Home > Dermatology > Dermatologists and psoriasis patients call for specialized care to prevent heart disease

Dermatologists and psoriasis patients call for specialized care to prevent heart disease

JAMA Dermatology
Reuters Health - 26/01/2022 - Dermatologists and patients with psoriatic disease agree that specialist-led care would help them prevent cardiovascular disease, according to a new survey.

Patients with psoriatic disease are at elevated risk of cardiovascular disease (CVD), but many don't regularly visit their primary-care physicians for blood pressure and cholesterol testing and treatment, researchers note in JAMA Dermatology.

"Patients with psoriatic disease report being just as likely pursue testing and treatment for cardiovascular risk factors whether these recommendations were made by their primary care physician or their dermatologist or rheumatologist," said senior author Dr. Joel M. Gelfand of the University of Pennsylvania Perelman School of Medicine, in Philadelphia.

"More than two-thirds of dermatologists agreed that screening for cardiovascular risk factors in patients with psoriasis was doable," he told Reuters Health by email.

Dr. Gelfand and his colleagues analyzed data from two electronic surveys conducted by the National Psoriasis Foundation and the American Academy of Dermatology: one survey of 183 dermatologists, and the other of 160 patients with psoriasis and 162 patients with psoriatic arthritis. Due to the low response rate by rheumatologists, their results were excluded from the main analysis.

Clinicians were asked for their preferred degree of involvement in patient care - telemedicine visits vs. electronic reminders to be screened for CVD, for example - and whether they think calculating a 10-year CVD risk score and prescribing statins would be feasible.

Among dermatologists, clinical decision support, clinician education, and patient education were strategies reported as likely to improve CVD prevention in patients with psoriatic disease. Overall, 69% of dermatologists agreed or strongly agreed that checking lipid levels and calculating 10-year cardiovascular risk were feasible, although only 36% agreed or strongly agreed that prescribing statins seemed doable.

Patients said they were equally likely to engage in cardiovascular risk screening and management if recommended by their primary-care physician or a specialist. Also, 60% of those with psoriasis and 75% of those with psoriatic arthritis agreed having a dermatologist or rheumatologist check their cholesterol would be convenient.

Dr. Laura Ferris, a dermatology professor at the University of Pittsburgh Medical Center, told Reuters Health by email, "Traditionally, screening for cardiovascular risk factors like hypertension and hyperlipidemia and treating these conditions has been the realm of the primary-care provider. However, many patients with severe psoriatic disease see their dermatologist or rheumatologist more than they see their primary-care provider."

Dr. Ferris, who was not involved in the study, recommended "more educational resources about choosing appropriate patients for statin therapy and guidelines for prescribing and monitoring while on these drugs." She said these steps "may improve specialists' willingness to play a more direct role in treating both the skin and joint manifestation of disease and the associated comorbidities."

According to lead author Dr. John S. Barbieri of Brigham and Women's Hospital in Boston, "Our results suggest that there may be an opportunity to increase the involvement dermatologists and rheumatologists in heart-disease prevention for patients with psoriasis and psoriatic arthritis. A collaborative care model may be one way to increase specialist involvement without overburdening clinicians."

Dr. Barbieri mentioned that, while a strength of the study is its inclusion of a large and diverse population of patients and clinicians, its survey design is a limitation. "Future research is needed to explore whether these survey responses will accurately predict behavior in clinical practice," he told Reuters Health by email.

"With continued support from the National Psoriasis Foundation, we are now developing and testing a collaborative care model with the goal of helping patients with psoriasis and psoriatic arthritis reduce their risk of heart disease," he added.

In an accompanying editorial, Drs. Michael S. Garshick and Jeffrey S. Berger of New York University Langone Health, in New York City, write, "The dermatology and rheumatology communities are at the forefront of treating patients with psoriasis and promoting awareness and research to explain and treat CVD risk in this group who is at risk for early heart disease."

Moving the needle forward includes refining and developing modifiable CVD risk reduction strategies for patients with psoriasis, and collaboration between the fields of dermatology, rheumatology, and cardiology is key," they add.

The study did not receive commercial support.

SOURCE: https://bit.ly/3tYCUQ4 and https://bit.ly/3FZS1uL JAMA Dermatology, online January 19, 2022.

By Lorraine L. Janeczko

© 2023 The Author(s). Published by Medicom Medical Publishers.
User license: Creative Commons Attribution – NonCommercial (CC BY-NC 4.0)

Posted on