a smoker, consider quitting. Dr. Dafna Gladman, a renowned rheumatology professor at the University of Toronto, notes that smoking not only contributes to inflammation but can also impact the effectiveness of treatments, especially for those with PsA.

• Embrace an active lifestyle. Regular activity not only helps in managing pain and improving function but also significantly lowers the risk of heart disease.

• Focus on a nutritious diet. Eating heart-healthy foods can help manage weight, blood sugar, and cholesterol, and even reduce inflammation.

• Monitor your medications. Collaborate with your physician to find treatments that manage pain and inflammation without increasing the risk to your heart.