What You Can Change
- Men and women should not drink more than 14 units a week on a regular basis
- Spread your drinking over 3 or more days if you regularly drink 14 units a week
- If you want to cut down, try to have several drink-free days each week
14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.
The following table will show you how many units are in different alcoholic drinks.
Type of drink
Large glass of red/white/rosé wine
Remember: for certain medications you will be advised to avoid alcohol , so do make sure your healthcare provider is aware of your alcohol consumption.Stress: Stress can increase your risk of heart disease, and it may also encourage your psoriasis to flare. It is important to learn how to reduce your stress in a healthy way rather than resorting to unhealthy strategies such as smoking, drinking and overeating. Exercise, yoga and relaxation techniques can be effective. Healthy stress release, such as listening to music, meeting with friends or pursuing a hobby is really good too. You may also wish to talk to your doctor about counselling or medication.
Review Medications With A Doctor
Some medications for PsA may reduce the risk of heart disease, while others may increase it.
For example, steroids can raise cholesterol levels and cause the body to become less sensitive to insulin. In turn, this can contribute to the risk of cardiovascular disease.
Conversely, biologics and disease-modifying antirheumatic drugs can not only ease pain in the joints but also protect the heart.
Health Conditions Linked To Psoriasis
It is important to visit your primary care provider regularly to screen for these diseases because you may not notice or feel symptoms for some of these health conditions. In addition, if some of these conditions are caught early, they can be easily treated with lifestyle changes or medications.
Evidence shows that people who treat their psoriasis effectively can also lower the risk of other comorbidities.
In 2019, the National Psoriasis Foundation and the American Academy of Dermatology published guidelines on the treatment of psoriasis with attention to comorbidities. The guidelines state the following health conditions as comorbidities of psoriasis.
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Ask About Regular Screening Tests
Unfortunately, traditional cardiovascular risk scores like the Framingham Risk Score underestimate the risk of heart disease in people with psoriatic arthritis because they do not account for systemic inflammation, according to research shared in a special Journal of Rheumatology report called Cardiovascular Diseases in Psoriasis and Psoriatic Arthritis.
The FRS estimates a 10-year risk of cardiovascular disease using an algorithm that takes into account traditional risk factors like age, cholesterol, hypertension, smoking, and diabetes as well as coronary disease, cerebrovascular disease, peripheral artery disease, and heart failure.
Last year, rheumatic inflammatory diseases, including PsA, were added as a risk enhancer to the general scoring system recommended by the American College of Cardiology and American Heart Association. In new guidelines on preventing heart disease, the ACC/AHA advises doctors to use additional risk-enhancing factors to guide decisions about preventive interventions for borderline- or intermediate-risk adults after their risk score is calculated.
Dr. Mankad hopes this change will encourage more doctors to prescribe cholesterol-lowering medication sooner to people with psoriatic arthritis.
For now, your best bet is to be proactive and request that your rheumatologist or primary care physician gives you the following screenings recommended by the American Heart Association to better identify and control your risk factors:
Does Treatment Affect Risk
Often, psoriasis treatments are relegated to being elective or cosmetic, but another important consideration is whether psoriasis treatments decrease CV disease risk. So far, studies have shown mixed results. Some preliminary data found that treatments like methotrexate and etanercept, a biologic tumor necrosis factor -alpha inhibitor, protected the heart, but other treatments may increase the burden of CV disease.
âThis is an emerging area with incomplete data, and many studies assess surrogate measures of CV events rather than actual events,â Dr. Schwartz notes. âThis is because many biological therapies for psoriasis are relatively new, with the exception of disease-modifying anti-rheumatic drugs and TNF inhibitors, and extremely long-term follow-up of 10 to 20 years is often required for assessment of CV events. With these caveats, treatment with anti-inflammatory therapies does appear to reduce the risk of vascular inflammation and major CV events in patients with psoriasis. However, the type of therapy matters. For example, biological therapies and DMARDs appear to improve outcomes, whereas corticosteroids and nonsteroidal anti-inflammatory drugs worsen outcomes.â
Further inquiry is warranted into psoriasis treatments and heart health because if there are benefits, it would reinforce that psoriasis treatment â like psoriasis â is more than skin deep. This would also likely contribute to a greater prevalence of individuals getting treatment.
