Holistic Lifestyle Assessment and Psoriasis Susceptibility

Psoriatic disease, including psoriasis and psoriatic arthritis, is associated with comorbidities such as cardiovascular disease (CVD), diabetes, hypertension, metabolic syndrome, anxiety, and depression.^7,8 These psoriasis-associated comorbidities represent a substantial burden on both society and individuals. Consequently, exploring modifiable and easily monitored risk factors holds considerable importance for preventing and managing psoriasis.

Life’s Essential 8 (LE8) is an updated metric introduced by the American Heart Association (AHA) in 2022 to assess cardiovascular health holistically. It builds on Life’s Simple 7 (introduced in 2010) by incorporating sleep as a new component. Ultimately, LE8 encompasses diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure.⁹  Each component is assigned a score on a scale of 0–100, and the overall composite score for cardiovascular health, ranging from 0–100, is calculated as the unweighted average of the 8 component scores. Following the guidelines of the AHA, composite scores are categorized into three groups: high level of cardiovascular health (80–100 points), moderate cardiovascular health (50–79 points), and low cardiovascular health (0–49 points).⁹ Genetic factors play a significant role in the onset of psoriatic disease, with the HLA-C*06:02 allele considered a major genetic risk factor for early-onset psoriasis. Inheriting this allele is associated with a 4–5-fold increased risk of developing psoriasis.^10,11 To date, genome-wide association studies have accounted for approximately 30% of the disease.

The authors of this aimed to investigate the longitudinal association between LE8 score and the risk of psoriatic disease, to specifically explore the association of lifestyle factors (as measured with LE8 score) with the onset of new cases of psoriatic disease and to investigate further whether genetic susceptibility could modify such associations.

The data for the study were derived from the UK Biobank, which has > 500,000 participants aged between 37 and 73 years and was initially established to investigate genetic and nongenetic determinants of various diseases comprehensively.¹²  After excluding participants who lacked data related to the LE8 components, had missing genetic information, had self-reported or already had been diagnosed with psoriatic disease at baseline, and those with incomplete follow-up data, a total of 261,642 participants were included. During an average follow-up of 12.3 years, 1,501 participants developed psoriatic disease. Compared with participants with low LE8 scores, the hazard ratio (HR)s of developing psoriatic disease for those with moderate and high LE8 scores were 0.51 (95% CI 0.43–0.59) and 0.34 (95% CI 0.27–0.42) after adjustments, respectively. However, the key take-home message from this study was that dose-response analysis revealed a linear negative association between continuous LE8 score and the risk of developing psoriatic disease (P<0.001), with no evidence of nonlinear association detected. Genetic susceptibility to psoriatic disease did not modify this association (P interaction = 0.63), meaning that maintaining good cardiovascular health could help prevent psoriatic disease and its associated risks. Further subgroup analyses revealed that women had a more pronounced beneficial association between LE8 scores and psoriatic disease risk (P interaction = 0.02) than men. However, the authors cautioned that, given the study’s observational nature, the association between LE8 and psoriatic disease risk should not be interpreted as causal.

In summary, this study suggests that maintaining good cardiovascular health could prevent the development of psoriatic disease in the entire population, regardless of genetic background. It emphasizes the crucial role of holistic lifestyle assessment (such as LE8 score) in prevention strategies/messaging.