1
|
Pletikosic I, Marasovic Krstulovic D, Bakovic D, Susilovic Grabovac Z, Tandara L, Martinovic Kaliterna D. Association of inflammatory biomarkers and disease activity with subclinical myocardial dysfunction in psoriatic arthritis. Sci Rep 2023; 13:10371. [PMID: 37365233 DOI: 10.1038/s41598-023-37412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
We examined the role of adipokines and pro-inflammatory cytokines in psoriatic arthritis-associated subclinical myocardial dysfunction, and the relationship between these variables and psoriatic arthritis (PsA) disease activity. Fifty-five PsA patients without cardiovascular risk factors and 25 controls underwent standard and speckle tracking echocardiography with global longitudinal strain (GLS) calculated. Standard anthropometric data and Disease Activity in Psoriatic arthritis (DAPSA) scores were recorded, with low disease activity defined as DAPSA ≤ 14 and moderate and high disease activity DAPSA > 14. Standard biochemical tests, adiponectin, resistin, leptin, tumor necrosis factor (TNF) alfa, interleukin 17 A (IL-17A), B lymphocyte chemoattractant (BLC), and monokine induced by intereferon gamma (MIG) were analyzed. Median age was 53.0 (46.0-61.0), median PsA duration 6.0 (4.0-13.0) years and median DAPSA score 25.5 (13.0-41.5). Lower GLS, tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (LVEF) were found in moderate and high PsA disease activity compared to low PsA disease activity and controls. PsA patients with GLS < 20 had higher body mass index (BMI), DAPSA score and uric acid levels, and lower adiponectin levels. Although patients with GLS < 20 had higher IL-17A levels, it was not statistically significant (P = 0.056). However, when we included healthy controls and analyzed differences based on a GLS cut-off of 20% in the entire population, the difference in IL-17A became statistically significant, 0.17 pg/mL (0.06-0.32) vs. 0.43 pg/mL (0.23-0.65), P = 0.017. The association between DAPSA score and GLS and IL-17 remained significant in multivariate analysis. Moreover, the association between GLS and IL-17 and adiponectin was significant after adjustment for age and BMI. Patients with moderate and high PsA disease activity have reduced myocardial function, lower adiponectin, and higher IL-17A levels.
Collapse
Affiliation(s)
- Ivan Pletikosic
- Cardiovascular Diseases Department, University Hospital Split, Split, Croatia.
| | | | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital Split, Split, Croatia
- Department of Physiology, School of Medicine, University of Split, Split, Croatia
| | | | - Leida Tandara
- Medical Laboratory Diagnostic Division, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | | |
Collapse
|
2
|
The Correlation between the Vascular Calcification Score of the Coronary Artery and the Abdominal Aorta in Patients with Psoriasis. Diagnostics (Basel) 2023; 13:diagnostics13020274. [PMID: 36673084 PMCID: PMC9858225 DOI: 10.3390/diagnostics13020274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Psoriasis is known as an independent risk factor for cardiovascular disease due to its chronic inflammation. Studies have been conducted to evaluate the progress of atherosclerotic plaques in psoriasis. However, inadequate efforts have been made to clarify the relationship between atherosclerosis progress in coronary arteries and other important blood vessels. For that reason, we investigated the correlation and development of the coronary artery calcification score (CACS) and the abdominal aortic calcification score (AACS) during a follow-up examination. Eighty-three patients with psoriasis underwent coronary computed tomography angiography (CCTA) for total CACS and abdominal computed tomography (AbCT) for total AACS. PASI score, other clinical features, and blood samples were collected at the same time. The patients' medical histories were also retrieved for further analysis. Linear regression was used to analyze the CACS and AACS associations. There was a moderate correlation between CACS and AACS, while both calcification scores relatively reflected the coronary plaque number, coronary stenosis number, and stenosis severity observed with CCTA. Both calcification scores were independent of the PASI score. However, a significantly higher CACS was found in psoriatic arthritis, whereas no similar phenomenon was recorded for AACS. To conclude, both CACS and AACS might be potential alternative tests to predict the presence of coronary lesions as confirmed by CCTA.
Collapse
|
3
|
Wu H, Luo Z, Liu J, Luo D, Song L, Zhao Y. Association between psoriasis and coronary artery calcification: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1044117. [PMID: 36505373 PMCID: PMC9732247 DOI: 10.3389/fcvm.2022.1044117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a hallmark of atherosclerosis and a predictor of poor cardiovascular prognosis, remains to be determined. We performed a systematic review and meta-analysis to comprehensively evaluate the association between these related inflammatory conditions. Methods Observational studies evaluating the relationship between psoriasis and CAC were retrieved by searching PubMed, Cochrane's Library, and Embase databases. Presence of CAC was confirmed according to an Agatston's Score >0 upon computed tomography examination. A random-effect model incorporating between-study heterogeneity was used to pool the results. Results Sixteen studies involving 3,039 patients with psoriasis and 46,191 controls without psoriasis were included in the meta-analysis. All participants were without previously known cardiovascular diseases. Pooled results showed that psoriasis was associated with overall CAC [odds ratio (OR): 1.54, 95% confidence interval: 1.23-1.91, p < 0.001; I 2 = 57%], after matching or adjusting the conventional cardiovascular risk factors. Subgroup analyses showed that study country, comorbidity of psoriatic arthritis, baseline Psoriasis Area and Severity Index, and duration of psoriasis (p for subgroup difference all >0.05) did not significantly affect the association of psoriasis and CAC. However, a stronger association was observed in younger patients (mean age <50 years, OR: 2.63, p < 0.001) compared to older patients (≥50 years, OR: 1.24, p = 0.02; p for subgroup difference <0.001). Conclusion Psoriasis is associated with CAC, and the association may be stronger in younger patients.
Collapse
Affiliation(s)
- Huihui Wu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zeyu Luo
- Department of Dermatology, Guangzhou Development District Hospital, Guangzhou, China
| | - Juanhua Liu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Diqing Luo
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Diqing Luo,
| | - Luli Song
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yukun Zhao
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Yukun Zhao,
| |
Collapse
|
4
|
Fabi M, Chessa MA, Panizza D, Dormi A, Gazzano A, Patrizi A, Bardazzi F, Rocca A, Filice E, Neri I, Lanari M. Psoriasis and Cardiovascular Risk in Children: The Usefulness of Carotid Intima-Media Thickness. Pediatr Cardiol 2022; 43:1462-1470. [PMID: 35316356 DOI: 10.1007/s00246-022-02869-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023]
Abstract
Psoriasis is a skin disorder which mostly affects adults, beginning in childhood in almost one-third of patients. In adults it is associated with increased risk for cardiovascular diseases (CVD), while this association is still debated at younger age. Our aim was to evaluate the association between psoriasis and metabolic markers and cardiovascular findings in this age group. Twenty consecutive patients previously diagnosed with psoriasis (group A) were enrolled and compared with healthy non- psoriatic age- and sex-matched subjects (group B). The severity of the disease, CV risk factors, including anthropometric data with adiposity and its distribution, blood pressure (BP), laboratory metabolic tests, echocardiography and vascular ultrasound (transcranial echo-Doppler and carotid artery echo-Doppler with carotid intima-media thickness, cIMT) were performed for each subject. Personal history for CV risk, BP, anthropometric data were similar between the two groups, while familiar history for psoriasis was more frequent in group A (p < 0.02). C-IMT was significantly higher in group A compared to B (right, p = 0.001; left, p = 0.002). In addition, c-IMT was positively correlated with disease duration, triglycerides and triglycerides/glucose. Cerebral flow velocities, cardiac measurements, systo-diastolic function, ventricle geometry and mass were normal and comparable between the two groups, and did not correlate with CV risk factors. In childhood psoriasis c-IMT could represent a marker of pre-clinical cardiovascular involvement and contribute to start a personalized management, while cardiac findings seem to be normal in the early stage of disease. Longitudinal studies can clarify the progression of CV involvement in paediatric-onset psoriasis.
Collapse
Affiliation(s)
- Marianna Fabi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy
| | - Marco A Chessa
- Dermatology Division, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), IRCCS University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Davide Panizza
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy.
