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Dr. Michael Garshick discusses recently published recommendations for cardiovascular risk screening for patients with psoriasis or psoriatic arthritis.

Patients who routinely see dermatologists or rheumatologists for psoriasis or psoriatic arthritis may inadvertently miss primary care visits, leaving key cardiovascular risk factors unaddressed. To close this gap, researchers Michael Garshick, MD, Samip Sheth, MD, Karla Inestroza, MD, Joseph F. Merola, MD, MMSc, and Brittany Weber, MD, PhD, crafted practical recommendations enabling dermatologists, rheumatologists, and primary care physicians to embed cardiovascular risk evaluation into psoriatic disease management. Published in the Journal of Psoriasis and Psoriatic Arthritis, the guidance underscores the need for interdisciplinary collaboration to ensure comprehensive care.

Dr. Garshick spoke with Physician’s Weekly (PW) about the significance of his research team’s work.

PW: Why was the development of practical recommendations for cardiovascular risk evaluation in psoriasis and psoriatic arthritis necessary?

Dr. Garshick: In general, patients with psoriasis and psoriatic arthritis have about a 50% increased risk for having a heart attack or stroke. On top of that, many of these patients with psoriatic disease also have a higher prevalence of traditional risk factors such as hypertension, diabetes, dyslipidemia, obesity, smoking, etc. Unfortunately, these risk factors are often underrecognized or undertreated for many years.  Many of these patients are so closely tied to visiting their rheumatologist or dermatologist that they often do not see their primary care doctor. A variety of complex topics are discussed during rheumatology or dermatology visits, but these risk factors are often not addressed by the providers. The patients don’t realize that anything is missing in their care, and because they are not seeing a primary care doctor, no other health issues are being addressed outside of their psoriatic disease.

We were asked by the Psoriasis & Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) under the guidance of the organization’s president Joseph F. Merola, MD, MMSc, and vice president, Jose U. Scher, MD, to develop best practice guidelines to get at the heart of a healthcare provider’s responsibility in terms of identifying and treating cardiovascular risk. The organization acknowledges that this is an issue and is calling for more aggressive approaches to addressing these comorbidities and their corresponding risks.

How will these recommendations impact healthcare providers?

I believe these recommendations will help increase awareness among providers, making them feel more comfortable and compelled to address these comorbidities in their patients. I think a lot of physicians do check these comorbidities and say, “Okay, I checked them. What do I do with them? How often do I check them? When should I be checking them?” We hope that by offering these practical recommendations, providers will have a treatment protocol in place that enhances comprehensive patient care.

How can physicians incorporate these recommendations into practice?

Intake is very important. Providers need to understand their patients’ individualized needs. They need to be proactive and ask, “Do you have a primary care doctor? Have you been seen by your primary care doctor? Do you know what your cholesterol is? Do you know what your blood pressure is? Has your weight been checked? Have you ever had your hemoglobin checked?”

Providers have a real opportunity when prescribing a biologic or systemic therapy. Most providers who see these patients with psoriasis will draw blood. This is an opportune time to add a comprehensive blood panel—at the start of their treatment, when patients are stable—it’s a great time to address comorbidities and risk factors.

Why is cardiovascular risk screening in psoriasis and psoriatic arthritis particularly urgent?

Too many of these patients are dying of heart disease when we have easy therapies to control their blood pressure, lipids, etc. We can’t let them slip through the cracks. We need to encourage patients to be hyperaware and remind them, “If you have psoriatic disease, you should have traditional risk factors checked.” We have effective therapies to prevent heart disease. All we need to do is implement them.