Cardio-Dermatology: Multidisciplinary Care Essential for Reducing Multifaceted Risk

Chronic skin conditions like psoriasis and atopic dermatitis (AD) are more than skin-deep—they carry significant risks for heart disease and require special attention, according to a compelling presentation given at Masterclasses in Dermatology 2025 in Sarasota.

In her talk, Brittany Weber, MD, PhD, a cardiologist, assistant professor of medicine, director of the Cardio-Rheumatology Clinic at Brigham and Women's Hospital, and a leading expert in cardio-dermatology, advocated for the need to address cardiovascular risks in dermatology patients. Enter the emerging field of cardio-dermatology, which focuses on the complex relationship between chronic skin diseases and heart health.

"Cardio-dermatology is an essential specialty for recognizing cardiovascular risks in patients with chronic inflammatory skin conditions," Dr. Weber said.

Diseases such as psoriasis, AD, and hidradenitis suppurativa are known to significantly increase the risk of heart disease, metabolic syndrome, and hypertension. Dr. Weber noted in her talk that patients with severe skin conditions often have cardiometabolic co-morbidities requiring tailored interventions. Customizing those interventions to best address cardiovascular risk at the individual patient level, she said, will be a challenge.

“This requires multidisciplinary care models and unfortunately that's just not available at the majority of institutions,” Dr. Weber implored “We really have to really think about innovative solutions.”

Drug Risks
One major area of concern Dr. Weber highlighted is the cardiovascular impact of dermatologic treatments. Drugs such as JAK inhibitors, demonstrably effective for treating skin conditions, often come with cardiovascular side effects. Dr. Weber noted that JAK inhibitors and other biologics, for example, can increase LDL cholesterol levels, necessitating careful monitoring and risk management. Dr. Weber also highlighted the promise of newer therapies, such as GLP-1 agonists, which not only treat obesity, but also reduce cardiovascular risk.

“Adverse effects on cardiovascular health demand comprehensive screening and collaborative decision-making with cardiologists and rheumatologists,” she said.

The Role of Advanced Imaging

She also emphasized the role of advanced imaging in improving cardiovascular risk detection. Modalities like coronary computed tomography (CT), cardiac magnetic resonance imaging (MRI), and stress perfusion positron emission tomography (PET) scans allow clinicians to detect conditions like atherosclerosis (plaque buildup) and microvascular dysfunction.

“Integrating these tools into routine practice enhances our ability to assess and manage risk effectively,” she said.

Risk from Psoriasis

Dr. Weber also noted the prevalence of traditional cardiovascular risk factors is increased among patients with psoriasis and psoriatic arthritis (PSA) and that both conditions have established relationships with increased cardiovascular risk.

“It is well established that psoriasis is associated with an increased risk of cardiovascular disease and an increased prevalence of cardiovascular risk factors,” she said. “It’s important to note that for all cardiovascular risk factors, but there is a strong propensity for dyslipidemia in these [psoriasis/PsA] patients and you see increased cardiovascular risk with the severity of the disease. A patient with severe skin disease received in your clinic has excess cardiovascular risk and increased traditional cardiovascular risk factors compared to mild disease.”

The Need for Guidelines
Dr. Weber rounded out the talk with a call to action for developing practical clinical guidelines to help dermatologists screen for cardiovascular risks in their clinics. She also previewed an upcoming publication she co-authored that will outline straightforward recommendations for risk assessment and when to refer patients to cardiologists. Dr. Weber also advocated for educational initiatives to promote cardio-dermatology, suggesting monthly case discussions and conferences designed to foster collaboration between specialists.

“Early recognition of cardiovascular risk factors like obesity, hyperlipidemia, and high blood pressure is vital,” she said. “By addressing these now, we can prevent long-term complications and improve patient outcomes.”

Dr. Weber works closely with Dr. Joseph Merola, MD, MMSc, a dermatologist, rheumatologist, expert in psoriatic disease, and chief of dermatology at the University of Texas Southwestern (UTSW) Medical Center. In summer 2025, Dr. Weber will be joining UTSW Medical Center to direct a new innovative program in cardio-dermatology and cardio-rheumatology. -by Eric Raible

Source: Weber B. Practical approach to cardiovascular prevention in dermatology. Presented at: Masterclasses in Dermatology, Sarasota, FL, USA; February 20–23, 2025.