| | - Ada Dormi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Gazzano
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Division, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), IRCCS University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Federico Bardazzi
- Dermatology Division, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), IRCCS University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Alessandro Rocca
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy
| | - Emanuele Filice
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy
| | - Iria Neri
- Dermatology Division, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), IRCCS University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Via Massarenti, 11, Bologna, Italy
| |
Collapse
|
5
|
Martínez-Doménech A, Forner Giner J, Pérez-Pastor G, Magdaleno-Tapial J, Herraez-Cervera B, Sánchez-Carazo J, Martínez-León J, Pérez-Ferriols A. [Artículo traducido] Realización del examen de calcio en los pacientes con psoriasis severa: evaluación del riesgo y potencial de reclasificación en una población de riesgo cardiovascular bajo. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
6
|
Martinez-Domenech A, Forner Giner J, Pérez-Pastor G, Magdaleno-Tapial J, Herraez-Cervera B, Sánchez-Carazo J, Martínez-Leon J, Pérez-Ferriols A. Performance of Coronary Artery Calcium Testing in Patients With Severe Psoriasis: Risk Assessment and Reclassification Potential in a Low Cardiovascular Risk Population. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:773-780. [DOI: 10.1016/j.ad.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022] Open
|
7
|
Schwartz DM, Parel P, Li H, Sorokin AV, Berg AR, Chen M, Dey A, Hong CG, Playford M, Sylvester M, Teague H, Siegel E, Mehta NN. PET/CT-Based Characterization of 18F-FDG Uptake in Various Tissues Reveals Novel Potential Contributions to Coronary Artery Disease in Psoriatic Arthritis. Front Immunol 2022; 13:909760. [PMID: 35720288 PMCID: PMC9201918 DOI: 10.3389/fimmu.2022.909760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Psoriasis is a heterogeneous inflammatory disease that involves the skin, joints, liver, heart, and other organs. Psoriatic arthritis (PsA) is associated with cardiovascular disease (CVD), but the relative contributions of inflammatory and metabolic dysregulation to CVD are incompletely understood. We set out to discover novel potential contributors to CVD in PsA patients by comprehensively phenotyping a cohort of PsA patients using these advanced technologies. Methods In this cross-sectional analysis of a cohort study, we investigated associations of systemic inflammation and metabolic dysregulation with Coronary CT angiography (CCTA)-proven coronary artery disease (CAD) in 39 subjects with PsA. We measured traditional CVD risk factors [blood pressure, Body Mass Index (BMI), diabetes, age, sex, smoking], serum markers of systemic inflammation (hsCRP, GlycA) and metabolic dysfunction (cholesterol efflux capacity), and inflammatory cytokines (IL-1β, IL-6, IL-12/IL-23, IL-17A, TNF-α, IFN-γ). We also incorporated radiographic measures of metabolic dysfunction (visceral and subcutaneous adipose volume) and tissue-specific inflammation (positron emission tomography-computed tomography, PET-CT). To quantify relative contributions of FDG (fluorodeoxyglucose) uptake and adiposity to coronary plaque, we performed multiple linear regression, controlling for Framingham risk score (FRS) and FRS + visceral adiposity. Results Compared with non-psoriatic volunteers, subjects with PsA had elevated markers of metabolic and inflammatory disease, which was more pronounced in subjects with moderate-to-severe skin disease. This included visceral (p = 0.005) and subcutaneous (p = 0.004) adiposity, BMI (p = 0.001), hemoglobin A1C (p = 0.037), high sensitivity C-reactive protein (p = 0.005), IL-6 (p = 0.003), IFN-γ (p = 0.006), and liver FDG uptake (p = 0.03). In subjects with PsA, visceral adiposity correlated significantly with subclinical CAD (standardized β = 0.681, p = 0.002), as did FDG uptake in bone marrow (standardized β = 0.488, p = 0.008), liver (standardized β = 0.619, p < 0.001), spleen (standardized β = 0.523, p = 0.004), and subcutaneous adipose (standardized β = 0.524, p = 0.003). Interpretation Together, these findings reveal inflammatory and metabolic potential contributors to subclinical CAD in PsA, including adipose inflammation, and suggesting novel targets for CVD prevention and treatment in PsA.
Collapse
Affiliation(s)
- Daniella M Schwartz
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.,Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Philip Parel
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Haiou Li
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alexander V Sorokin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alexander R Berg
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Amit Dey
- Department of Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Christin G Hong
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Martin Playford
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - McKella Sylvester
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Heather Teague
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Evan Siegel
- Arthritis and Rheumatism Associates, Wheaton, MD, United States
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
8
|
Aryanian Z, Shirzadian A, Mehraeen R, Ashrafian Amiri M, Azizpour A, Goodarzi A, Hatami P. Over estimation of subclinical atherosclerosis in psoriasis. Clin Exp Dermatol 2022; 47:1722-1724. [PMID: 35510302 DOI: 10.1111/ced.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Azar Shirzadian
- Department of Dermatology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Raheleh Mehraeen
- Radiology Department of Beheshti University's Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Morteza Ashrafian Amiri
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Azizpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Ellis CN, Neville SJ, Sayyouh M, Elder JT, Nair RP, Gudjonsson JE, Ma T, Kazerooni EA, Rubenfire M, Agarwal PP. Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: A cross-sectional study. J Am Acad Dermatol 2021; 86:535-543. [PMID: 34678237 DOI: 10.1016/j.jaad.2021.09.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with psoriasis have elevated risk of coronary artery disease. OBJECTIVE Do patients with severe psoriasis have larger epicardial adipose tissue volumes (EAT-V) that are associated with cardiovascular risk? METHODS For this cross-sectional study, we recruited dermatology patients with severe psoriasis and control patients without psoriasis or rheumatologic disease themselves or in a first-degree relative. Participants aged 34 to 55 years without known coronary artery disease or diabetes mellitus underwent computed tomography (CT); EAT-V was obtained from noncontrast CT heart images. RESULTS Twenty-five patients with psoriasis (14 men, 11 women) and 16 controls (5 men, 11 women) participated. Groups had no statistical difference in age, body mass index, various cardiovascular risk factors (except high-sensitivity C-reactive protein in men), CT-determined coronary artery calcium scores or plaque, or family history of premature cardiovascular disease. Mean EAT-V was greater in the psoriasis group compared to controls (P = .04). There was no statistically significant difference among women; however, male patients with psoriasis had significantly higher EAT-V than controls (P = .03), even when corrected for elevated high-sensitivity C-reactive protein (P = .05). LIMITATIONS A single-center convenience sample may not be representative. CONCLUSION Males with psoriasis without known coronary disease or diabetes had greater EAT-V than controls. EAT-V may be an early identifier of those at increased risk for cardiovascular events.
Collapse
Affiliation(s)
- Charles N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen J Neville
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mohamed Sayyouh
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rajan P Nair
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tianwen Ma
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Prachi P Agarwal
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan.
| |
Collapse
|
10
|
Atherosclerosis attacks in patients with psoriasis vulgaris but without a relationship with the severity and course of the disease. Postepy Dermatol Alergol 2021; 38:673-681. [PMID: 34658712 PMCID: PMC8501432 DOI: 10.5114/ada.2021.108908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction In recent years numerous research studies have indicated that chronic inflammation in psoriasis can be associated with an increased risk of developing atherosclerosis. Aim The presented study was aimed at demonstrating whether patients suffering from psoriasis vulgaris are at a greater risk of developing atherosclerosis depending on the presence of selected cardiovascular risk factors and the course and severity of the disease. Material and methods Sixty-two patients with diagnosed psoriasis vulgaris and 42 healthy volunteers were included in the study. All the patients underwent carotid ultrasound with the assessment of the common carotid artery intima-media thickness (IMT) and the computed tomography with determination of coronary artery calcification (CAC). Results The IMT was significantly higher in the study group (1.030 ±0.303 mm vs. 0.838 ±0.151 mm, p < 0.0001). We also found a significantly increased severity of Calcium Score (CS) in Agatston units (168.20 ±309.63 vs. 24.52 ±43.21, p = 0.0207) of CAC in patients with psoriasis. There was no significant correlation between the degree of atherosclerosis and psoriasis severity determined in the PASI (Psoriasis Area and Severity Index) scale, duration of the disease, number of exacerbations per year or C-reactive protein values. Conclusions The study showed an increased risk of developing atherosclerosis in patients diagnosed with psoriasis vulgaris, but no correlation was found between the degree of atherosclerosis and the severity of the disease.
Collapse
|
11
|
Bilim S, Içağasioğlu A, Akbal A, Kasapoğlu E, Gürsel S. Assessment of subclinical atherosclerosis with ankle-brachial index in psoriatic arthritis: A case-control study. Arch Rheumatol 2021; 36:210-218. [PMID: 34527925 PMCID: PMC8418778 DOI: 10.46497/archrheumatol.2021.8083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/11/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to evaluate subclinical atherosclerosis using the Ankle-Brachial Index (ABI) in patients with psoriatic arthritis (PsA). Patients and methods This case-control study included 51 PsA patients (24 males, 27 females; median age 47; range, 41 to 52 years) recruited at our hospital's outpatient clinics between October 2016 and January 2017 and 50 healthy controls (24 males, 26 females; median age: 48.5; range, 40.7 to 56 years). Anthropomorphic measurements and laboratory results were recorded. In patients, the 66 swollen/68 tender joints count, dactylitis score, Leeds Enthesitis Index, Health-related Quality of Life, the Psoriasis Area and Severity Index, and Dermatology Life Quality Index were evaluated. Ankylosing Spondylitis Quality of Life and Bath Ankylosing Spondylitis Disease Activity Index were applied to patients with axial disease. Then, Composite Psoriatic Disease Activity Index was determined. A Doppler probe and a standard blood pressure cuff were used to calculate the ABI values for each participant. Results Patients had lower right ABI (median, 1.05 vs. 1.1, p<0.01), lower left ABI (1.04 vs. 1.09, p<0.01) and lower overall ABI (1.03 vs. 1.09, p<0.01) compared with healthy subjects. Twelve (23.5%) patients had borderline ABI, but none of the controls (p<0.01). Patients with borderline ABI had a longer duration of psoriasis (25 vs. 15 years, p=0.03). The distribution of borderline ABI value was statistically significant between patients with axial disease and peripheral disease only (42.1% vs. 12.5%, p=0.02). Disease activity was found as an independent risk factor for borderline ABI in a binary logistic regression (odds ratio 6.306, 95% confidence interval 1.185 to 33.561, p=0.031). Conclusion Lower ABI was found in PsA patients than healthy controls even in those matched with traditional cardiovascular risk factors. All participants with borderline ABI were in the patient group. Borderline ABI was associated with disease activity and disease duration.
