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Abbad-Jaime de Aragón C, Berna-Rico E, Ballester-Martinez MA, Jaén P, Solís J, Barderas MG, Fernández-Friera L, N Mehta N, Gelfand JM, González-Cantero Á. Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis (EDSAP): protocol for an observational, single-centre, prospective cohort study. BMJ Open 2023; 13:e072455. [PMID: 37751953 PMCID: PMC10533786 DOI: 10.1136/bmjopen-2023-072455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/16/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Life expectancy of patients with psoriasis is reduced by 4-5 years due to cardiovascular disease with an increased risk of myocardial infarction at an earlier age compared with the general population. This increased risk is independent of traditional cardiovascular risk factors and higher in moderate-to-severe forms of psoriasis. Inflammation may play a key role in the development of atherosclerosis in these patients. METHODS AND ANALYSIS A prospective cohort study, Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis (EDSAP), was initiated in January 2020 to investigate the presence and progression of subclinical atherosclerosis in patients with psoriasis. 120 patients aged 30-65 years and eligible for biological treatment have been recruited at Hospital Ramón y Cajal in Madrid, Spain. Patients undergo a baseline visit, and 1-year follow-up visit after starting biological therapy. Each visit includes: assessment of cardiovascular risk factors, screening for subclinical atherosclerosis by two-dimensional/three-dimensional ultrasound of carotid and femoral arteries, cardiac CT of coronary arteries and blood sampling. All baseline visits were completed by December 2022, and the remaining follow-up visits will be concluded by the end of 2023. The EDSAP study aims to identify new molecular and imaging markers associated with the presence of atherosclerosis and its progression in a chronic inflammatory state such as psoriasis. This has the potential to: (1) help improve primary cardiovascular prevention strategies in these patients; (2) understand the effect of biological drugs on the cardiovascular system; and (3) serve as a model for understanding atherosclerosis in other chronic inflammatory diseases. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Review Board of the Hospital Ramón y Cajal in Madrid. We will present our findings at national and international congresses, and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05858099.
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Affiliation(s)
| | | | | | - Pedro Jaén
- Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Jorge Solís
- Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Cardiology, Atria Clinic, Madrid, Spain
| | - María G Barderas
- Vascular Physiopathology, Hospital Nacional de Parapléjicos, IDISCAM, Toledo, Spain
| | - Leticia Fernández-Friera
- Cardiology, Atria Clinic, Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares HM CIEC, HM Hospitales, Madrid, Spain
| | - Nehal N Mehta
- Cardiology, George Washington Medical Center, Washington, DC, USA
| | - Joel M Gelfand
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Álvaro González-Cantero
- Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Comunidad de Madrid, Spain
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Štšepetova J, Rätsep M, Gerulis O, Jõesaar A, Mikelsaar M, Songisepp E. Impact of Lactiplantibacillus plantarum Inducia on metabolic and antioxidative response in cholesterol and BMI variable indices: randomised, double-blind, placebo-controlled trials. Benef Microbes 2023; 14:1-16. [PMID: 36437811 DOI: 10.3920/bm2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Probiotics may have potential in reducing cardiovascular disease (CVD) risk in middle-aged persons with borderline metabolic indices. The ability of potential probiotic Lactiplantibacillus plantarum Inducia to reduce CVD risk factors in persons with variable cholesterol and body mass indices (BMI) was assessed. In two parallel-armed double-blind placebo-controlled interventions (n=136) and (n=104), participants daily received either test yoghurt (Inducia) or placebo yoghurt. BMI, blood pressure, plasma glucose, cholesterol, high-sensitivity C-reactive protein (hs-CRP), oxidative stress and immunological markers were measured. Total counts of lactobacilli and L. plantarum Inducia were evaluated using real-time PCR. Significant reduction of total cholesterol, low density lipoprotein cholesterol (LDL-c) and non-high-density cholesterol occurred in both trials. The change in cholesterol (P=0.023) in persons with normal BMI and borderline cholesterol levels after four weeks of yoghurt consumption was detected. A difference was also found between placebo and test yoghurt groups (P=0.042) in LDL-c with normal BMI. Blood glucose reduction (P=0.01) and antioxidative effect was detected in overweight volunteers of the test yoghurt group. The suppression of oxidised LDL was associated with lowered oxidative stress index and total peroxide concentration values and faecal recovery of Inducia. The Inducia strain expresses antioxidative effect on blood lipids and has anti-glycaemic impact that allow to apply it as dietary probiotic supplement for the management of CVD risks in humans.
