Effect of treating psoriasis on cardiovascular co-morbidities: focus on TNF inhibitors.

Psoriasis patients are at increased risk for cardiovascular disease. Literature on rheumatoid arthritis has shown the association of treatment with tumor necrosis factor (TNF) inhibitors and improvement of cardiovascular disease. Recent literature has also shown similar findings in psoriasis patients. We present a review of the literature on the effect of TNF inhibitors for psoriasis treatment on cardiovascular disease, cardiovascular biomarkers, and insulin resistance. We conclude that TNF inhibitors may be especially beneficial in preventing myocardial infarction, to a degree greater than methotrexate, especially in the Caucasian population. The effects of TNF inhibitors in altering insulin sensitivity or preventing new onset diabetes have been contradictory. Case reports of both hyperglycemia and hypoglycemia developing in patients under TNF inhibitor treatment teach us to warn patients about these side effects. More robust clinical studies are needed to evaluate the true effect of TNF inhibitors in diabetic psoriasis patients. More studies are also needed to assess the effect of TNF inhibitors on hypertension, dyslipidemia, and stroke.