Collapse
Affiliation(s)
- Serhad Bilim
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Afitap Içağasioğlu
- Department of Physical Medicine and Rehabilitation, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Ayla Akbal
- Department of Physiotherapy and Rehabilitation, Istanbul Bilim University, Istanbul, Turkey
| | - Esen Kasapoğlu
- Department of Internal Medicine, Division of Romatology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Sıdıka Gürsel
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
12
|
Jamil M, Aslam R, Patel A, Nadir B, Khan S. Prevalence and Extent of Subclinical Atherosclerosis and Associated Cardiovascular Risk Factors in Adult Patients With Psoriatic Arthritis: A Systematic Review. Cureus 2021; 13:e16853. [PMID: 34513433 PMCID: PMC8412334 DOI: 10.7759/cureus.16853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/03/2021] [Indexed: 01/15/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory condition affecting a considerable proportion of psoriasis (PSO) patients and a small segment of the general population. Recent studies have shown that patients with PsA are prone to premature atherosclerosis and are at an increased risk of cardiovascular disease (CVD) events, but the extent and prevalence of this are unknown. Our objective was to evaluate the prevalence and extent of subclinical atherosclerosis by measuring the intima-media thickness (IMT) of arteries in adult patients with PsA, as well as identify cardiovascular (CV) risk factors associated with PsA. An extensive literature search was conducted using PubMed as our main database. The articles exploring the association between PsA and subclinical atherosclerosis were included. We also searched other databases like MEDLINE and PubMed Central (PMC). A total of 2,561 studies published between 2005-2021 were obtained by searching the databases, and after the screening process, a total of nine studies were included for review and an additional 22 studies for comparison and backup evidence. As for results, our review included a total of 542 patients with PsA from nine different studies. All the reviewed studies showed a significant association between subclinical atherosclerosis and PsA, as endothelial functions were found to be impaired in PsA patients as deduced by measuring the carotid intima-media thickness (CIMT). PsA patients exhibited greater IMT than healthy controls. Increased IMT independently correlated with parameters of disease activity and conventional risk factors of atherosclerosis. An increased prevalence of CV risk factors such as hypertension, diabetes, obesity, and metabolic syndrome was also found in PsA patients.
Collapse
Affiliation(s)
- Maria Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Reema Aslam
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aanal Patel
- Hepatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bakhtawar Nadir
- Neurological Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
13
|
Su X, Zhang G, Cheng Y, Wang B. New insights into the emerging effects of inflammatory response on HDL particles structure and function. Mol Biol Rep 2021; 48:5723-5733. [PMID: 34319542 DOI: 10.1007/s11033-021-06553-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
According to the increasing results, it has been well-demonstrated that the chronic inflammatory response, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease are associated with an increased risk of atherosclerotic cardiovascular disease. The mechanism whereby inflammatory response up-regulates the risk of cardio-metabolic disorder disease is multifactorial; furthermore, the alterations in high density lipoprotein (HDL) structure and function which occur under the inflammatory response could play an important modulatory function. On the other hand, the serum concentrations of HDL cholesterol (HDL-C) have been shown to be reduced significantly under inflammatory status with remarked alterations in HDL particles. Nevertheless, the potential mechanism whereby the inflammatory response reduces serum HDL-C levels is not simply defined but reduces apolipoprotein A1 production. The alterations in HDL structure mediated by the inflammatory response has been also confirmed to decrease the ability of HDL particle to play an important role in reverse cholesterol transport and protect the LDL particles from oxidation. Recently, it has been shown that under the inflammatory condition, diverse alterations in HDL structure could be observed which lead to changes in HDL function. In the current review, the emerging effects of inflammatory response on HDL particles structure and function are well-summarized to elucidate the potential mechanism whereby different inflammatory status modulates the pathogenic development of dyslipidemia.
Collapse
Affiliation(s)
- Xin Su
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Guoming Zhang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China
| | - Ye Cheng
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
| | - Bin Wang
- Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, No. 2999 Jinshan Road, Xiamen, 361000, Fujian, China.
| |
Collapse
|
14
|
Shary N, Kalb RE. Optimizing the Treatment of Moderate-to-Severe Psoriasis in Older Adults. Drugs Aging 2020; 37:715-723. [PMID: 32776216 DOI: 10.1007/s40266-020-00790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psoriasis is a lifelong disease and its prevalence in older adults continues to increase as the population ages. Therefore, it is important for physicians to understand the management of the disease in this population. While the management of psoriasis in older adults is similar to the management of patients below the age of 65 years, there are special considerations when treating older patients. Older patients may have more comorbidities, more immunosuppression, and are often taking additional medications that can interact with those being used to treat psoriasis. Safer and more effective treatment options for psoriasis have been introduced in recent years, particularly injectable biological agents. Unfortunately, older patients with psoriasis are oftentimes underrepresented in the clinical trials for these new medications. Subsequent studies have focused on the safety and efficacy of these medications in older adults. The results of these studies demonstrate that biologic agents are well tolerated in older patients and are more effective in treating psoriasis than conventional systemic therapies. In addition, new small-molecule agents such as apremilast also offer an effective and safe treatment option for older patients with psoriasis. The results of these studies can help guide physicians with incorporating these newer medications into the treatment regimen of older psoriasis patients. Despite the proven safety and efficacy of biologic agents, their frequency of use in elderly patients is still almost half of that in non-elderly patients.
Collapse
Affiliation(s)
- Nico Shary
- Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Robert E Kalb
- Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| |
Collapse
|
15
|
Psoriatic arthritis is associated with myocardial repolarization dysregulation as assessed by the QTc interval and the Tp-e/QTc ratio. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.792850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Cheung T, Ho LM, Chung HY, Lau CS, Tse HF, Yiu KH. Cumulative Rheumatic Inflammation Modulates the Bone-Vascular Axis and Risk of Coronary Calcification. J Am Heart Assoc 2020; 8:e011540. [PMID: 31130038 PMCID: PMC6585350 DOI: 10.1161/jaha.118.011540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Rheumatic diseases are related to both abnormal bone turnover and atherogenesis, but a mechanistic link was missing. Methods and Results We investigated the effect of cumulative rheumatic inflammation (CRI) on risk of coronary calcification in a retrospective cohort of 145 rheumatoid arthritis patients. A time‐adjusted aggregate CRI score was derived by conglomerating all quarterly biomarker encounters of serum C‐reactive protein over 60 months immediately preceding computed tomography coronary angiography. Flow cytometry was performed to measure the osteocalcin‐positive (OCN+) CD34+KDR+ and OCN+CD34+ circulating endothelial progenitor cells (EPCs). Conventional early circulating EPCs CD34+CD133+KDR+ was determined. Coronary calcification was defined as any Agatston score >0. 50% of patients (n=72/145) had coronary calcification. CRI score was associated with presence of coronary calcification (P=0.004) (multivariable‐adjusted: highest versus lowest quartile: odds ratio=5.6 [95% CI 1.1–28.9], P=0.041). Receiver operating characteristics curve revealed divergent behavior of OCN‐expressing circulating EPCs (OCN+CD34+EPCs: area under the curve=0.60, P=0.034; OCN+CD34+KDR+EPCs: area under the curve=0.59, P=0.053, positive predictors) versus conventional early EPCs (CD34+CD133+KDR+: area under the curve=0.60, P=0.034, negative predictor) for coronary calcification, which persisted after multivariable adjustments (OCN+CD34+KDR+ [>75th percentile]: odds ratio=7.2 [95% CI 1.8–27.9], P=0.005; OCN+CD34+EPCs [>75th percentile]: odds ratio=6.0 [95% CI 1.5–23.3], P=0.010; CD34+CD133+KDR+ [>75th percentile: odds ratio=0.3 [95% CI 0.1–1.0], P=0.053). Intriguingly, the CRI score was associated with increased OCN+CD34+EPCs (highest versus lowest quartile: B=+25.6 [95% CI 0.8–50.5] [×103/mL peripheral blood], P=0.043), but reduced CD34+CD133+KDR+EPCs (highest versus lowest quartile: B=−16.2 [95% CI −31.5 to −0.9], P=0.038). Conclusions Preceding 60 months of CRI is associated with increased risk of coronary calcification and altered OCN expression in circulating EPCs.
Collapse
Affiliation(s)
- Yap-Hang Chan
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Michael Cheong Ngai
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Yan Chen
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
| | - Mei-Zhen Wu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Yu-Juan Yu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Zhe Zhen
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Kevin Lai
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Tommy Cheung
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Lai-Ming Ho
- 4 School of Public Health The University of Hong Kong Hong Kong
| | - Ho-Yin Chung
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Chak-Sing Lau
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Hung-Fat Tse
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
| | - Kai-Hang Yiu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
| |
Collapse
|
17
|
Niknezhad N, Haghighatkhah HR, Zargari O, Ghalamkarpour F, Younespour S, Niknejad N, Alikhan A, Abdollahimajd F. High-sensitivity C-reactive protein as a biomarker in detecting subclinical atherosclerosis in psoriasis. Dermatol Ther 2020; 33:e13628. [PMID: 32431027 DOI: 10.1111/dth.13628] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 01/04/2023]
Abstract
Psoriasis is known to be associated with increased risk of cardiovascular diseases. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and an independent risk factor for atherosclerosis. We aimed to assess the correlation between hs-CRP and subclinical atherosclerosis in psoriatic patients. In 60 patients with moderate to severe psoriasis and 60 age- and gender matched healthy controls, we evaluated the serum hs-CRP level and mean intima-media thickness of the common carotid artery (MIMT-CCA). Psoriatic patients had higher levels of hs-CRP (median, 2.25 mg/L; IQR, 0.98-3.80; and range, 0.29-11.60) than did those in the control group (median, 1.03 mg/L; IQR, 0.36-2.15; and range, 0.10-3.35). Psoriatic patients also had higher mean MIMT (0.74 ± 0.19 and 0.54 ± 0.12, respectively, and P < .0001) compared with healthy subjects. The serum level of hs-CRP was significantly correlated with MIMT (P < .0001). Our results indicate that psoriatic patients have a higher risk of subclinical atherosclerosis and hs-CRP may be a useful marker for future risk of cardiovascular diseases in these patients. So, not only does anti-inflammatory drugs play a key role in the treatment of psoriasis, but also they may reduce the risk of cardiovascular diseases by decreasing level of inflammatory markers including hs-CRP.
