Subclinical Atherosclerosis in Psoriatic Patients: Relation with Vitamin D

Abstract

Background Psoriasis is a chronic, inflammatory disease that mainly affects skin and nails. Approximately 13%-25% of Psoriasis patients develop Psoriatic arthritis (PsA). Psoriasis and PsA are strongly associated with numerous comorbid diseases and among them, cardiovascular diseases are of particular importance. Low levels of serum vitamin D are associated with increasing risk of metabolic diseases and cardiovascular diseases. Vitamin D deficiency is observed in numerous chronic systemic inflammatory diseases including psoriasis. Carotid intima-media thickness (CIMT) is a marker of arterial vascular disease used to predict a future vascular event. It can serve as a surrogate marker for subclinical atherosclerosis and cardiovascular diseases. Coronary artery calcification score (CACS) is a non-invasive and highly reliable method to measure coronary atherosclerosis through non-contrast cardiac CT. Objective To detect subclinical atherosclerosis and study its relation with serum levels of 25hydroxyvitamin D in psoriatic patients with and without arthritis. Patients and Methods This study was carried out on 25 Egyptian psoriatic patients and 25 healthy individuals matched as regarding age, sex and BMI as a control group. Patients were classified into 2 groups; Group I: 13 patients with PsA and Group II: 12 patients with psoriatic skin lesion without any arthritic manifestations. All patients were subjected to full medical history taking, thorough clinical examination. Basic laboratory investigations in addition to assessment of serum levels of 25-OH vitamin D were done to all patients and control. carotid duplex for measurement of CIMT in addition to measurement of CACS using coronary CT. Results Patients with PsA had lower values of vitamin D than psoriatic patients and controls despite being statistically insignificant (median; 5, 5.5 & 11). CIMT and CACS were statistically higher among PsA patients (CIMT mean; 0.57, 0.52 & 0.44) and (CACS median; 53, 1.5 & 0) respectively. Vitamin D was found to be negatively well correlated with PASI, ALT, AST, serum creatinine and CACS in psoriatic patients. A significant relation between higher PASI and low vitamin D levels in psoriatic patients. CIMT was significantly positively correlated with age, BMI, LEI, ALT, AST, SUA, cholesterol and CACS in psoriatic patients, while CACS was positively correlated with age, ALT, SUA and cholesterol. Conclusion Psoriatic patients especially those with PsA had lower values of vitamin D than controls despite being statistically insignificant. They also suffered from increased risk of CVDs and subclinical atherosclerosis due to increased burden of inflammation and lack of physical activity. Vitamin D was negatively correlated with CACS in psoriatic patients in addition to a strong positive correlation between CIMT and CACS among them.