People living with psoriasis and psoriatic arthritis (PsA) have an increased risk for heart disease that is between 1.5 and 2 times greater than that of the general population. The risk is at the higher end of the spectrum in cases of severe psoriasis or in cases of psoriasis with PsA.

Heart disease is a significant comorbidity for people with psoriasis and PsA. A comorbidity is when two or more conditions occur at the same time.

Heart disease, also known as cardiovascular disease, includes a range of conditions such as:

• Coronary artery disease (blocked blood vessels or atherosclerosis)
• High blood pressure (hypertension)
• Heart valve disease
• Arrhythmia (heart rhythm disorder)
• Heart muscle disease

Heart disease can cause life-threatening complications like heart attack, stroke, and heart failure.

Psoriasis is an autoimmune disease that occurs due to dysfunction in the immune system. The condition causes inflammation that is characterized by dry, thickened patches of skin that can be itchy, discolored, or infected during flare-ups. Approximately one-third of people with psoriasis develop PsA, which causes symptoms like painful joints and swollen fingers and toes. Psoriasis and PsA can affect other organs, such as uveitis, a form of eye inflammation.

Cardiovascular disease with psoriasis is a subject of conversation on MyPsoriasisTeam. “I worry about heart disease and stroke a lot, especially since my symptoms are getting worse, and my tests are coming back with issues,” said one member. “It is one of the reasons that I’m going to try methotrexate.”

Another member described their heart condition. “I had a heart attack in mid-December. It was mild, but I’m in the first stages of heart failure,” they said, listing the conditions diagnosed: “Pulmonary hypertension, global cardiomyopathy, and systolic pulmonary hypertension.”

Understanding connections between psoriasis and heart disease can help you recognize symptoms and take action to improve your health.

Causes and Risk Factors

Psoriasis is considered a hereditary condition that causes genetic disorders in the immune system, which affect the skin barrier. People with psoriasis are susceptible to flare-ups caused by environmental triggers such as mental stress, injury or irritation to the skin, and bacterial infection.

Heart disease can be hereditary, or it can be caused by cardiovascular risk factors that include other conditions and unhealthy habits, such as:

• Diabetes
• Autoimmune and chronic inflammatory conditions like psoriasis, rheumatoid arthritis, and other types of rheumatic diseases and inflammatory arthritis
• Smoking
• Obesity and a lack of physical activity
• High cholesterol levels
• Eating too much sugar, salt, or fat
• Drinking excessive alcohol

Research suggests that a buildup of cholesterol in arteries may trigger proinflammatory proteins in the immune system that also contribute to the development of heart disease. The connection between psoriasis and heart disease is not fully understood, but it is believed to be related to chronic inflammation that is associated with both conditions.

Metabolic Syndrome and Heart Disease

Along with heart disease, psoriasis and PsA are associated with many comorbidities, including metabolic syndrome, inflammatory bowel disease, osteoporosis, fibromyalgia, and depression.

Some studies have shown that people with psoriasis have a particularly high prevalence of developing metabolic syndrome, which is a type of systemic inflammation associated with heart disease, along with obesity, hypertension, diabetes, liver disease, and high levels of fat in the bloodstream, all of which can increase your risk for cardiovascular disease. Risk factors for metabolic syndrome include:

• High blood sugar
• Low levels of HDL cholesterol
• High levels of triglycerides
• Belly fat and large waist
• Hypertension

Be sure you are getting regular blood tests to screen for metabolic syndrome, particularly if you have hypertension or a large waist circumference. People with psoriasis have a 22 percent to 98 percent higher risk of developing metabolic syndrome, depending on the severity of their psoriasis.

Living With Psoriasis and Heart Disease

Research has shown that people with moderate or severe psoriasis and PsA who maintain their treatment plans can reduce the incidence of cardiovascular events like heart attacks, strokes, and heart-related deaths.

Some anti-rheumatic drugs that are used to treat psoriasis may also reduce the risk of cardiovascular disease. Methotrexate and biologics, such as tumor necrosis factor inhibitors and interleukin inhibitors, may help protect the heart, including these drugs, among others:

• Cimzia (certolizumab pegol)
• Cosentyx (secukinumab)
• Enbrel (etanercept)
• Remicade (infliximab)
• Stelara (ustekinumab)

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Celebrex (celecoxib) that are sometimes used in the treatment of PsA can increase your risk for heart disease. Talk to your doctors if you are taking NSAIDs.

Heart Disease Drugs That May Provoke Psoriasis

Some drugs that are used for the treatment of heart disease have been shown to induce or exacerbate psoriasis in some people. The following heart disease drugs have been associated with provoking psoriasis:

• Beta blockers
• Tetracycline
• Angiotensin-converting enzyme inhibitors
• Digox (digoxin)
• Catapres (clonidine)
• Pacerone (amiodarone)

Discuss any heart medication you may be taking with your dermatologist and rheumatologist.

One MyPsoriasisTeam member described their experience with heart medication. “I have a small heart issue, too, that I see my cardiologist regularly for. Recently, we found out that the old med she had me on (carvedilol) exacerbated my psoriasis,” they wrote. “New derm called her, and I was changed immediately to a calcium-based drug. PsA and my flare calmed down immensely.”

Managing Heart Disease With Psoriasis

Heart disease treatment options include lifestyle changes such as decreasing consumption of sodium and fat, moderate exercise, limiting alcohol, and quitting smoking. Some people may need medications, depending on their condition and the type of heart disease. In acute cases of heart disease, surgery may be indicated.

Be aware of the signs of heart disease and seek immediate help if you are experiencing:

• Chest pain or tightness
• Pain, swelling, coldness, or numbness in legs or arms
• Unusual pain in jaw, neck, throat, or upper abdomen
• Abnormal heartbeat
• Fainting

Maintaining a healthy weight with a well-balanced, healthy diet, regular physical activity, and stress management can improve your heart health, your overall well-being, help reduce psoriatic disease flares, and improve your quality of life.

Your doctors can provide referrals for nutritionists, physical therapists, and mental health practitioners. People with psoriasis and PsA may benefit from a multidisciplinary health care team. It’s important to advocate for your care and find the resources you need to feel your best.

One MyPsoriasisTeam member described their care. “I have built a team of professionals: rheumatologist, immunologist, cardiologists, neurologists, dermatologists, and a psychologist that all have insight into being the best version of me,” they said.

“I fight back by going to a pain management clinic, and it is helping me so much,” another member wrote. “They offer free things like yoga, massages, occupational therapy, and have pain groups. I do as much as I can there. This place is a lifesaver for me.”

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriasis and psoriatic arthritis, more than 99,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis and have questions about heart disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.