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Chronic Obstructive Pulmonary Disease
COPD refers to a group of diseases that impair the flow of air to the lungs, making it more difficult to breathe.
A 2015 systematic review and meta-analysis looked at the link between psoriasis and COPD. The researchers concluded that people with psoriasis had a , compared to the general population. The risk was higher in people with severe psoriasis.
Cardiovascular Morbidity In Psa
In summary, there is an increased prevalence of cardiovascular morbidity and their risk factors in patients with PsA when compared with general population. The prevalence of CVD in PsA was found to resemble that in RA in a cross-sectional study on 489 patients with PsA and 353 patients with RA . The age- and sex-adjusted odds risk of CVD showed no significant difference between patients with RA and those with PsA . In a recent cross-sectional study by Husted et al., prevalence of cardiovascular morbidities was compared between 611 patients with PsA and 449 patients with psoriasis only . Results indicated significantly increased prevalence of hypertension , obesity , hyperlipidemia , type 2 diabetes mellitus , and at least 1 cardiovascular event among patients with PsA compared with those with psoriasis only. The increased prevalence of hypertension remained significant after adjusted for demographics, psoriasis severity, and use of medication. Overall, these findings tentatively support the role of inflammatory arthritis in cardiovascular morbidity in patients with PsA.
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What Is The Relationship Between Psoriasis And Heart Disease
A systematic review of 90 studies confirmed that patients with psoriasis had a higher risk of ischemic heart disease, stroke, and peripheral arterial disease but also a greater prevalence of risk factors for cardiovascular disease, compared with controls. The authors concluded that large prospective studies with long-term followup are required to determine whether psoriasis is an independent risk factor for vascular disease or is merely associated with known risk factors. Another study identified psoriasis as an independent risk factor for cardiovascular disease in women, especially if they had psoriatic arthritis and suffered from psoriasis for a longer time period .
What You Cannot Change
Some risk factors for heart disease cannot be changed.
- Gender: Men over the age of 55 and postmenopausal women are at the greatest risk of heart disease.
- Increasing age: The risks of heart attacks and stroke increase with age.
- Ethnicity: People of African or South Asian descent are more likely to have diabetes and high blood pressure and are therefore at greater risk of heart disease and stroke
- Family history: If a brother, sister or parent developed heart disease before the age of 55 or had a stroke before the age of 65 you are also at higher risk.
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Earlier Research Pointed To This
Science has been zeroing in on the connection among inflammation, psoriasis and heart disease for some years now:
- An analysis of past studies by doctors from four different hospitals in China ended with this statement: These findings have led to the recommendation that all patients with psoriasis should undergo detailed screening and management of cardiovascular risk.
- A 2014 French study concluded that the prevalence of psoriasis is twofold higher in patients with CAD than in patients without CAD. It is associated with a more severe coronary artery involvement.
In other words, they found that twice as many people with CAD had psoriasis, compared to people without CAD, a very strong association.
- And, in 2016, Dr. Nehal Mehta led a study showing that psoriasis patients had moderate to severe coronary artery calcification that was five times higher than in people without psoriasis.
If You Notice Symptoms Suggestive Of A Heart Attack Or Stroke Seek Emergency Medical Attention Immediately
- Take action! Do not smoke. If you are a smoker, take steps to reduce the amount you smoke.
- Maintain a healthy weight. If your waist measures more than 102 centimetres for men or 88 centimetres for women, talk to your GP about weight loss strategies.
- Eat a balanced diet, including whole grains, cereals, vegetables, fruit, lower-fat dairy products, leaner meats and food prepared with little to no fat. Avoid saturated and trans-fats instead use olive oil, which is high in desirable monounsaturated fats.
