St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, King's College London, Guy's Hospital, London SE1 9RT, UK.
Br J Dermatol. 2011 Jan;164(1):26-32. doi: 10.1111/j.1365-2133.2010.10031.x. Epub 2010 Nov 8.
There is well-documented evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular disease (CVD). While this risk can, at least in part, be attributed to the high prevalence of traditional risk factors in the population with psoriasis, some epidemiological evidence suggests it may be independent of these.
This prospective, case-controlled study investigates whether psoriasis is a risk factor for CVD using two, validated, sensitive markers of CVD, endothelial dysfunction and high-sensitivity C-reactive protein (hsCRP).
Patients were recruited from a tertiary referral psoriasis clinic and exclusion criteria included established CVD and/or conventional risks for CVD. Preclinical CVD was assessed using flow-mediated brachial artery dilatation, which measures endothelial dysfunction, and hsCRP, a serological marker of atherosclerosis.
Sixty-four patients (22%) out of a total of 285 consecutive patients attending the severe psoriasis clinic were entered into the study. One hundred and sixty-one (56%) were excluded following identification of cardiovascular risk; 39 of the 161 (24%) had at least two cardiovascular risk factors. A further 16 (6%) patients were excluded because of established CVD. No statistically significant difference in endothelial dysfunction was observed between patients with psoriasis (n = 60) and healthy controls (n = 117) (P = 0·508). The hsCRP level was, however, significantly elevated in the psoriasis group (2·828 mg L(-1), SEM 0·219; controls 0·728 mg L(-1), SEM 0·142; P < 0·05).
This large, investigative study is the first to assess endothelial function in patients with psoriasis after exclusion of traditional risk factors for CVD. These data suggest that psoriasis per se is not a risk factor for CVD and that elevated hsCRP is possibly independent of atheroma risk. There was a high prevalence of traditional risk factors in our population with severe psoriasis.
有大量文献证明，中重度银屑病患者发生心血管疾病（CVD）的风险显著增加。虽然这种风险至少部分归因于银屑病患者中传统危险因素的高发，但一些流行病学证据表明，这种风险可能独立于这些因素。
本前瞻性病例对照研究使用两种经过验证的 CVD 敏感标志物，即内皮功能障碍和高敏 C 反应蛋白（hsCRP），来探究银屑病是否是 CVD 的一个危险因素。
从三级转诊银屑病诊所招募患者，并排除已确诊的 CVD 和/或 CVD 的常规危险因素。通过血流介导的肱动脉扩张来评估亚临床 CVD，该方法可测量内皮功能障碍，hsCRP 是动脉粥样硬化的血清学标志物。
在总共 285 例连续就诊的重度银屑病患者中，有 64 例（22%）患者进入了研究。在识别心血管风险后，有 161 例（56%）被排除在外；其中 161 例中有 39 例（24%）至少有两种心血管危险因素。由于已确诊的 CVD，另有 16 例（6%）患者被排除。银屑病患者（n=60）与健康对照组（n=117）的内皮功能障碍无统计学显著差异（P=0.508）。然而，银屑病组的 hsCRP 水平显著升高（2.828 mg/L，SEM 0.219；对照组 0.728 mg/L，SEM 0.142；P<0.05）。
这项大型研究首次在排除 CVD 的传统危险因素后，评估了银屑病患者的内皮功能。这些数据表明，银屑病本身不是 CVD 的危险因素，而 hsCRP 的升高可能独立于动脉粥样硬化风险。我们的重度银屑病患者人群中传统危险因素的患病率很高。
