Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center

Abstract

BackgroundPsoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation.MethodsWe conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch’s t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP.Results296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders.ConclusionsA tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-0947-0) contains supplementary material, which is available to authorized users.

Increased incidence of ischaemic heart disease and cerebrovascular disease in psoriasis patients with depression: a nationwide retrospective cohort study

“…The increased risk of ischaemic heart disease and cerebrovascular disease in patients with concurrent psoriasis and depression may be due to the systemic inflammatory nature of these two diseases, which may incrementally promote atherosclerosis development . Prior studies have demonstrated an increased degree of aortic vascular inflammation, coronary artery atherosclerosis and carotid artery atherosclerosis in psoriasis patients compared with healthy controls . Similarly, the prevalence and severity of atherosclerosis is known to be greater in patients with depression .…”

“…11 Prior studies have demonstrated an increased degree of aortic vascular inflammation, 31,32 coronary artery atherosclerosis 33,34 and carotid artery atherosclerosis in psoriasis patients compared with healthy controls. 35,36 Similarly, the Psoriasis, depression and cardiovascular diseases prevalence and severity of atherosclerosis is known to be greater in patients with depression. [37][38][39][40][41] Therefore, the combined impact of psoriasis and depression on atherosclerosis development may contribute to the higher vascular risk in patients with both diseases.…”

Nanodermatology‐based solutions for psoriasis: State‐of‐the art and future prospects

“…Medical comorbidities do not only comprise cardiovascular diseases (Santilli et al, ). They range from autoimmunity disorders (Della Valle et al, ; Fiore, Leone, Maraolo, Berti, & Damiani, ; Watad et al, ) to respiratory ones (Confalonieri et al, ; Damiani, Radaeli, Olivini, Calvara‐Pinton, & Malerba, ; Malerba et al, ; Santus et al, ) and were computed to have contributed to the economic burden of psoriasis with $36.4 billion.…”

“…Medical comorbidities do not only comprise cardiovascular diseases (Santilli et al, 2016). They range from autoimmunity disorders (Della Valle et al, 2018;Fiore, Leone, Maraolo, Berti, & Damiani, 2018;Watad et al, 2019) to respiratory ones (Confalonieri et al,in Sweden (€11,928), based also on treatment type.…”

Tissue inflammatory biomarkers in chronic plaque psoriasis: Exploring lesional versus non‐lesional skin relative expression and possible clinical correlations

“…This explains the several comorbidities that frequently present in patients with psoriasis. [2][3][4] The pathomechanism involves a complex interaction of inflammatory chemokines, with a predominantly T-helper 17 profile, that have been shown to be elevated in serum and skin. 1,5 Conflicting results have been reported regarding clinical uses for proinflammatory biomarkers, such as correlation with clinical severity and prediction of therapeutic response.…”