A comparative cross-sectional study on evaluation of carotid artery intima-media thickness in patients of psoriasis vulgaris: an early predictor of subclinical atherosclerosis
Keywords:Psoriasis, Subclinical atherosclerosis, Carotid artery intima-media thickness, Cardiovascular risk
Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Carotid artery intima-media thickness (CIMT) is used as a non-invasive marker in the assessment of subclinical atherosclerosis. In this study, by using a doppler ultra-sonogram, subclinical atherosclerosis in patients with psoriasis was evaluated in need of special follow-up to reduce cardiovascular morbidity. It was aimed to evaluate the mean CIMT, determine the prevalence of subclinical atherosclerosis and to evaluate the association between the severity, duration of psoriasis and CIMT.
Methods: A hospital-based cross-sectional study was done on 25 patients with psoriasis and age, gender, and body mass index (BMI) matched 25 healthy controls over 2 months. CIMT was measured using a doppler ultra-sonogram.
Results: Compared to the controls, patients had higher CIMT. 24% of patients had subclinical atherosclerosis compared to 12% of controls. Chronic smokers with psoriasis had a significant association with subclinical atherosclerosis. Because of the COVID-19 pandemic, it was unable to determine the severity and prognosis of subclinical atherosclerosis through follow up.
Conclusions: This study provides an insight into the higher prevalence of subclinical atherosclerosis in psoriasis patients, smokers in particular. CIMT can serve as an important noninvasive marker to assess cardiovascular risk.
Lyell A. Leprosy and psoriasis. J Am Acad Dermatol. 1987;16(3):620.
Michalek IM, Loring B, John SM. Global report on psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205-12.
Goldminz AM, Au SC, Kim N, Gottlieb AB, Lizzul PF. NF-κB: an essential transcription factor in psoriasis. J Dermatol Sci. 2013;69(2):89-94.
Tsuruta D. NF-κB links keratinocytes and lymphocytes in the pathogenesis of psoriasis. Recent patents on inflammation & allergy drug discovery. 2009;3(1):40-8.
Rapp SR, Feldman SR, Exum ML, Fleischer Jr AB, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3):401-7.
Kothiwala SK, Khanna N, Tandon N, Naik N, Sharma VK, Sharma S, et al. Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study. Indian J Dermatol Venereol Leprol. 2016;82(5):510.
Altekin ER, Koç S, Karakaş MS, Yanıkoğlu A, Başarıcı İ, Demir İ, et al. Determination of subclinical atherosclerosis in plaque type Psoriasis patients without traditional risk factors for atherosclerosis. Arch Turk Soc Cardiol. 2012;40(7):574-80.
Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksäss A. Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Weekly. 2012;142(4344).
Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, et al. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol. 2008;23(1):1-6.
El-Mongy S, Fathy H, Abdelaziz A, Omran E, George S, Neseem N, et al. Subclinical atherosclerosis in patients with chronic psoriasis: a potential association. J Eur Acad Dermatol Venereol. 2010;24(6):661-6.
Ogdie A, Schwartzman S, Eder L, Maharaj AB, Zisman D, Raychaudhuri SP, et al. Comprehensive treatment of psoriatic arthritis: managing comorbities and extraarticular manifestations. J Rheumatol. 2014;41:2315-22.
Hansson G. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-95.
Weber C, Noels H. Atherosclerosis: current pathogenesis and therapeutic options. Nat Med. 2011;17:1410-22.
Fatkhullina AR, Peshkova IO, Koltsova EK. The role of cytokines in the development of atherosclerosis. Biochem Biokhimiia. 2016;81(11):1358.
Hafid AO, Soraya T, Ziad M, Alain T. Recent advances on the role of cytokines in atherosclerosis. Arterioscler Thromb Vasc Biol. 2011;31(5):969-79.
Gonzalez-Juanatey C, Llorca J, Miranda-Filloy J, Amigo-Diaz E, Testa A, Garcia-Porrua C, et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57:287-93.
Tabas I, Williams K, Boren J. Subendothelial lipoprotein retention as the initiating process in atherosclerosis: update and therapeutic implications. Circulation. 2007;116:1832-44.
Karbach S, Croxford A, Oelze M, Schuler R, Minwegen D, Wegner J, et al. Interleukin 17 drives vascular inflammation, endothelial dysfunction, and arterial hypertension in psoriasis-like skin disease. Arterioscler Thromb Vasc Biol. 2014;34:2658-68.
Wu JJ, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatol Treat. 2014;26:1-5.
Bańska-Kisiel K, Haberka M, Bergler-Czop B, Brzezińska-Wcisło L, Okopień B,
Postepy ZG. Dermatol Alergol. 2016;33(4):286-9.
Pryor WA, Stone K. Oxidants in cigarette smoke radicals, hydrogen peroxide, peroxynitrate, and peroxynitrite. Ann New York Acad Sci. 1993;686(1):12-27.
Armstrong AW, Armstrong EJ, Fuller EN, Sockolov ME, Voyles SV. Smoking and pathogenesis of psoriasis: a review of oxidative, inflammatory and genetic mechanisms. Br J Dermatol. 2011;165(6):1162-8.
Cassano N, Vestita M, Apruzzi D, Vena GA. Alcohol, psoriasis, liver disease, and anti_psoriasis drugs. Int J Dermatol. 2011;50(11):1323-31.
Balci DD, Balci A, Karazincir S, et al. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol. 2009;23:1-6.
Kimhi O, Caspi D, Bornstein NM. Prelevance and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthriti Rheum. 2007;6:2003-9.