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Affiliation(s)
- J Štšepetova
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
- Institute of Biomedicine and Translational Medicine, Department of Microbiology, University of Tartu, 19 Ravila, 50411 Tartu, Estonia
| | - M Rätsep
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
| | - O Gerulis
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
| | - A Jõesaar
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
| | - M Mikelsaar
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
- Institute of Biomedicine and Translational Medicine, Department of Microbiology, University of Tartu, 19 Ravila, 50411 Tartu, Estonia
| | - E Songisepp
- BioCC OÜ, 1 Kreutzwaldi, 51006 Tartu, Estonia
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Ruiyang B, Panayi A, Ruifang W, Peng Z, Siqi F. Adiponectin in psoriasis and its comorbidities: a review. Lipids Health Dis 2021; 20:87. [PMID: 34372872 PMCID: PMC8353790 DOI: 10.1186/s12944-021-01510-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated inflammatory skin disease characterized by abnormal T cell activation and excessive proliferation of keratinocytes. In addition to skin manifestations, psoriasis has been associated with multiple metabolic comorbidities, such as obesity, insulin resistance, and diabetes. An increasing amount of evidence has highlighted the core role of adipokines in adipose tissue and the immune system. This review focus on the role of adiponectin in the pathophysiology of psoriasis and its comorbidities, highlighting the future research avenues.
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Affiliation(s)
- Bai Ruiyang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Adriana Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Wu Ruifang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhang Peng
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Fu Siqi
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Pourani MR, Abdollahimajd F, Zargari O, Shahidi Dadras M. Soluble biomarkers for diagnosis, monitoring, and therapeutic response assessment in psoriasis. J DERMATOL TREAT 2021; 33:1967-1974. [PMID: 34369253 DOI: 10.1080/09546634.2021.1966357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is an inflammatory disease associated with multiple comorbidities. Biomarkers for the assessment of psoriasis, its associated comorbidities, and the therapeutic response are not well characterized. A number of possible biomarkers for the diagnosis and monitoring of psoriasis have been proposed. PURPOSE To assess potential biomarkers for diagnosis of psoriasis, its associated comorbidities and response to treatment. METHODS We investigated medical databases from 2000 to 2021 and assessed relevant research. In this review, we evaluated the important biomarkers to help predict potential risk of psoriasis and disease activity (Beta-defensin-2, VEGF, Lipocalin-2, and YKL-40) and its possible inflammatory-related comorbidities like cardiovascular diseases (hs-CRP, GlycA, Psoriasin, IL-18, NT-proBNP, and Adipokines). In addition, we described the potential biomarkers for psoriatic arthritis (CXCL10, S100A8 and S100A9, and MicroRNA) and related manifestations such as enthesitis. Finally, we discussed novel markers for monitoring the response to specific treatments (HLA-C 06, PLC, TARC, NLR, and PLR) as well as potentially useful biomarkers for evaluation of therapy-associated adverse events (liver fibrosis-related markers). CONCLUSION A wide range of genetic, tissue and serum markers have been investigated in psoriasis; however, most of them are not used in routine clinical practice; and thorough physical examination along with the appropriate application of clinical scoring systems like Psoriasis Area and Severity Index (PASI) score are still of particular importance.
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Affiliation(s)
| | - Fahimeh Abdollahimajd
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit of 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
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Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume. J Clin Med 2020; 9:jcm9010186. [PMID: 31936662 PMCID: PMC7019311 DOI: 10.3390/jcm9010186] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022] Open
Abstract
In a subset of psoriasis (PsO) and psoriatic arthritis (PsA) patients, the skin and/or joint lesions appear to generate biologically significant systemic inflammation. Red cell distribution width (RDW) and mean platelet volume (MPV) are readily available clinical tests that reflect responses of the bone marrow and/or plasma thrombogenicity (e.g., inflammation), and can be markers for major adverse cardiac events (MACE). We aimed to evaluate if RDW and MPV may be employed as inexpensive, routinely obtained biomarkers in predicting myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) in psoriatic and psoriatic arthritis patients. The study was divided into two parts: (a) case control study employing big data (Explorys) to assess MPV and RDW in psoriasis, psoriatic arthritis and control cohorts; (b) a clinical observational study to validate the predictive value of RDW and to evaluate RDW response to anti-psoriatic therapies. We used Explorys, an aggregate electronic database, to identify psoriatic patients with available MPV and RDW data and compared them to gender and age matched controls. The incidence of myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) was highest among patients with both elevated RDW and MPV, followed by patients with high RDW and normal MPV. RDW elevation among PsA patients was associated with an increased risk of MI, AF, and CHF. In a local clinical cohort, high RDWs were concentrated in a subset of patients who also had elevated circulating resistin levels. Among a small subset of participants who were treated with various systemic and biologic therapies, and observed over a year, and in whom RDW was elevated at baseline, a sustained response to therapy was associated with a decrease in RDW. RDW and MPV, tests commonly contained within routine complete blood count (CBC), may be a cost-effective manner to identify PsO and PsA patients at increased risk of MACE.
