Inflammation and Cardiovascular Disease with Dr Nehal Mehta

In this conversation, Dr. Nehal Mehta and Dr. Thomas Nero discuss the critical relationship between systemic inflammation and cardiovascular health, particularly in patients with psoriasis. He emphasizes the importance of understanding how an overactive immune system can lead to increased risks of heart disease and other health issues. The discussion also covers lifestyle changes that can help manage inflammation, including diet, exercise, and mental health support.

takeaways

• Systemic inflammation can lead to cardiovascular disease.
• Psoriasis is linked to increased heart attack risk.
• Visceral fat contributes to inflammation and diabetes.
• Weight loss can improve response to treatment.
• Lifestyle changes are crucial for managing inflammation.
• Family support plays a role in health management.
• Mental health is important in managing chronic conditions.
• Dietary changes can significantly impact inflammation levels.
• Regular exercise is beneficial for heart health.
• Education and awareness are key for patients.

keywords

systemic inflammation, cardiovascular disease, psoriasis, immune system, lifestyle changes, diabetes, obesity, heart health, inflammation management, patient education

Transcript

Dr Nero:, Dr. Mehta, thank you for joining us with Patient Pulse. , I wanted to talk to you today , about systemic inflammation, , how it affects our cardiovascular system and how it affects our body and how our body affects it.

Dr Mehta: . So Tom, thanks for having me. It's really a pleasure to be able to speak to our community of patients who are interested in and people who are interested in systemic inflammation and CVD. I guess the first thing I would say is there is an overactive component of our bodies that is an immune system that could in some people become hyperactive.

And when that hyperactive immune system drives these immune cells, They can cause, deposit into the heart arteries as well as the neck arteries, predisposing to heart attack and stroke. These have, long lasting implications on patients quality of life as well as the family around them.

And so one of the things that I always try to point folks to is [00:01:00] there's a rich amount of educational tools and resources out there along with this discussion you and I are having. And I urge folks to look into educational tools provided by the foundations as well as the Medical provider, you know sort of websites because the the the link is strong tom and it's real and it's not going away

Dr Nero: So you, , essentially cut your teeth in, , research looking at, psoriasis patients and ultimately , you found that patients who had psoriasis had marked increased risk of having cardiovascular disease. Can you walk us through that just a little bit? And then what you see as a systemic component to that and where it fits within our populations.

Dr Mehta: Yeah, for sure. So there's two seminal bodies of So I'm going to talk a little bit about some of the early discoveries that happened in the early 2000s. It was shown that in a big, big, big database when you had severe psoriasis, you had a larger first heart attack, and it was more severe.

If you have more severe disease, what the [00:02:00] data there showed was even beyond risk factors for heart disease, and it was controlled and adjusted for everything under the sun that it could be, there was still something about psoriasis that provided anywhere between 11 and 60 percent increase in first heart attack.

Why that is happening and what the systemic component is, is that psoriasis is an inflammatory skin disease seeping into the blood driving these things going forward. And the systemic component can be detected two ways, looking at the person's skin and actually measuring the blood and checking for certain, you know, immune profiles, which are standard of care.

But I think the biggest thing is, is that our research showed us that. There is a definitive relationship between psoriasis severity and heart disease and psoriasis severity and diabetes and psoriasis severity and future risk of cancers. So you got to treat your psoriasis.

Dr Nero: And one of the other things that you showed was that, people who have big bellies for lack of a better [00:03:00] term, wide waistbands, and a lot of visceral fat had increased levels of inflammation. That patients who had increased levels of inflammation had , increased risk of developing diabetes.

And those two components both markedly increased the risk of developing cardiovascular disease. So, I guess one of the questions is, which came first, the chicken or the egg? Or was it just eating too many chickens and too many eggs?

Dr Mehta: That's a really good question and it's probably a bit of both to dissect which one came first. I would say that, with psoriasis actually have a weight spike before they get their psoriasis phenotype, so I bet you the adiposity is driving this. Now, what caused the adiposity? Could it be genetics?

Sure. Obesity is a genetic disease. Could it be external and too many cheeseburgers and fries? Sure, but it's probably an interplay between the two. The big bellies lead to this visceral adipose, uh, component, which is the adipose tissue or fat tissue around organs. That does [00:04:00] lead to more inflammation, more diabetes, but more importantly, Tom.

More cardiovascular disease, more non calcified burden. And most recently, just I think about a week or two ago, we published a paper in JAMA Dermatology showing that when you look at psoriasis severity and future risk of heart disease, it is mediated. All in part by systemic inflammation. And you can look at that whether it's in the coronaries or whether it's hard cardiovascular events.

So we really need to take the big belly seriously. How do you cut that off? Losing weight will actually help response to biologics. So we just got to figure out how to do that.

Dr Nero: So, , we could spend probably an hour or two discussing Ozympic and Monjaro. So, and I'm going to skip over that for the moment because I think that that's a, a bigger conversation. But are there other ways that you would address people other than weight loss in order to try to address their inflammation?

Are there things that they can be doing in their lifestyle that will help? Are there other therapies? Well,

Dr Mehta: hundred percent Tom. And [00:05:00] really glad you asked that because In order to reduce inflammation, first, treat the source. So, treat the skin disease, go see your doctor. Number two, Mehta's 3Bs.

I've been usually saying, get your body mass index under control. So, yeah, we said weight loss, . Cardiovascular risk factors. Blood pressure. Blood for cholesterol, blood for glucose. What can you do? Watch what you eat. The AHA actually has a great step one diet. It has a step two diet.

Either of those are fine. We're doing a trial with folks in Spain called MEDSO, the Mediterranean diet in psoriasis. We believe it's going to be highly effective. Um, you can exercise. We say that if you can't get into the aquatics, walk. Keeping yourself moving is going to be important. And then most of all, the mood.

Gotta keep your mood elevated. It's not something that if you feel depression, talk about it. There's a high amount of depression and anxiety. It's not easy not being able to wear short sleeved shirts or the color black. It's terrible to [00:06:00] feel people looking at you and saying, is your skin falling off? Um, Don't let that get to you.

There's hope out there and the hope is treat your disease and everything will fall into place. Um, and in order to reduce the systemic inflammation beyond diet, lifestyle, and treating your psoriasis and your mood, the last one really would be, um, get the family involved. What you put in your mouth, whatever you put in you, the house, the pantry, it's all common, uh, with the family.

So this is a disease of family , effort if, if I call it that.

Dr Nero: I can tell you honestly that every time I talk to you, improve my mood. And, uh, I do believe that you're probably one of the hardest working men in show business or the hardest working men in, uh, in medicine. So, um, I appreciate you taking your time today to share all this with us. And, uh, I look forward to continuing these conversations soon.

Dr Mehta: Absolutely, Tom, looking forward to the next one. Thank you for having me.