A review published in Nature Reviews Cardiology highlights connections between dermatological conditions and cardiovascular disease, outlining implications for screening and treatment.

The review examined evidence linking skin disorders to cardiac outcomes, with psoriasis showing the strongest associations. The condition, affecting over 60 million people worldwide, correlated with myocardial infarction, stroke, and cardiovascular death, with risks increasing alongside skin involvement, a 5-year reduction in life expectancy, aortic and coronary artery inflammation, atherosclerosis with lipid-rich necrotic cores, insulin resistance and diabetes, dyslipidemia, chronic kidney disease, and metabolic dysfunction-associated steatotic liver disease.

The authors identified inflammatory pathways active in both psoriatic skin and atherosclerosis, including IL-6, IL-8, interferon-γ, and TNF. This parallel inflammatory response underscores the link between dermatological and cardiovascular diseases.

The review also documented cardiovascular effects associated with dermatologic treatments:

• JAK Inhibitors: While increased cardiovascular events were noted in rheumatoid arthritis, dermatology-focused meta-analyses did not show an increased risk. JAK inhibitors were associated with mean increases of 11.4 mg/dL in LDL and 8.1 mg/dL in HDL.

• TNF Inhibitors: High doses (10 mg/kg) showed increased heart failure risk, though observational studies noted reduced myocardial infarction risk with lower doses. TNF inhibitors decreased IL-6 and C-reactive protein levels.

Additional findings included:

• Apremilast: 5-6% reduction in visceral adiposity over 52 weeks
• Ciclosporin: Associated with hypertension and nephrotoxicity
• Retinoids: Linked with dyslipidemia
• Low-dose oral minoxidil: Cardiovascular effects observed in 1-3% of users

Several international guidelines now recommend early cardiovascular screening and preventive measures for patients with psoriasis. However, the study noted that these cardiovascular risks are often under-screened and under-managed in practice, suggesting a need for improved clinical implementation.

The review methodology incorporated clinical trials, observational studies, genetic analyses, and basic science research from both dermatology and cardiology, providing an interdisciplinary view on skin and heart health.

Conflict of interest disclosures can be found in the study.