Collapse
Affiliation(s)
- Nasim Niknezhad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Haghighatkhah
- Department of Radiology and Medical Imaging Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Zargari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghalamkarpour
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nakisa Niknejad
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Alikhan
- Department of Dermatology, Sutter Health, Sacramento, California, USA
| | - Fahimeh Abdollahimajd
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Kaiser H, Abdulla J, Henningsen KMA, Skov L, Hansen PR. Coronary Artery Disease Assessed by Computed Tomography in Patients with Psoriasis: A Systematic Review and Meta-Analysis. Dermatology 2019; 235:478-487. [PMID: 31480039 DOI: 10.1159/000502138] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with psoriasis have an increased risk of coronary artery disease (CAD) but data on coronary calcium score (CCS) and cardiac computed tomography angiography (CCTA) are inconsistent. OBJECTIVES The present study quantitatively summarizes the literature data on the prevalence and burden of CAD in patients with psoriasis compared with controls using CCS and CCTA. METHODS A systematic review and meta-analysis was conducted. The search included all studies examining CAD prevalence and burden detected by CCS with or without CCTA in patients with psoriasis without prior CAD compared with controls, between the year 2000 and May 30, 2018. RESULTS Fourteen eligible studies provided data on 1,427 patients with psoriasis and 9,670 controls. Pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in psoriasis patients versus controls. Meta-analysis of the prevalence and burden of CCS showed that patients with psoriasis had an increased risk of CAD (RR 1.14, 95% CI 1.04-1.26; p = 0.004), and for more severe CAD (CCS >100) the risk was further increased (RR 1.71, 95% CI 1.28-2.30; p < 0.001) compared with controls. Weighted mean difference for CCS was significantly higher in patients with psoriasis (12.74, 95% CI 10.70-14.78; p < 0.001). The risk of high-risk coronary plaques identified by CCTA was also significantly higher in psoriasis patients compared with controls (RR 1.77, 95% CI 1.37-2.28; p < 0.001). CONCLUSIONS Patients with psoriasis have a higher prevalence of subclinical CAD, a higher burden of the disease, and more high-risk coronary plaques compared with controls without psoriasis.
Collapse
Affiliation(s)
- Hannah Kaiser
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark,
| | - Jawdat Abdulla
- Department of Medicine, Section of Cardiology, Glostrup University Hospital, Glostrup, Denmark
| | | | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Arnone M, Takahashi MDF, Carvalho AVED, Bernardo WM, Bressan AL, Ramos AMC, Terena AC, Souza CDS, Nunes DH, Bortoletto MCDC, Oliveira MDFSPD, Neffá JM, Fieri LC, Azulay-Abulafia L, Felix PAO, Magalhaes RF, Romiti R, Jaime TJ. Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:76-107. [PMID: 31166402 PMCID: PMC6544036 DOI: 10.1590/abd1806-4841.2019940211] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian
population. The most common clinical manifestations are erythematous, scaling
lesions that affect both genders and can occur on any anatomical site,
preferentially involving the knees, elbows, scalp and genitals. Besides the
impact on the quality of life, the systemic nature of the disease makes
psoriasis an independent risk factor for cardiovascular disease, especially in
young patients with severe disease. By an initiative of the Brazilian Society of
Dermatology, dermatologists with renowned clinical experience in the management
of psoriasis were invited to form a work group that, in a partnership with the
Brazilian Medical Association, dedicated themselves to create the Plaque
Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the
diagnosis (evaluation of severity and comorbidities) and treatment of plaque
psoriasis were defined. The issues generated a search strategy in the
Medline-PubMed database up to July 2018. Subsequently, the answers to the
questions of the recommendations were devised, and each reference selected
presented the respective level of recommendation and strength of scientific
evidence. The final recommendations for making up the final text were worded by
the coordinators.
Collapse
Affiliation(s)
- Marcelo Arnone
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Wanderley Marques Bernardo
- Center of Development of Medical Education, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aline Lopes Bressan
- Service of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andrea Machado Coelho Ramos
- Service of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Cacilda da Silva Souza
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Holthausen Nunes
- Service of Dermatology, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | - Jane Marcy Neffá
- Department of Medicine, Dermatology Clinic, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | - Luna Azulay-Abulafia
- Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Renata Ferreira Magalhaes
- Department of Internal Medicine, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ricardo Romiti
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
20
|
Evaluation of ventricular repolarization features with novel electrocardiographic parameters (Tp-e, Tp-e/QT) in patients with psoriasis. Anatol J Cardiol 2019; 18:397-401. [PMID: 29256874 PMCID: PMC6282903 DOI: 10.14744/anatoljcardiol.2017.7901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Psoriasis is a chronic inflammatory disorder, which affects around 1%–3% of the human population worldwide. Cardiovascular events are the leading cause of morbidity and mortality in patients with psoriasis. Some studies have reported that psoriasis is related to increased arrhythmias. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with psoriasis using Tp-e interval and Tp-e/QT ratio. Methods: The study population consisted of 74 patients with psoriasis and 74 healthy volunteers. The diagnosis of psoriasis was based on a clinical or histopathological examination of all patients. QT interval, corrected QT (QTc), QT dispersion (QTd), Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. Results: According to the electrocardiographic parameters, QT and QTc intervals and QTd were significantly higher in patients with psoriasis than in control subjects (p<0.001; p<0.001; p=0.014; respectively). The Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in patients with psoriasis than in control subjects [93±13 milliseconds (ms) vs. 98±14 ms, p=0.040; 104±17 ms vs. 111±17 ms, p=0.008; 0.23±0.03 vs. 0.25±0.03, p<0.001; respectively]. Additionally, the CRP value was an independent predictor of an increased Tp-e/QT ratio (β=0.537, p< 0.001). Conclusion: Our study revealed that ventricular repolarization features were impaired in patients with psoriasis. Therefore, these patients should be more closely screened for ventricular arrhythmias.
Collapse
|
21
|
Sabry HH, Sabry JH, Daifalla AEH, Akl EM, Hamed AM, Torky AAA. Serum markers for asymptomatic atherosclerosis in Egyptian psoriatic patients: study controlled by Doppler estimation of carotid intima-media thickness. Vasc Health Risk Manag 2018; 14:145-152. [PMID: 30022835 PMCID: PMC6042496 DOI: 10.2147/vhrm.s164274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The aim of the study was to measure serum levels of endocan, myeloperoxidase (MPO), pentraxin 3 (PTX3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in psoriatic patients and to study their correlations with carotid intima-media thickness (CIMT) in trial to evaluate predictability of these parameters in diagnosing asymptomatic atherosclerosis (AAS). Patients and methods Seventy-five psoriasis patients and 75 control subjects underwent complete clinical examination and Doppler estimation of CIMT using thickness of 0.9 mm as cutoff point for diagnosis of AAS. Blood samples were collected for determination of fasting blood glucose, lipid profile and serum C-reactive protein (CRP), endocan, MPO, PTX3 and 1,25(OH)2D3. Results Estimated blood low-density lipoprotein cholesterol (LDL-c) and serum CRP, PTX3, MPO and endocan levels were significantly higher, while blood high-density lipoprotein cholesterol (HDL-c) and serum 1,25(OH)2D3 levels were significantly lower in patients than in controls. CIMT showed significant positive correlation with disease severity and duration; patients’ age; and endocan, MPO, LDL-c, PTX3 and CRP levels, and significant negative correlation with HDL-c and 1,25(OH)2D3 levels. Regression analysis defined high serum endocan and MPO, low serum 1,25(OH)2D3 and increased disease severity as significant predictors of high CIMT. Conclusion Elevated serum levels of endocan and MPO and low 1,25(OH)2D3 levels may underlie the development of psoriasis-related cardiac manifestations. Elevated serum endocan and low 1,25(OH)2D3 levels could be used as early predictors of increased CIMT, which is a pathognomonic feature of AAS.
Collapse
Affiliation(s)
- Hanan Hassan Sabry
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt,
| | - Jehan Hassan Sabry
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Aliaa El Husseiny Daifalla
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt,
| | - Essam Mohamed Akl
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt,
| | - Ahmed Mohamed Hamed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt,
| | | |
Collapse
|
22
|
Interleukin 17, inflammation, and cardiovascular risk in patients with psoriasis. J Am Acad Dermatol 2018; 79:345-352. [PMID: 29477740 DOI: 10.1016/j.jaad.2018.02.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/23/2022]
Abstract
In addition to being recognized as a chronic inflammatory disease that manifests in the skin, psoriasis is increasingly understood to be a systemic disease that causes immune dysregulation throughout the body. The systemic nature of psoriasis is evidenced by the higher burden of comorbidities and shorter life expectancies of patients with psoriasis, particularly those with early-onset and severe disease. Notably, psoriasis is associated with an increased risk for cardiovascular disease, which is the most common cause of morbidity and mortality in patients with psoriasis. In this review, we examine the association between psoriasis and cardiovascular disease and specifically focus on the role of interleukin 17-mediated inflammation as a potential mechanistic link between psoriasis and cardiovascular disease. Moreover, we describe potential treatment approaches to reduce the burden of cardiovascular disease in patients with psoriasis and discuss the clinical importance of the association of these 2 diseases with respect to patient management and education.
