A specialized cardiological outpatient clinic for patients with psoriasis: results from a single-center pilot study

Abstract Background Immune-mediated diseases, including moderate-to-severe psoriasis, represent an independent risk factor for cardiovascular disease (CVD) development. Although patients with these conditions require a specific approach to cardiovascular prevention, structures equipped for this task still do not exist. We therefore investigated preventive screening in a specialized cardiology outpatient clinic in this high-risk patient population. Methods Within a pilot study, we report on a cohort of patients from the psoriasis outpatient clinic (Department of Dermatology, University Medical Center, Mainz, Germany) investigated in a specialized consultation at the Department of Cardiology (University Medical Center, Mainz, Germany). Examination consisted of classical cardiological medical history, cardiological instrumental diagnostics (12-lead ECG, 24-h ECG, 24-h blood pressure profile, transthoracic echocardiography) and lipid profile. Psoriasis severity was categorized by Psoriasis Area and Severity (PASI) score and estimated cardiovascular prognosis was calculated by established risk scores. PASI score was correlated to calculated cardiovascular risk. Results Of the 20 patients examined (median (IQR) age 43 (36–63) years; 70% men), all demonstrated at least one other established cardiovascular risk factor (CVRF) in addition to psoriasis. The median estimated cardiovascular prognosis calculated as 10-year risk of fatal and non-fatal cardiovascular events (myocardial infarction, stroke) was 3% (2–6) and 2% (1–7) applying the score by the Systematic Coronary Risk Estimation 2 (SCORE2) and Predicting Risk of cardiovascular disease EVENTs (PREVENT™) score, respectively. 60% of patients demonstrated at least two classical CVRF. Most pronounced was overweight/obesity (90%; median BMI 29 (26–36) kg/m2), followed by arterial hypertension (40%; median 24-h systolic to diastolic blood pressure 120 (115–124) mmHg to 70 (67–79) mmHg), and dyslipidemia (25%). Elevated LDL cholesterol (> 70 mg/dl) and Lp(a) (> 30 mg/dl) were observed in 85% and 25% of patients, respectively. Echocardiography and 24-h ECG revealed no significant abnormalities in most of the patients. The current PASI score of the patients did not relate to the calculated cardiovascular risk. Importantly, including the cardiovascular risk factor of psoriasis itself in the estimation of the cardiological prognosis is unavailable in established risk scores. Recommended life-style changes or changes in medication concerned dyslipidemia as well as blood pressure regulation. Conclusion Psoriasis patients are at increased risk for CVD and demonstrate an unmet need for preventive cardiovascular investigation. Optimizing lipid diagnostics and blood pressure may be beneficial in this high-risk patient cohort. Our hypothesis-generating study supports routine CVRF screening by dermatologists and primary care physicians to identify the overall cardiovascular risk profile, and interdisciplinary specialized care for specific cardiological challenges.