ABC | Volume 113, Nº2, August 2019

Short Editorial Bacchiega Psoriasis and cardiovascular risk Arq Bras Cardiol. 2019; 113(2):250-251 1. Oliveira AN, Simões MM, Simões R, Malachias MVB, Rezende BA. Cardiovascular Risk in Psoriasis Patients: Clinical, Functional and Morphological Parameters. Arq Bras Cardiol. 2019; 113(2):242-249. 2. RadnerH,LesperanceT,AccorttNA,SolomonDH.Incidenceandprevalence of cardiovascular risk factors among patients with rheumatoid arthritis, psoriasis, or psoriatic arthritis. Arthritis Care Res. 2017;69(10):1510-8. 3. MehtaNN,AzfarRS,ShinDB,NeimannAL,TroxelAB,GelfandJM.Patientswith severe psoriasis are at increased risk of cardiovascular mortality: cohort study usingtheGeneralPracticeResearchDatabase.EurHeartJ.2010;31(8):1000-6. 4. Egeberg A, Thyssen JP, Jensen P, Gislason GH, Skov L. Risk of myocardial infarction in patients with psoriasis and psoriatic arthritis: a nationwide cohort study. Acta Derm Venereol. 2017;97(7):819-24. 5. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardialinfarctioninpatientswithpsoriasis.JAMA.2006;296(14):1735-41. 6. Zhao TX, Mallat Z. T argeting the immune system in atherosclerosis: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(13):1691-1706. 7. Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003;108(24):2957-63. 8. Boehncke WH, Boehncke S, Tobin A-M, Kirby B. The ‘psoriatic march’: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011;20(4):303-7. 9. Kaur S, Kingo K, Zilmer M. Psoriasis and cardiovascular risk-do promising new biomarkers have clinical impact? Mediators Inflamm. 2017;2017:7279818. 10. Joshi AA, Lerman JB, Aberra TM, Afshar M, Teague HL, Rodante JA, et al. GlycA is a novel biomarker of inflammation and subclinical cardiovascular disease in psoriasis. Circ Res. 2016;119(11):1242-53. 11. Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80(4):1073-1113. 12. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28. 13. Eder L, Joshi AA, Dey AK, Cook R, Siegel EL, GladmanDD, et al. Association of tumor necrosis factor inhibitor treatment with reduced indices of subclinical atherosclerosis in patients with psoriatic disease. Arthritis Rheumatol. 2018;70(3):408-16. 14. Ahlehoff O, Skov L, Gislason G, Gniadecki R, Iversen L, Bryld LE, et al. Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort. J Eur Acad Dermatol Venereol. 2015;29(6):1128-34. 15. Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann RheumDis. 2015;74(3):480-9. 16. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119-31. References This is an open-access article distributed under the terms of the Creative Commons Attribution License seems to be crucial to decrease CV diseases. In a cohort of psoriatic patients, the use of anti-TNF- α drugs decreased carotid IMT in men, and aortic stiffness in both genders. 13 Even more impressive was the analysis of data collected by a Danish registry of psoriatic arthritis, in which the use of immunobiologicals and methotrexate reduced overall mortality. 14 A meta-analysis helped to estimate the impact of anti-inflammatory therapies on the psoriatic population. 15 The use of anti-TNF- α reduced major adverse cardiovascular events (MACE) – cardiovascular death, acute myocardial infarction (AMI), or non-fatal cerebrovascular accident (CVA) – robustly by 70%. Methotrexate led to a 19% drop in the risk of AMI and 28% in global events. On the other hand, treatment with selective COX-2 inhibitor non-steroidal anti-inflammatory drugs more than doubled the risk of CVA, while corticosteroid raised MACE by 62%. Until now, the most debated randomized clinical study was the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), 15 which confirmed the hypothesis that the control of systemic inflammation reduces CV events in very high-risk patients (those who had AMI and even after optimized secondary therapy maintained high t-CRP levels) . This study revealed that interleukin 1 β blockade with a monoclonal antibody controlled the systemic inflammation and, additionally to the optimized treatment, decreased CV mortality, AMI, and CVA by 15% in a population with a high risk of recurrence of CV events. This fact opened doors for paradigmatic changes in the understanding of the physiopathology of the coronary artery disease and will contribute very significantly to the future development of new medicines, with targets unexplored until now. 251