Collapse
|
23
|
Jindal S, Jindal N. Psoriasis and Cardiovascular Diseases: A Literature Review to Determine the Causal Relationship. Cureus 2018; 10:e2195. [PMID: 29662733 PMCID: PMC5898839 DOI: 10.7759/cureus.2195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Psoriasis is a chronic, complex autoimmune disease characterized by erythematous, scaly patches over extensor aspects of skin and is associated with joint involvement in about one-third of patients. An association between psoriasis and cardiovascular diseases (CVD) has been a topic of dilemma, and many studies have shown an increased risk of cardiovascular morbidity in patients with psoriasis. There is increasing evidence that psoriasis is associated with higher risk of CVD and increased prevalence of cardiovascular risk factors, as compared with the general population. We provide an extensive review of the literature and adhere to Gordis guidelines to show a positive association between psoriasis and cardiovascular events.
Collapse
Affiliation(s)
- Shanu Jindal
- Public Health Education, University of North Carolina-Greensboro
| | - Nitin Jindal
- James K. Elrod Department of Health Administration, Louisiana State University, Shreveport, LA
| |
Collapse
|
24
|
Eder L, Harvey P, Chandran V, Rosen CF, Dutz J, Elder JT, Rahman P, Ritchlin CT, Rohekar S, Hayday R, Barac S, Feld J, Zisman D, Gladman DD. Gaps in Diagnosis and Treatment of Cardiovascular Risk Factors in Patients with Psoriatic Disease: An International Multicenter Study. J Rheumatol 2018; 45:378-384. [PMID: 29419462 DOI: 10.3899/jrheum.170379] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We aimed to estimate the proportion of underdiagnosis and undertreatment of cardiovascular risk factors (CVRF) in an international multicenter cohort of patients with psoriasis and psoriatic arthritis (PsA). METHODS A cross-sectional analysis was conducted of patients with psoriatic disease from the International Psoriasis and Arthritis Research Team cohort. The presence of modifiable CVRF [diabetes, hypertension (HTN), dyslipidemia, smoking, elevated body mass index, and central obesity] and the use of appropriate therapies for HTN and dyslipidemia were determined. The 10-year CV risk was calculated according to the Framingham Risk Score. Physician adherence with guidelines for the treatment of dyslipidemia and HTN was assessed. Regression analysis was used to assess predictors of undertreatment of HTN and dyslipidemia. RESULTS A total of 2254 patients (58.9% PsA, 41.1% psoriasis) from 8 centers in Canada, the United States, and Israel were included. Their mean age was 52 ± 13.8 years and 53% were men. Of the patients, 87.6% had at least 1 modifiable CVRF, 45.1% had HTN, 49.4% dyslipidemia, 13.3% diabetes, 75.3% were overweight or obese, 54.3% central obesity, and 17.3% were current smokers. We found 59.2% of patients with HTN and 65.6% of patients with dyslipidemia were undertreated. Undertreatment was associated with younger age (≤ 50 yrs), having psoriasis, and male sex. CONCLUSION In real-world settings, a large proportion of patients with psoriasis and PsA were underdiagnosed and undertreated for HTN and dyslipidemia. Strategies to improve the management of CVRF in psoriatic patients are warranted.
Collapse
Affiliation(s)
- Lihi Eder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel. .,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
| | - Paula Harvey
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Vinod Chandran
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Cheryl F Rosen
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Jan Dutz
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - James T Elder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Proton Rahman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Christopher T Ritchlin
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Sherry Rohekar
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Richard Hayday
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Snezana Barac
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Joy Feld
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Devy Zisman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Dafna D Gladman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| |
Collapse
|
25
|
Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci 2017; 19:ijms19010058. [PMID: 29295598 PMCID: PMC5796008 DOI: 10.3390/ijms19010058] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
There is solid epidemiologic evidence linking psoriasis and psoriatic arthritis (PsA) to cardiovascular risk factors and an increased risk of developing cardiovascular disease. Chronic inflammation, with shared pathways and cytokines common to metabolic syndrome, atherosclerosis and psoriasis, might provide the basis for the cardiovascular and metabolic comorbidities of psoriasis and PsA. The purpose of this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of cardiovascular risk factors and cardiovascular disease in patients with psoriasis and/or PsA; the use of analytical determinations, physiologic measures and imaging techniques as surrogate biomarkers of atherosclerosis, endothelial dysfunction and cardiovascular disease in these patients; and the epidemiological and clinical data, including results of clinical trials, supporting a cardioprotective role of anti-inflammatory and disease-modifying treatment in psoriasis and PsA.
Collapse
|
26
|
Honma M, Shibuya T, Iwasaki T, Iinuma S, Takahashi N, Kishibe M, Minami-Hori M, Ishida-Yamamoto A. Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases. J Dermatol 2017; 44:1122-1128. [PMID: 28464401 DOI: 10.1111/1346-8138.13895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
Psoriasis is a multifactorial inflammatory disorder, in which the inflammation affects not only the skin but also the other internal organs, and can induce cardiovascular and cerebrovascular involvements. However, few predictive factors of cardiovascular diseases have been clarified in patients with psoriasis. This study was performed to verify whether diagonal earlobe creases (ELC) can reflect the hidden comorbidities in Japanese psoriatic patients. Prevalence and subtypes of ELC were analyzed in patients with psoriatic and with non-psoriatic skin diseases, and the correlation with coronary artery calcification (CAC) or fatty liver (FL) detected by computed tomography. Prevalence of CAC was approximately twice higher than data of a Japanese resident-based study previously reported. Generally, prevalence of ELC in a psoriatic group and mean age of psoriatic groups accompanied by ELC were higher and younger than those of a non-psoriatic skin disease group, respectively. Statistically significant differences were detected in the mean age of total or male subjects accompanied by bilateral ELC with complete and incomplete length. Bilateralism of ELC was closely correlated with prevalence of CAC and CAC on multiple branches in psoriatic patients (P = 6.6e-6 and odds ratio [OR] = 14.1, P = 0.00884 and OR = 10.7, respectively), but not with that of FL. On the contrary, body mass index of more than 25 was closely correlated with prevalence of FL, but not that of CAC. Comorbidities of psoriatic patients are frequently unnoticed. ELC, an apparatus-related feature, can be a useful predictive factor for hidden coronary artery involvements in psoriatic patients.
Collapse
Affiliation(s)
- Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Takashi Shibuya
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Takeshi Iwasaki
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Shin Iinuma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | | | - Mari Kishibe
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Masako Minami-Hori
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | | |
Collapse
|
27
|
Doumas M, Katsiki N, Papademetriou V. Psoriasis and Cardiovascular Disease: Two Sides of the Same Coin? Angiology 2017; 69:5-9. [PMID: 28401789 DOI: 10.1177/0003319717702303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Michael Doumas
- 1 Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.,2 VAMC and George Washington University, Washington, DC, USA
| | - Niki Katsiki
- 1 Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Vasilios Papademetriou
- 1 Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.,3 VAMC and Georgetown University, Washington, DC, USA
| |
Collapse
|
28
|
C K, M E, G K, O K, Ag E, Th E, Gi K, T D, T K, E B. The Relationship between Lichen Planus and Carotid Intima Media Thickness. ACTA CARDIOLOGICA SINICA 2016; 32:738-743. [PMID: 27899862 DOI: 10.6515/acs20160224a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Lichen planus (LP) is a chronic inflammatory disease. Although the association between chronic inflammation and subclinical atherosclerosis has been reported in the literature, the relationship between LP and carotid intima media thickness (CIMT) has not been previously investigated. The aim of this study was to investigate the relationship between LP and CIMT. METHODS One hundred eleven LP patients and 105 controls were enrolled in the study. Then, CIMT examination was performed with an ultrasonography device. Cross-sectional associations of LP with CIMT were analyzed using linear regression models adjusted for related confounders. RESULTS No statistical difference was found between LP and the controls except for the female gender, white blood cell, LDL cholesterol and triglycerides (p = 0.046, p = 0.019, p = 0.011 and p = 0.013, respectively). Significant difference was found between the groups in terms of CIMT (0.90 ± 0.2 mm vs. 0.61 ± 0.3 mm, p = 0.001). CIMT was correlated with longevity of the LP, but we did not find LP to be an independent predictor of increased CIMT in logistic regression analysis (r = 0.449, p < 0.001, β = -0.117, p = 0.092; respectively). CONCLUSIONS The results of our study suggested that LP was associated with increased mean CIMT, and furthermore that CIMT was correlated with longevity of LP. However, LP was not an independent predictor of increased CIMT.
Collapse
Affiliation(s)
- Koseoglu C
- Deparment of Cardiology, Ankara Training and Research Hospital
| | - Erdogan M
- Department of Cardiology, Ataturk Training and Research Hospital
| | - Koseoglu G
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara
| | - Kurmus O
- Department of Cardiology, Tarsus State Hospital, Mersin
| | - Ertem Ag
- Department of Cardiology, Ataturk Training and Research Hospital
| | | | - Kurmus Gi
- Department of Dermatology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Durmaz T
- Department of Cardiology, Ataturk Training and Research Hospital
| | - Keles T
- Department of Cardiology, Ataturk Training and Research Hospital
| | - Bozkurt E
- Department of Cardiology, Ataturk Training and Research Hospital
| |
Collapse
|
29
|
Bissonnette R, Cademartiti F, Maffei E, Tardif JC. Increase in coronary atherosclerosis severity and the prevalence of coronary artery mixed plaques in patients with psoriasis. Br J Dermatol 2016; 176:800-802. [PMID: 27291937 DOI: 10.1111/bjd.14797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R Bissonnette
- Department of Dermatology, Innovaderm Research Inc., 1851 Sherbrooke St East, Suite 502, Montreal, QC, H2K 4L5, Canada
| | - F Cademartiti
- Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - E Maffei
- Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - J-C Tardif
- Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Studies have shown that chronic inflammatory disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and psoriasis are associated with an increased risk of atherosclerotic cardiovascular disease. The mechanism by which inflammation increases cardiovascular disease is likely multifactorial but changes in HDL structure and function that occur during inflammation could play a role. RECENT FINDINGS HDL levels decrease with inflammation and there are marked changes in HDL-associated proteins. Serum amyloid A markedly increases whereas apolipoprotein A-I, lecithin:cholesterol acyltransferase, cholesterol ester transfer protein, paraoxonase 1, and apolipoprotein M decrease. The exact mechanism by which inflammation decreases HDL levels is not defined but decreases in apolipoprotein A-I production, increases in serum amyloid A, increases in endothelial lipase and secretory phospholipase A2 activity, and decreases in lecithin:cholesterol acyltransferase activity could all contribute. The changes in HDL induced by inflammation reduce the ability of HDL to participate in reverse cholesterol transport and protect LDL from oxidation. SUMMARY During inflammation multiple changes in HDL structure occur leading to alterations in HDL function. In the short term, these changes may be beneficial resulting in an increase in cholesterol in peripheral cells to improve host defense and repair but over the long term these changes may increase the risk of atherosclerosis.
