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.