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Pietrzak A, Chabros P, Grywalska E, Kiciński P, Pietrzak-Franciszkiewicz K, Krasowska D, Kandzierski G. Serum lipid metabolism in psoriasis and psoriatic arthritis - an update. Arch Med Sci 2019; 15:369-375. [PMID: 30899289 PMCID: PMC6425200 DOI: 10.5114/aoms.2018.74021] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/20/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Psoriasis and psoriatic arthritis (PSA) are chronic, inflammatory, systemic diseases characterized by metabolic abnormalities, including an increased cardiovascular risk and an oxidative imbalance. This study assessed blood parameters of lipid metabolism and markers of oxidative stress in patients with psoriasis and PSA. MATERIAL AND METHODS The study included 93 patients with psoriasis (31 patients with PSA and psoriasis, 62 patients with psoriasis vulgaris), and 60 healthy, age-matched controls. Serum concentrations of the glucose and the following lipid metabolism parameters were measured: triglycerides (TG), total cholesterol (TC), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), high-density lipoproteins (HDL), and apolipoproteins A and B (ApoA, ApoB). Oxidative status was determined as serum concentrations of ox-LDL/MDA Adduct. The Psoriasis Area and Severity Index (PASI) was used to determine disease severity. RESULTS Among the three studied groups, controls had the highest HDL concentration (p < 0.001), patients with PSA had the highest ApoB concentration (p < 0.05), ApoA : ApoB ratio (p < 0.05), ox-LDL/MDA adduct concentration (p < 0.001), and TC: HDL and LDL : HDL ratios (accordingly p < 0.05, p < 0.01). In patients with psoriasis or PSA, oxidative status correlated positively with TC and ApoB concentrations. CONCLUSIONS In line with previous research, among patients with psoriasis and PSA, we found lipid metabolism abnormalities and an oxidative imbalance, which might be due to chronic inflammation in these conditions. Effective treatment of patients with psoriasis or PSA could reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Aldona Pietrzak
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Paweł Chabros
- Orthopedics and Traumatology Department, Medical University of Lublin, Lublin, Poland
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland
| | - Paweł Kiciński
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
| | | | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Kandzierski
- Department of Paediatric Orthopaedics and Rehabilitation, Medical University of Lublin, Lublin, Poland
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Elkamshoushi AM, Omar SS, El Abd AM, Hassan SZ, Sultan EA, Abd Elkawy E. Subclinical atherosclerosis in psoriatic disease: relation to endocan, TNF-α, age of onset, and body fat. Int J Dermatol 2018; 58:456-464. [PMID: 30471086 DOI: 10.1111/ijd.14290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psoriasis is a common multisystem inflammatory disease with several associated comorbidities. Serological markers to detect associated subclinical atherosclerosis in psoriatic patients are needed. We aimed to study serum endocan levels in psoriasis vulgaris and its relation to severity of psoriasis, systemic inflammation, associated atherosclerosis, obesity, and the possible factors affecting its level in psoriatic patients. METHODS This study was conducted on 30 moderate-severe psoriasis vulgaris patients and 30 healthy controls. Body mass index, body fat percent, and PASI assessments were done. Serum endocan and tumor necrosis factor-α levels were measured by ELISA. Carotid artery intima-media thickness measurement by high-resolution ultrasound was performed. RESULTS Psoriasis patients showed significantly higher serum tumor necrosis factor-α and endocan levels (P1 = 0.008, P2 = 0.003). Additionally, there was a statistically significant difference between mean carotid artery intima-media thickness of both groups (P = 0.005). Serum endocan levels positively correlated with PASI score (P = 0.002), tumor necrosis factor-α levels (P < 0.001), mean carotid artery intima-media thickness (P = 0.001), and body mass index (P < 0.001) in the patients group. Additionally, the age of onset of disease negatively correlated with serum endocan (P = 0.003). CONCLUSION Serum endocan is a promising marker of severity of psoriasis and associated atherosclerosis. Early onset psoriasis is associated with higher serum endocan levels. Body mass index is positively correlated with serum endocan levels. The positive correlation of endocan and tumor necrosis factor-α supports the regulatory effect of the cytokine on endocan production and suggests the role of endocan as an inflammatory marker.