Collapse
Affiliation(s)
- Kenneth R Feingold
- Metabolism Section, Department of Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA
| | | |
Collapse
|
31
|
Yayla Ç, Gayretli Yayla K, Ünal S, Açar B, Ertem AG, Akboga MK, Kirbaş Ö. Disease Duration and Inflammation in Psoriasis. Angiology 2016; 68:271-272. [PMID: 27568386 DOI: 10.1177/0003319716665045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Çağri Yayla
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- 2 Department of Cardiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sefa Ünal
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Burak Açar
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ahmet Goktuğ Ertem
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mehmet Kadri Akboga
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Özgür Kirbaş
- 1 Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
32
|
Santilli S, Kast DR, Grozdev I, Cao L, Feig RL, Golden JB, Debanne SM, Gilkeson RC, Orringer CE, McCormick TS, Ward NL, Cooper KD, Korman NJ. 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. J Transl Med 2016; 14:217. [PMID: 27448600 PMCID: PMC4957305 DOI: 10.1186/s12967-016-0947-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/17/2016] [Indexed: 02/08/2023] Open
Abstract
Background Psoriasis 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. Methods We 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. Results 296 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. Conclusions A 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 material The online version of this article (doi:10.1186/s12967-016-0947-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S Santilli
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - D R Kast
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - I Grozdev
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - L Cao
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - R L Feig
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - J B Golden
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,Department of Pathology, Case Western Reserve University, Cleveland, USA
| | - S M Debanne
- Center For Clinical Investigation, Case Western Reserve University, Cleveland, USA.,Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, USA
| | - R C Gilkeson
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - C E Orringer
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,University of Miami, Miller School of Medicine, Miami, FL, 33125, USA
| | - T S McCormick
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA. .,The Murdough Family Center for Psoriasis, Cleveland, USA.
| | - N L Ward
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| | - K D Cooper
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA.,Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - N J Korman
- Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.,The Murdough Family Center for Psoriasis, Cleveland, USA
| |
Collapse
|
33
|
Abstract
The association between psoriasis and carotid intima-media thickness (CIMT) or impaired flow-mediated dilation (FMD) remains controversial. We aimed to evaluate the extent of subclinical atherosclerosis as measured by CIMT and FMD in patients with psoriasis by conducting a meta-analysis.A systematic literature search was performed using PubMed, Embase, Cochrane databases, China National Knowledge Infrastructure, and VIP databases up to February 2015. Observational studies investigating CIMT or FMD in patients with psoriasis and controls were eligible. Psoriatic patients and controls were at least age- and sex-matched. Random-effects analysis was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI) between psoriatic patients and controls.A total of 20 studies were identified and analyzed. Meta-analysis showed that psoriatic patients had a significantly thicker CIMT (WMD 0.11 mm; 95% CI 0.08-0.15) and lower FMD (WMD -2.79%; -4.14% to -1.43%) than those in controls. Subgroup analysis indicated that psoriatic arthritis appeared to have less impaired FMD (WMD -2.45%) and thinner CIMT (WMD 0.10 mm). Psoriatic patients with mean age >45 years had much thicker CIMT (WMD 0.13 mm). The impaired FMD (WMD -3.99%) seemed more pronounced in psoriatic patients with mean age <45 years.This meta-analysis suggests that patients with psoriasis are associated with excessive risk of subclinical atherosclerosis. Screening and monitoring CIMT and brachial artery FMD may be recommended to identify a subgroup of psoriatic patients at higher risk for cardiovascular events.
Collapse
Affiliation(s)
- Na Fang
- From the Institute of Molecular Biology & Translational Medicine, the Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, PR China
| | | | | |
Collapse
|
34
|
Ganzetti G, Campanati A, Molinelli E, Offidani A. Psoriasis, non-alcoholic fatty liver disease, and cardiovascular disease: Three different diseases on a unique background. World J Cardiol 2016; 8:120-131. [PMID: 26981209 PMCID: PMC4766264 DOI: 10.4330/wjc.v8.i2.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/04/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic inflammatory immune-mediated skin disease, frequently associated with systemic comorbidities. According to recent data, patients with psoriasis show a greater prevalence of metabolic syndrome, which confers a higher cardiovascular risk. The link between these pathological conditions appears to be a chronic low-grade inflammatory status. The aim of this review is to focus on the multiple epidemiological and physio-pathogenetic aspects linking non-alcoholic fatty liver disease, psoriasis, and cardiovascular disease.
Collapse
|
35
|
Abstract
Psoriasis is a systemic inflammatory disease that confers significant risk of metabolic derangements and adverse cardiovascular outcomes. Early detection and treatment of modifiable risk factors and modulation of the systemic inflammatory response are important treatment goals. Studies have shown that there is a significant lack of awareness of the relationship between psoriasis and cardiovascular disease, so future considerations should focus on education of and collaboration with health care providers, especially those in primary care, and development of updated, rigorous screening guidelines. In addition, targeted biologic therapies such as TNF-a inhibitors have shown immense promise in targeting the systemic inflammation associated with psoriatic disease, but whether they will impact long-term cardiovascular outcomes remains to be seen.
Collapse
Affiliation(s)
- Kathryn T Shahwan
- Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 240, Boston, MA 02114, USA
| | - Alexa B Kimball
- Clinical Unit for Research Trials and Outcomes in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 240, Boston, MA 02114, USA.
| |
Collapse
|
36
|
Shahidi-Dadras M, Haghighatkhah HR, Abdollahimajd F, Younespour S, Partovi kia M, Zargari O. Correlation between vascular endothelial growth factor and subclinical atherosclerosis in patients with psoriasis. Int J Dermatol 2015; 55:52-9. [DOI: 10.1111/ijd.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/10/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Affiliation(s)
| | - Hamid Reza Haghighatkhah
- Department of Radiology and Medical Imaging Center; Shohada-e Tajrish Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | | | - Shima Younespour
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Masoud Partovi kia
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Omid Zargari
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| |
Collapse
|
37
|
Srivastava RAK, Mistry S, Sharma S. A novel anti-inflammatory natural product from Sphaeranthus indicus inhibits expression of VCAM1 and ICAM1, and slows atherosclerosis progression independent of lipid changes. Nutr Metab (Lond) 2015; 12:20. [PMID: 26064179 PMCID: PMC4462118 DOI: 10.1186/s12986-015-0018-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/29/2015] [Indexed: 11/11/2022] Open
Abstract
A large body of evidence suggests that atherosclerosis is an inflammatory disease, in which cytokines and growth factors play a major role in disease progression. The methanolic extracts of Sphaeranthus indicus as well as its active ingredient, 7-hydroxy frullanoide (7-HF), are shown to suppress LPS-induced cytokine production from mononuclear cells, and inhibit the expression of VCAM1, ICAM1 and E-selectin by TNF-α- stimulated HUVECs in a concentration-dependent manner. We tested the hypothesis that the inhibition of cytokines and adhesion molecules should attenuate the progression of atherosclerosis, independent of changes in the lipid profile. Studies were carried out in two animal models: a high fat-fed LDLr-/- mouse and a high fat-fed hyperlipidemic hamster. Methanolic extract of S. indicus was dosed to hyperlipidemic LDLr-/- at 100 and 300 mg (equivalent to 20 and 60 mg 7-HF)/kg body weight/ day for 8 weeks, and plasma lipids as well as aortic lesion area were quantitated. Hyperlipidemic hamsters were treated with one dose of 200 mg/kg/day. S. indicus extract treatment did not alter the lipid profile in both animal models, but reduced aortic lesion area in LDLr-/- mice and hyperlipidemic hamsters by 22 % and 45 %, respectively. Fenofibrate, included as a reference agent, decreased aortic lesions by 26 % in LDLr -/- mice and 84 % in hyperlipidemic hamsters, respectively, which was driven by massive reductions in proatherogenic lipoproteins. The lipid-independent anti-atherosclerotic activity of S. indicus was associated with the reductions in the circulating levels of MCP-1, TNF-α, and IL-6 via phosphorylation and degradation of IkB-α that prevents translocation of NF-kB in the nucleus to induce proinflammatory cytokines. Our findings demonstrate that anti-inflammatory agents that lower pro-inflammatory proteins inhibit the progression of atherosclerosis. The methanolic extract of S. inducus, currently being used to treat psoriasis, offer promise to benefit individuals who have high circulating pro-inflammatory cytokines, and predisposed to coronary artery disease.
