IL-23 and IL-17 Inhibitors Reduce Cardiovascular Outcomes in Statin-Treated Psoriasis Patients

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Investigators at the University of California, Los Angeles Division of Dermatology identified which biologics positively reduce the risk of adverse cardiovascular outcomes in statin-treated psoriasis patients.¹ The global population study was presented in a poster at the Society for Investigative Dermatology Annual Meeting, May 7-10, 2025, in San Diego, California.

Background

Psoriasis is proven to be heavily associated with increased cardiovascular risk.² Statins, a drug class frequently prescribed to patients with psoriasis, may not fully mitigate cardiovascular risk in this vulnerable population. Biologics, which are particularly effective for cutaneous symptoms, may have a beneficial impact on the cardiovascular outcomes of patients treated with statins.

Methods

The retrospective cohort trial included 32,552 participants, who were identified via TriNetX. All were 12 years of age and over and had severe disease for at least > 5 years. Patients who were treated with non-statin lipid-lowering therapy were not eligible. With a 2.5-year median follow-up, the participants were divided into 2 cohorts. Cohort 1 included statin-treated patients on biologics, while Cohort 2 included statin-treated patients on non-biologic systemics or phototherapy.

The researchers evaluated cardiovascular outcomes such as percutaneous coronary interventions, heart failure, vascular disease, cerebrovascular events like stroke and transient ischemic attack, myocardial infarction, and ischemic heart disease. Propensity score matching and multivariate logistic regression were also used to adjust for age, sex, body mass index, smoking, type 2 diabetes, chronic kidney disease, and circulatory disease.

Results

Patients who received biologic treatments for psoriasis, even when on statin therapy, saw statistically significant decreases in adverse cardiovascular outcomes. Cerebrovascular events and myocardial infarction, 2 potentially fatal outcomes, had significant deductions. The percentages are as follows;

• 52% reduction in percutaneous coronary interventions
• 31% reduction in heart failure
• 30% reduction in vascular disease
• 27% reduction in cerebrovascular events
• 25% reduction in myocardial infarction
• 20% reduction in ischemic heart disease

Specifically, IL-23 inhibitors were the most impactful category of biologics, with a 54% average decrease and a mean adjusted odds ratio of 0.46. Cerebrovascular events had the highest rate of reduction (70%), followed by heart failure (60%), percutaneous coronary interventions (55%), and myocardial infarction (48%).

IL-17 inhibitors were second, with a 37% average decrease and a mean adjusted odds ratio of 0.63. Percutaneous coronary interventions had the highest rate of reduction (57%), followed by heart failure (45%), cerebrovascular events (36%), and myocardial infarction (23%)

IL-12/23 inhibitors were the next effective method, with a 27% average decrease and a mean adjusted odds ratio of 0.73. Myocardial infarction had the highest rate of reduction (36%), followed by heart failure (29%) and peripheral vascular disease (28%).

Finally, TNF-α inhibitors were the least effective biologics, with a 22% average decrease and a mean adjusted odds ratio of 0.78. Here, peripheral vascular disease had the highest rate of reduction (24%), followed by myocardial infarction and cerebrovascular events (22%), along with heart failure (21%). Although these effects were lesser compared to other biologic classes, they were still significant.

Conclusion

This study proves that biologic therapies, especially IL-23 and IL-17 inhibitors, significantly reduce cardiovascular risk in patients with psoriasis who had been treated with statins. This powerful systemic inflammation, beyond the use of statins on their own, offers even more cardioprotection along with the cutaneous symptom relief.

References

1. Johnsen N, Ma E, Yan M, et al. Biologics reduce adverse cardiovascular outcomes in statin-treated psoriasis patients: A global population study. Poster presented at: Society for Investigative Dermatology Annual Meeting; May 7-10; San Diego, California.

2. Jindal S, Jindal N. Psoriasis and Cardiovascular Diseases: A Literature Review to Determine the Causal Relationship. Cureus. 2018;10(2):e2195. Published 2018 Feb 15. doi:10.7759/cureus.2195