Psoriasis patients can suffer from mild forms of the disease, with small patches of red, inflamed skin on elbows and knees. Or they can endure much more severe cases in which the body is totally covered in red, unsightly rashes.

But as it turns out, psoriasis—and the severity to which people have it—is more than just an uncomfortable, sometimes painful, skin disease.

According to a new study from Penn Medicine, it’s also an accurate marker of risk for other ailments, including heart disease.

In a series of extensive research projects, Assistant Professor of Dermatology Joel Gelfand has found that psoriasis patients have an increased risk of heart attack and coronary heart disease, especially if the psoriasis is moderate to severe. In addition, Gelfand says, diabetes, hypertension, obesity and elevated cholesterol are all more common in people with psoriasis than in the general population.

People with mild versions of psoriasis do have an elevated risk, he says, but less so than moderate to severe psoriasis patients. Gelfand is so convinced of the link between psoriasis and other diseases that he actually worries that the condition isn’t being diagnosed in all those who have it.

“There are more than 2 million people out there who have it,” Gelfand says. “And they don’t know it.”

In a paper published in the Dec. 15, 2008 issue of the American Journal of Cardiology, Gelfand recommended that patients with psoriasis, especially those with moderate to severe cases, get themselves checked for heart disease and other cardiovascular diseases, as well as be educated about their increased risk. He also warned that any medication prescribed to reduce high cholesterol or heart disease in patients should be monitored closely, since psoriasis can be worsened by some medications.

In his work studying the disease, Gelfand has looked at the medical records of all patients with psoriasis in the U.K.—identifying more than 130,000. What he found adds to the growing evidence that diabetes, hypertension, smoking and increased BMI are all associated with psoriasis, especially those patients with the severe form of the disease.
The work suggests that psoriasis may be caused by the interactions of multiple genes, the immune system and environmental factors.

“I think people are really excited,” says Gelfand of his findings. [This is] part of the research that’s really driving the way we think about the disease.”

Since the 1970s, doctors have been aware of a connection between psoriasis and an elevated risk of heart attacks, but early studies seeking a link were flawed, says Gelfand, because they didn’t control for heart disease risk factors. Today, it’s still up in the air exactly what causes the connection between psoriasis and heart disease, but Gelfand says it could have to do with inflammation: Chemical markers for inflammation associated with psoriasis are the same as those linked to heart attacks.

Gelfand has a National Institutes of Health grant pending for a study similar to the one he did in the U.K., but with the addition of surveys sent to patients already diagnosed with psoriasis. This, he says, will allow for his team to more accurately assess who is getting treatment for moderate and severe forms of the skin disease and ask questions of patients, such as whether they believe having diabetes makes their psoriasis worse.

The goal, Gelfand says, is to firm up the connection between psoriasis and other health issues—and also get the message out that patients with this disease really may be facing greater health risks than they know.
Simply put, Gefland says: “Psoriasis is an important risk factor of when people die.”