Collapse
Affiliation(s)
- Rai Ajit K Srivastava
- Department of Pharmacology, Piramal Life Sciences Ltd, Mumbai, India ; Present address: Integrated Pharma Solutions, Philadelphia, Department of Pharmacology & Physiology, Drexel University School of Medicine, Philadelphia, USA
| | - Sapna Mistry
- Department of Pharmacology, Piramal Life Sciences Ltd, Mumbai, India ; Present address: BioMarin Pharmaceuticals, Novato, CA USA
| | - Somesh Sharma
- Department of Pharmacology, Piramal Life Sciences Ltd, Mumbai, India
| |
Collapse
|
38
|
Kim SY, Yang HS, Lee YW, Choe YB, Ahn KJ. Evaluation of the Beta Stiffness Index and Carotid Intima–Media Thickness in Asian Patients With Psoriasis. Angiology 2015; 66:889-95. [DOI: 10.1177/0003319714568790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The risk of cardiovascular (CV) events is reportedly elevated in patients with psoriasis. Evaluation of the beta stiffness index (BSI) and carotid intima–media thickness (cIMT) are noninvasive methods of assessing arterial stiffness and subclinical atherosclerosis. We aimed to determine carotid arterial stiffness and cIMT, using high-resolution ultrasonography, in patients with psoriasis compared with controls, and to analyze whether psoriasis is an independent risk factor for atherosclerosis. A total of 54 consecutive patients with psoriasis and 60 age and gender-matched healthy controls were enrolled. Compared with control participants, patients with psoriasis exhibited a significantly higher BSI ( P < .001). The cIMT tended to be higher in patients with psoriasis but statistically not significant ( P = .076). BSI was positively correlated with age, systolic blood pressure, disease severity defined according to history of systemic treatment, and traditional CV risk factors. Also, psoriasis was independently associated with BSI. These findings suggest that psoriasis is an independent risk factor for arterial stiffness, and the BSI is an earlier indicator of atherosclerosis than cIMT in these patients.
Collapse
Affiliation(s)
- Soo Young Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Suk Yang
- Department of Cardiovascular Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Seremet S, Genc B, Tastan A, Akyildiz ZI, Nazli C, Ozcelik S, Afsar FS, Solak A, Emren V. Are all patients with psoriasis at increased risk for coronary artery disease? Int J Dermatol 2014; 54:355-61. [PMID: 25428719 DOI: 10.1111/ijd.12673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Associations have been recently recognized between psoriasis and an increased incidence of atherosclerotic diseases. However, there are scarce data on the prevalence of coronary lesions in patients with psoriasis. The aim of this study was to identify the calcified and non-calcified atherosclerotic coronary lesions in patients with psoriasis compared to controls. Forty patients with psoriasis and 42 control subjects matched for age, sex, and cardiovascular risk profile were included in this case-control study. Coronary lesions were evaluated by a 128-slice dual source multidetector computed tomography scanner. Coronary calcification scoring was calculated according to the Agatston score. The prevalence of atherosclerotic coronary lesions (psoriasis: 15%, controls: 16.7%; P = 0.83) and the mean coronary calcification scoring (psoriasis: 9.9 ± 35.2 Agatston unit, controls 2.8 ± 12.0 Agatston unit; P = 0.81) did not show a significant difference between the two groups. Multivariate analysis identified age ≥48 years and fasting blood glucose ≥99.0 mg/dl as independent predictors of coronary artery disease in patients with psoriasis (F = 30.9; P = 0.001; adjusted R(2) = 0.49). Patients with psoriasis had the same prevalence of calcified and non-calcified atherosclerotic coronary lesions as compared to controls. Our results demonstrated the necessity of considering the age and fasting blood glucose of patients with psoriasis in a decision for further cardiovascular evaluation.
Collapse
Affiliation(s)
- Sila Seremet
- Department of Dermatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Staniak HL, Bittencourt MS, de Souza Santos I, Sharovsky R, Sabbag C, Goulart AC, Lotufo PA, Benseñor IM. Association between psoriasis and coronary calcium score. Atherosclerosis 2014; 237:847-52. [PMID: 25463132 DOI: 10.1016/j.atherosclerosis.2014.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/17/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emerging data suggests that chronic inflammatory disease, such as psoriasis, may be associated to coronary artery disease (CAD). OBJECTIVE Analyze the association between psoriasis and subclinical atherosclerosis using coronary calcium score (CAC). METHODS We investigated 221 participants with psoriasis and 718 age- and sex-matched controls without prior known CAD. All participants completed a questionnaire and underwent laboratory tests and a CAC exam. Logistic regression models adjusted for Framingham risk score (FRS) and C-reactive protein (hs-CRP) were built. CAC was included in the models as a binary variable with different cut off values. RESULTS Body-mass index, race, hypertension, HDL, LDL and hs-CRP were significantly associated with psoriasis presence and severity. Psoriasis severity was significantly associated with CAC (p = 0.04), particularly for very high CAC (>400) (p < 0.01). The OR for severe psoriasis and CAC >400 was 2.45 (95%CI: 1.26-4.75) in unadjusted models. In a model adjusted for the FRS, this association was no longer significant, but a trend was noted (p = 0.09). No significant changes in the association were noted after the inclusion of hs-CRP in the model. CONCLUSION Psoriasis is associated with higher CAC values, mainly in individuals with severe psoriasis. The current findings also suggest the potential involvement of other mechanisms beyond classical cardiovascular risk factors and inflammation in this association.
Collapse
Affiliation(s)
- Henrique L Staniak
- Division of Internal Medicine, Hospital Universitário, University of São Paulo, Brazil; Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Márcio Sommer Bittencourt
- Division of Internal Medicine, Hospital Universitário, University of São Paulo, Brazil; Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Itamar de Souza Santos
- Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Rodolfo Sharovsky
- Division of Internal Medicine, Hospital Universitário, University of São Paulo, Brazil; Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Cid Sabbag
- Postgraduate Student, University of São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiologic Research, Hospital Universitário, University of São Paulo, Brazil.
| |
Collapse
|
41
|
Dinc M, Aydin E, Balta S, Demirkol S, Karaman M. Subclinical inflammation and cardiovascular risk in psoriasis. J Intern Med 2014; 276:195. [PMID: 24372585 DOI: 10.1111/joim.12185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Dinc
- Department of Internal Medicine, Beytepe Military Hospital, Ankara, Turkey
| | | | | | | | | |
Collapse
|
42
|
Pirro M, Stingeni L, Vaudo G, Mannarino MR, Ministrini S, Vonella M, Hansel K, Bagaglia F, Alaeddin A, Lisi P, Mannarino E. Systemic inflammation and imbalance between endothelial injury and repair in patients with psoriasis are associated with preclinical atherosclerosis. Eur J Prev Cardiol 2014; 22:1027-35. [PMID: 24906366 DOI: 10.1177/2047487314538858] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systemic inflammation and imbalance between endothelial injury and repair, the latter referred to as vascular incompetence, are associated with atherosclerosis and cardiovascular risk. Psoriasis, an inflammatory disease of the skin, has been associated with atherosclerosis. We investigated whether, in psoriasis, inflammation and vascular incompetence are associated with carotid intima-media thickness (cIMT) irrespective of metabolic syndrome and other established cardiovascular risk factors. METHODS High sensitivity C-reactive protein (hsCRP), the ratio between endothelial microparticles (EMPs) and progenitors (EPCs), a marker of vascular incompetence, and cIMT were measured in 84 patients with psoriasis and 90 healthy controls, balanced for age, gender and the prevalence of metabolic syndrome. RESULTS Patients with psoriasis had higher hsCRP, EMP/EPC ratio and cIMT than controls. Patients with both psoriasis and metabolic syndrome had the highest hsCRP levels, psoriasis and metabolic syndrome being associated with a 3.1- and 2.6-fold increased risk of having high hsCRP levels, respectively. Logarithm transformed hsCRP and EMP/EPC ratio were predictors of high cIMT (odds ratio 3.8; 95% confidence interval 1.3-11.4; p = 0.02 and odds ratio 8.7; 95% confidence interval 2.7-27.5; p < 0.001, respectively) regardless of confounders. Patients with high hsCRP and EMP/EPC ratio had higher cIMT than those with none or at least one of risk variable. CONCLUSIONS Patients with psoriasis have an increased burden of cardiovascular risk, including inflammation, vascular incompetence and early atherosclerosis. Increased hsCRP levels, possibly sustained by the inflammatory nature of psoriasis and metabolic syndrome, and vascular incompetence are associated with early carotid atherosclerosis, regardless of metabolic syndrome and other established cardiovascular risk factors.
Collapse
Affiliation(s)
- Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Luca Stingeni
- Unit of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Massimo R Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Stefano Ministrini
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Marilisa Vonella
- Unit of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Italy
| | - Katharina Hansel
- Unit of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Italy
| | - Francesco Bagaglia
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Abdalkader Alaeddin
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| | - Paolo Lisi
- Unit of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Italy
| | - Elmo Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Italy
| |
Collapse
|
43
|
Khalid U, Ahlehoff O, Gislason GH, Kristensen SL, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis and risk of heart failure: a nationwide cohort study. Eur J Heart Fail 2014; 16:743-8. [PMID: 24903077 DOI: 10.1002/ejhf.113] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/22/2014] [Accepted: 05/02/2014] [Indexed: 01/09/2023] Open
Abstract
AIMS Psoriasis is a common inflammatory disease that is associated with increased risk of cardiovascular disease, including myocardial infarction. Heart failure (HF) is independently associated with several cardiovascular risk factors and is a major cause of cardiovascular morbidity and mortality. The association between psoriasis and HF is unclear and we therefore investigated the risk of new-onset HF in a nationwide cohort of psoriasis patients compared with the background population. METHODS The study included the entire Danish population aged ≥18 years followed from 1 January 1997 until HF, death or 31 December 2011. Information on comorbidity and concomitant medication was identified by individual-level linkage of administrative registers. New-onset HF was defined as first hospital admission for HF. Incidence rates of new-onset HF were calculated and adjusted hazard ratios were estimated by multivariable Cox regression models adjusted for age, gender, comorbidity and cardiovascular medications. RESULTS A total of 5 485 856 subjects were eligible for analysis. In the study period 66 389 patients with new-onset psoriasis, including 11 242 patients with severe psoriasis, were identified. The overall incidence rates of new-onset HF were 2.82, 4.22 and 4.70 per 1000 person-years for the reference population, mild psoriasis and severe psoriasis, respectively. Compared with the reference population, the fully adjusted hazard ratios for new-onset HF were increased in patients with psoriasis with a hazard ratio 1.22 (95% confidence interval 1.16-1.29) and hazard ratio of 1.53 (95% confidence interval 1.34-1.74) for those with mild and severe disease, respectively. CONCLUSION In this nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of new-onset HF.
