EP412: Talking Psoriasis with Dr Foo and Dr Smith

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Dr. Warrick Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode with two expert guests: Dr. Fiona Foo, a general and interventional cardiologist from Sydney Cardiology Group, and Dr. Annika Smith, a consultant dermatologist specializing in complex inflammatory skin conditions. The episode explores psoriasis not merely as a skin condition, but as a systemic inflammatory disease with significant cardiovascular implications. Key Takeaways: Psoriasis is a chronic inflammatory skin disease affecting 2-4% of the population, characterized by rapid skin cell turnover resulting in scaly, heaped-up skin typically on elbows, knees, and scalp. Psoriasis is a systemic disorder extending far beyond the skin, affecting the heart, joints (psoriatic arthritis in ~30% of patients), brain neurochemistry (depression and anxiety), and liver, with excess cardiovascular mortality due to increased atherosclerosis rates. Only 20% of psoriasis patients are aware of the relationship between their skin condition and cardiovascular disease, and time to diagnosis is often prolonged, delaying effective treatment initiation. Psoriasis is an independent cardiovascular risk factor equivalent to diabetes, hypertension, or high cholesterol, with patients experiencing up to 50% increased risk of heart attacks and presenting with cardiac events earlier than non-psoriasis patients. Patients with psoriasis commonly have multiple concurrent cardiovascular risk factors including obesity, hypertension, diabetes, high cholesterol, and metabolic syndrome, creating a compounding effect on cardiovascular risk. Early diagnosis and prompt commencement of effective therapy are critical for altering disease trajectory and preventing comorbidities like heart disease. Disease severity markers—including body surface area involvement greater than 10%, longer disease duration, and increased inflammation—correlate with elevated cardiovascular risk, independent of the extent of visible skin involvement. Risk calculators used by clinicians may underestimate cardiovascular risk in psoriasis patients since psoriasis is not factored into standard risk assessment tools, necessitating treatment of these patients as high-risk similar to diabetic patients. Anti-inflammatory medications including statins, colchicine, and monoclonal antibodies like canakinumab should be considered for psoriasis patients due to their potential to reduce inflammation-driven atherosclerosis and cardiovascular events. Lifestyle interventions including diet, exercise, and weight management are crucial as obesity creates a vicious cycle that worsens psoriasis severity and increases inflammation, further elevating cardiovascular risk.