- Control your portion sizes. An easy method for determining meal portions is to use two open hands as your measure for vegetables one closed hand for carbohydrates, such as pasta or rice one closed hand for fruit the palm of your hand for meat or protein alternative and the tip of your thumb for fats, such as oil, margarine or butter.
- Limit alcohol intake.
- Deal with stress in a healthy way.
- Be physically active for at least 30 minutes most days of the week.
Drink more water. Although there is no strict guideline, replacing fluids is important and you should aim to drink at least 2-3 litres of water a day, particularly during warm or hot weather.
This article is adapted from the Psoriasis and the heart leaflet.
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Biologic Therapy For Psoriasis May Reduce Heart Disease
- American Heart Association
- Biologic therapy for psoriasis – protein-based infusions to suppress inflammation – was associated with a significant reduction in high-risk plaque in heart arteries, over one-year, according to new research. The positive association between biologic therapy and a decrease in high-risk plaque in heart arteries was significant after adjusting for cardiovascular risk factors and psoriasis severity.
Patients with psoriasis treated with biologic therapy, which are protein-based infusions to suppress inflammation, had a significant reduction in high-risk plaque in heart arteries, over one-year, according to new research published today in Circulation: Cardiovascular Imaging, an American Heart Association journal.
Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Biologic therapy medications are proteins that are given by injection or infusion and suppress the inflammation process by blocking the action of cytokines, which are proteins that promote systemic inflammation.
Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. This study provides characterization of a lipid-rich necrotic core, a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture. Ruptured plaque can lead to a heart attack or stroke.
Does Treating Psa Reduce Cardiovascular Risk
It makes sense that drugs that suppress skin and joint inflammation would suppress inflammation in blood vessels, too. But Dr. Ogdie-Beatty says theres lack of good evidence to support that idea.
Systemic inflammation can accelerate plaque development, so we think suppressing inflammation might decrease cardiovascular risk. Observational studies suggest thats the case, and anti-TNFs are possibly better than methotrexate for that. But we just dont have a lot of good data. We do know that reducing weight and treating diabetes effectively are important and lead to better outcomes, she says.
Some arthritis medications, especially nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen, are known to raise the risk of heart attack, stroke and heart failure in the general population even when taken for a short time. Dr. Ogdie-Beatty says its not clear NSAIDs have the same effect in people with inflammatory arthritis, but says shes very cautious prescribing them for patients with existing heart disease.
She says both doctors and patients need to understand the cardiovascular risks in PsA, and patients should feel empowered to ask questions about treatments, including medications. Dr. Mody agrees, saying primary care physicians and cardiologists should treat PsA patients as higher-risk and work to modify any traditional cardiovascular risk factors they have.
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Lipoprotein Composition And Function
The composition and function of lipoprotein particles may be altered in psoriasis patients. Previous studies have shown that the antioxidant and anti-inflammatory activities of HDL are reduced in patients with psoriasis compared to healthy controls, indicating functional impairment of HDL in psoriasis . In patients with psoriasis, changes in the composition of HDL particles may also impede their capacity to induce cholesterol efflux from macrophages, thus leading to atherosclerosis and cardiovascular disease . Interestingly, both the HDL particle composition and cholesterol efflux ability become normalized following anti-psoriasis therapy .
Recommendations For Cardiovascular Risk Management
The European League Against Rheumatism has developed recommendations for cardiovascular risk management in patients with RA and other inflammatory arthritis, including AS and PsA . The EULAR recommendations recognize the association between inflammation and atherosclerosis in patients with inflammatory arthritis and recommend that aggressive suppression of disease activity or inflammation is necessary to lower the cardiovascular risk. Annual assessment of cardiovascular risk using national guidelines is recommended for all patients with PsA. Any risk factors identified should be managed according to local guidelines. In the absence of local guidelines, cardiovascular risk management should follow the Systematic COronary Risk Evaluation model. Unlike the Framingham risk score, in which the pragmatic outcome bases on both cardiovascular mortality and morbidity , the SCORE model estimates the 10-year risk of developing cardiovascular death and includes the following risk factors: age, gender, smoking habit, systolic blood pressure, and either total cholesterol or the total cholesterol/HDL cholesterol ratio . Statins, angiotensin-converting enzyme inhibitors, and/or angiotensin II blockers are preferred treatment options due to their potential anti-inflammatory effects. Prescribing COX2 inhibitors and most NSAIDs in patients with a documented CVD or in the presence of cardiovascular risk factors should be cautious due to their potential cardiovascular risk.