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Affiliation(s)
- Abdelaal M Elkamshoushi
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Salma S Omar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr M El Abd
- Department of Radiodiagnosis and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Seham Z Hassan
- Department of Medical Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman A Sultan
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Abd Elkawy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Manolis AA, Manolis TA, Melita H, Manolis AS. Psoriasis and cardiovascular disease: the elusive link. Int Rev Immunol 2018; 38:33-54. [PMID: 30457023 DOI: 10.1080/08830185.2018.1539084] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psoriasis, an autoimmune inflammatory disease, with its most common coexisting condition, psoriatic arthritis, seem to be more than just a local skin or joint disease, as evidence has accumulated over the years that it is associated with cardiovascular disease (CVD), which may confer an increased cardiovascular event and death rate. The data come mostly from observational studies and meta-analyses and indicate a potential pathogenetic link between these two systemic diseases, however definite proof of this detrimental relationship awaits further prospective studies. Newer anti-psoriatic biologic therapies seem to confer a cardiovascular benefit, but this needs future randomized controlled studies to confirm. All these intricate issues of a potential link between psoriasis and CVD are discussed and elaborated in this overview, in an attempt to shed further light on pivotal aspects of the association between psoriasis and CVD.
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Affiliation(s)
| | | | - Helen Melita
- c Onassis Cardiac Surgery Center , Athens , Greece
| | - Antonis S Manolis
- d Third Department of Cardiology , Athens University School of Medicine , Athens , Greece
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Groot J, Nybo Andersen AM, Adam A, Tind Nielsen TE, Blegvad C, Skov L. Associations between maternal socioeconomic position and psoriasis: a cohort study among the offspring of the Danish National Birth Cohort. Br J Dermatol 2018; 180:321-328. [PMID: 30117154 DOI: 10.1111/bjd.17091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The socioeconomic determinants of paediatric-onset psoriasis have not been previously investigated. OBJECTIVE To identify whether a social gradient exists for paediatric-onset psoriasis, using measures of maternal socioeconomic position. METHODS Data on paediatric-onset psoriasis from 36 003 Danish National Birth Cohort offspring were cross-linked with nationwide registry data on maternal age and three measures of maternal socioeconomic position: maternal educational attainment, maternal labour market attachment and equivalized household income. Univariable and multivariable logistic regression analyses were conducted to estimate the odds ratios (ORs) of psoriasis in the offspring, in cohort analyses for data from the year of enrolment and cross-sectional analyses from the year of the 11-year follow-up. RESULTS Maternal age at birth, maternal educational attainment and equivalized household income were inversely associated with psoriasis in the offspring. Low maternal educational attainment was associated with offspring psoriasis [adjusted OR 1·62, 95% confidence interval (CI) 1·20-2·18] after adjusting for maternal psoriasis and age in the cohort analysis. The crude OR of psoriasis in offspring of mothers in the highest quartile compared with mothers in the lowest quartile of equivalized household income was 0·57 (95% CI 0·43-0·76), and the adjusted OR was 0·59 (95% CI 0·44-0·80) after adjusting for maternal psoriasis and age. Similar results were observed for data on maternal socioeconomic position at enrolment and at follow-up. CONCLUSIONS A steep social gradient in paediatric-onset psoriasis was observed. Maternal socioeconomic position may play a role in early-life exposure to modifiable risk factors for psoriasis. Future studies may help to elucidate which biological factors mediate the social gradient observed in our study.
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Affiliation(s)
- J Groot
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - A M Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Adam
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T E Tind Nielsen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Blegvad
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
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