Collapse
Affiliation(s)
- Usman Khalid
- Department of Cardiology, Gentofte Hospital University of Copenhagen, Hellerup
| | | | | | | | | | | | | |
Collapse
|
44
|
Eder L, Thavaneswaran A, Chandran V, Cook R, Gladman DD. Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis. Ann Rheum Dis 2014; 74:1830-5. [DOI: 10.1136/annrheumdis-2014-205267] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/19/2014] [Indexed: 01/18/2023]
|
45
|
Torres T, Bettencourt N, Mendonça D, Vasconcelos C, Gama V, Silva BM, Selores M. Epicardial adipose tissue and coronary artery calcification in psoriasis patients. J Eur Acad Dermatol Venereol 2014; 29:270-277. [PMID: 24750319 DOI: 10.1111/jdv.12516] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated disease associated with several cardio-metabolic comorbidities, accelerated atherosclerosis and cardiovascular disease (CVD). Other causes beyond systemic inflammation and traditional cardiovascular risk factors (CVRF) may be implicated in the increased risk of CVD observed in these patients. Epicardial adipose tissue (EAT), a type of visceral adipose tissue surrounding the heart and coronary vessels has been implicated in the development of coronary artery disease, by endocrine mechanisms, but particularly by local inflammation. OBJECTIVE To compare EAT volumes in psoriasis patients and controls using multidetector computed tomography (MDCT) and to analyse if eventual differences were independent from abdominal visceral adiposity; to determine, within psoriasis patients, its relation with subclinical atherosclerosis and other markers of cardiometabolic risk. METHODS One hundred patients with severe psoriasis, without CVD underwent MDCT, with EAT and abdominal visceral fat (AVF) assessment and coronary artery calcification (CAC) quantification and were compared with 202 control patients. RESULTS EAT volume was increased in psoriasis patients compared to control subjects, independently from age, sex and AVF, being, on average, 15.2 ± 4.41 mL higher (95% CI: 6.5-26.0, P = 0.001) than in controls. Moreover, psoriasis patients had a statistically significant higher risk of having subclinical atherosclerosis (OR 2.52, 95% CI: 1.23-5.16) than controls, after adjusting for traditional CVRF. Within psoriasis patients EAT volume was associated with subclinical atherosclerosis, independently of age, sex, psoriasis duration, classical CVRF and AVF. CONCLUSION This study showed that psoriasis was associated with increased EAT volume independently of visceral abdominal fat and with subclinical atherosclerosis. Within psoriasis patients EAT volume was independently associated with CAC. EAT may be another important contributor to the higher cardiovascular risk observed in psoriasis.
Collapse
Affiliation(s)
- T Torres
- Department of Dermatology, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Investigation in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - N Bettencourt
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Porto, Portugal
| | - D Mendonça
- Department of Population Studies, Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - C Vasconcelos
- Unit for Multidisciplinary Investigation in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.,Department of Clinical Immunology, Centro Hospitalar of Porto, Porto, Portugal
| | - V Gama
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Porto, Portugal
| | - B M Silva
- Unit for Multidisciplinary Investigation in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.,Immunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - M Selores
- Department of Dermatology, Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|
46
|
Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
Collapse
Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| |
Collapse
|
47
|
Abstract
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.
Collapse
Affiliation(s)
- Catherine Ni
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| |
Collapse
|
48
|
Imbalzano E, Casale M, D’Angelo M, Mandraffino G, Giugno V, Di Bella G, Carerj S, Dattilo G. Cardiovascular Risk and Psoriasis. Angiology 2014; 66:101-3. [DOI: 10.1177/0003319714527339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Matteo Casale
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Myriam D’Angelo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | - Vincenza Giugno
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| |
Collapse
|
49
|
Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, Le Maître M, Ortonne JP, Paul C, Richard MA. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013; 27 Suppl 3:12-29. [PMID: 23845149 DOI: 10.1111/jdv.12163] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 12/18/2022]
Abstract
UNLABELLED Previous epidemiological studies have demonstrated a high prevalence of cardiovascular (CV) risk factors in psoriasis patients, including metabolic syndrome, cigarette smoking, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidaemia. An increase in CV morbidity and mortality attributable to psoriasis is still under question. PRIMARY OBJECTIVE to assess CV morbidity and mortality in psoriasis and psoriatic arthritis (PsA) including stroke, coronary artery disease, myocardial infarction (MI) and peripheral artery disease. SECONDARY OBJECTIVES to assess if psoriasis per se is an independent CV risk factor and if psoriasis severity is a predictor of CV risk. We also evaluated the effect of conventional systemic treatments for psoriasis on CV mortality. A systematic literature search was carried out from 1980 to December 2011, in the Embase, Medline and Cochrane Library databases, in English and French using a combination of keywords including (Psoriasis) OR (Psoriatic arthritis) AND (Myocardial infarction) OR (Coronaropathy) OR (Stroke) OR (Cardiovascular) AND (Methotrexate) AND (Ciclosporin) AND (Retinoids). Of the 929 identified references, 33 observational studies evaluating the rates of cardiovascular events (CVE) in patients with psoriasis and PsA compared with controls were selected. Meta-analysis of both cohort and cross-sectional studies showed an increased risk of MI with Odds Ratio (OR) of 1.25 (95% CI 1.03-1.52) and 1.57 (95% CI 1.08-2.27) in psoriasis and PsA, respectively, compared with the general population. The risk of MI was more pronounced for patients having severe psoriasis and for patients with psoriasis of early onset. It remained significantly elevated after controlling for major CV risk factors. The meta-analysis identified a small, but significant association between psoriasis, PsA and coronary artery disease with an OR between 1.19 (95% CI 1.14-1.24) for cross-sectional studies, 1.20 (95% CI 1.13-1.27) for cohort studies and 1.84 (95% CI 1.09-3.09) for case-control studies. The risk of coronary artery disease seemed to be more pronounced in patients with severe psoriasis and in patients with psoriasis of early onset. The meta-analysis assessing the risk of stroke gave inconclusive results: analysis of cross-sectional studies suggested that psoriasis patients had a slightly higher risk of stroke with an OR of 1.14 (95% CI 1.08-1.99), whereas the meta-analysis of cohort studies failed to show an association. There was also an increased risk of peripheral artery disease in psoriasis. No significant increased risk of CV mortality could be shown for both psoriasis and PsA patients. The use of methotrexate was associated with a reduced incidence of cardiovascular disease in two studies. The use of etretinate was associated with a reduction of CV mortality in one study. Potential selection bias such as the 'healthy user effect' prevents from drawing definite conclusions. There may be a small, but significant increased risk of CVE, but not of CV mortality in psoriasis and PsA patients. The psoriasis attributable risk remains difficult to assess due to confounding factors. The moderate quality of CV risk factors reporting in studies should be acknowledged. In addition, heterogeneity in study design, outcome definition and assessment represent major limitations. Nevertheless, screening and management of CV risk factors are important in psoriasis.
Collapse
Affiliation(s)
- C Horreau
- Aix-Marseille University, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Shaharyar S, Warraich H, McEvoy JW, Oni E, Ali SS, Karim A, Jamal O, Blaha MJ, Blumenthal RS, Fialkow J, Cury R, Budoff MJ, Agatston AA, Nasir K. Subclinical cardiovascular disease in plaque psoriasis: association or causal link? Atherosclerosis 2013; 232:72-8. [PMID: 24401219 DOI: 10.1016/j.atherosclerosis.2013.10.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psoriasis patients have a high prevalence of cardiovascular events and are thought to have a relative risk increase of 25% as compared to the general population. However, a causal relationship between psoriasis and cardiovascular disease has not been established. We sought to perform a systematic review of existing data regarding the presence of endothelial dysfunction and subclinical atherosclerosis in patients with plaque psoriasis. METHODS A systematic literature search was performed, using Medline database and Ovid SP for relevant literature up to November 2012. Twelve studies met inclusion criteria from an initial search result of 529 articles. RESULTS Among the twelve studies meeting inclusion criteria, two (17%) reported increased mean coronary artery calcification (CAC) in psoriatic patients. Six studies (50%) showed carotid intima-media thickness [CIMT] increase in psoriasis. Five studies (42%) examined flow mediated dilation [FMD], of which three showed decreased FMD in psoriasis patients. One study (8%) each demonstrated a decreased coronary flow reserve and increased arterial stiffness as assessed by pulse wave velocity. CONCLUSIONS Patients with psoriasis have an increased burden of subclinical atherosclerosis and endothelial dysfunction. Patients with greater severity and/or disease duration should be targeted for primary screening for cardiovascular disease risk reduction.
Collapse
Affiliation(s)
- Sameer Shaharyar
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Haider Warraich
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John W McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Ebenezer Oni
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Shozab S Ali
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Adil Karim
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Omar Jamal
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Jonathan Fialkow
- Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA
| | - Ricardo Cury
- Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA; Department of Radiology, Florida International University, Miami, FL, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, UCLA Harbor Medical Center, CA, USA
| | - Arthur A Agatston
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
| |
Collapse
|