Karoli Ritu, Fatima Jalees, Shukla Vaibhav, Dhillon K S, Khanduri Sachin, Maini Sumit, Chandra Ashok
J Assoc Physicians India. 2013 Nov;61(11):798-803.
INTRODUCTION/BACKGROUND: Psoriasis is a chronic immune mediated inflammatory disorder of the skin and joints. Recent studies have shown increased prevalence of traditional cardiovascular risk factors such as diabetes mellitus, hypertension and metabolic syndrome. Since atherosclerosis and psoriasis share a common link of inflammation, different workers have shown psoriasis to be a risk factor for atherosclerosis. The aim of our study was assessment of cardiovascular risk factors and evidence of subclinical atherosclerosis in patients of psoriasis.
In a hospital based, cross-sectional study, 96 patients with psoriasis and 100 age, sex and weight matched controls were enrolled. Prevalence of diabetes, hypertension, metabolic syndrome was studied. They were also assessed for endothelial dysfunction by brachial artery flow mediated dilatation(FMD) and carotid intima media thickness (CIMT).
There was higher prevalence of hypertension, hypertriglyceridaemia, diabetes mellitus and metabolic syndrome in patients with psoriasis than in controls. FMD was lower in patients with psoriasis than in controls (5.6 +/- 2 vs7.5 +/- 2.8, P = 0.02). The mean CIMT was significantly increased (0.78 +/- 0.12 vs 0.62 +/- 0.08, P = 0.001) in patients with psoriasis compared with controls. In psoriasis patients, CIMT was associated with hypertension, hypertriglyceridaemia, diabetes, insulin resistance, increased severity and duration of psoriasis while in multivariate analysis insulin resistance (OR 2.8, 95% CI 1.92-6.34 P = 0.02) and increased duration of disease (OR 3.12, 95% CI 2.34-7.56) a were the independent risk factors associated with higher CIMT.
Patients of psoriasis have higher prevalence of metabolic syndrome, cardiovascular risk factors and subclinical atherosclerosis than general population. As a routine, individuals with moderate to severe psoriasis of long duration should be recognised as being at increased cardio vascular risk and thus encouraged for therapeutic interventions to reduce the modifiable risk factors.
引言/背景：银屑病是一种慢性免疫介导的皮肤和关节炎症性疾病。最近的研究表明，糖尿病、高血压和代谢综合征等传统心血管危险因素的患病率有所上升。由于动脉粥样硬化和银屑病有共同的炎症联系，不同的研究人员已表明银屑病是动脉粥样硬化的一个危险因素。我们研究的目的是评估银屑病患者的心血管危险因素和亚临床动脉粥样硬化的证据。
在一项基于医院的横断面研究中，纳入了96例银屑病患者以及100例年龄、性别和体重匹配的对照者。研究了糖尿病、高血压、代谢综合征的患病率。还通过肱动脉血流介导的扩张（FMD）和颈动脉内膜中层厚度（CIMT）对他们的内皮功能障碍进行了评估。
银屑病患者中高血压、高甘油三酯血症、糖尿病和代谢综合征的患病率高于对照组。银屑病患者的FMD低于对照组（5.6±2对7.5±2.8，P = 0.02）。与对照组相比，银屑病患者的平均CIMT显著增加（0.78±0.12对0.62±0.08，P = 0.001）。在银屑病患者中，CIMT与高血压、高甘油三酯血症、糖尿病、胰岛素抵抗、银屑病严重程度增加和病程延长相关，而在多变量分析中，胰岛素抵抗（OR 2.8，95%CI 1.92 - 6.34，P = 0.02）和病程延长（OR 3.12，95%CI 2.34 - 7.56）是与较高CIMT相关的独立危险因素。
银屑病患者代谢综合征、心血管危险因素和亚临床动脉粥样硬化的患病率高于普通人群。作为常规，中度至重度且病程较长的银屑病患者应被视为心血管风险增加，因此应鼓励他们进行治疗干预以降低可改变的危险因素。