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When Should You See Your Doctor
It is crucial that you consult your health professional if you have any questions regarding your chronic skin condition or heart disease. Also, if you have psoriasis, you need to be up-to-date about the risk factors. The best way to do this is by being aware of the various signs of a looming heart attack. Some of these symptoms include:
Review Medication Choices With A Healthcare Provider
Rheumatologists can help choose an individualized treatment plan for people with PsA based on the severity of symptoms and inflammation.
Medications for treating PsA include:
- Nonsteroidal anti-inflammatory drugs , especially for mild disease
- Disease-modifying anti-rheumatic drugs which include Otrexup
- Biologic medications, like TNF-inhibitors and interleukin inhibitors
Some anti-inflammatory medications for PsA appear to reduce vascular inflammation and atherosclerosis. For example, one study showed that those on TNF-alpha inhibitors had favorable effects in people with coronary atherosclerosis. More research is needed to determine the exact role for particular PsA therapies in reducing heart disease risk.
Another aspect to consider is that certain anti-inflammatory medications may increase blood pressure and blood sugar, and cause weight gain. Furthermore, some medications used to treat PsA may not be as effective in people with clinical obesity.
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Can Psoriatic Arthritis Affect The Esophagus
Psoriatic arthritis is an autoimmune condition that affects many parts of the body, such as the eyes and gastrointestinal tract, including the esophagus. Symptoms of PsA may include inflamed, itchy skin, swollen joints, and the possibility of infections.
The inability to swallow effectively is known as dysphagia. Studies have not yet found a clear link between PsA and dysphagia, but research is ongoing.
This article examines whether PsA affects the esophagus. It also explores potential esophageal-related problems PsA may cause and possible treatment options.
People who have dysphagia may experience symptoms such as:
- difficulty swallowing starchy foods, such as bread or potatoes
- feeling as though food is too big to swallow
- pain in the chest when food travels down the esophagus
- acid reflux after a meal or after eating particular foods
- gastroparesis, where the stomach muscles that push food through the intestines stop working or slow down
- weakness in the esophagus that can cause a pocket to form and trap food
- inflammatory bowel syndrome that has links to PsA through triggering chronic inflammation
- ulcerative colitis that relates to PsA and may cause mouth ulcers
Mass Building Supplements & Legal Steroids
They can affect.
drugs including prednisone, rituximab, methotrexate and azathioprine. Psoriasis and Psoriatic Arthritis Psoriasis is an inflammatory skin disease that causes silvery red.
As COPD and asthma share common disease features, and because.
The recording of cardiovascular diseases in the hospital separation database has been.
In fact, heart failure is a major cause of death.
more predictive of heart attack than in patients who do not have RA. There was a link between heart attacks and steroid use, which is not.
They can affect.
drugs including prednisone, rituximab, methotrexate and azathioprine. Psoriasis and Psoriatic Arthritis Psoriasis is an inflammatory skin disease that causes silvery red.
Untreated, the disorder can cause blindness, strokes, even heart attacks. Because of that risk, when the diagnosis of G.C.A. is considered, treatment with high doses of steroids must be started.
The effect of anabolic steroids on the heart can cause myocardial infarction and strokes. Conditions pertaining to hormonal imbalances such as gynecomastia and testicular size reduction may also be caused by AAS. In women and children, AAS can cause irreversible masculinization.
Steroids are no friend of the heart, either.Abusing steroids can cause heart attacks and strokes, even in young athletes. Heres how: Steroid use can lead to a condition called atherosclerosis.
betamethasone, or dexamethasone, have, so far as I can.
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