Santilli S, Kast D R, Grozdev I, Cao L, Feig R L, Golden J B, Debanne S M, Gilkeson R C, Orringer C E, McCormick T S, Ward N L, Cooper K D, Korman N J
Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.
The Murdough Family Center for Psoriasis, Cleveland, USA.
J Transl Med. 2016 Jul 22;14(1):217. doi: 10.1186/s12967-016-0947-0.
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.
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.
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.
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.
银屑病是一种皮肤和关节的慢性炎症性疾病，也可能具有全身炎症效应，包括心血管疾病（CVD）的发生。多项流行病学研究表明银屑病患者中CVD发生率增加，尽管尚未确立因果关系。越来越多的证据表明，银屑病患者即使在年轻时也可能发生亚临床全身炎症。我们旨在评估动脉粥样硬化的患病率，并确定与早期血管炎症相关的特定临床危险因素。
我们对一组三级医疗银屑病患者队列进行了横断面研究，使用冠状动脉钙化（CAC）评分和颈动脉内膜中层厚度（CIMT）来检测动脉粥样硬化，并使用高敏C反应蛋白（hsCRP）来测量炎症。银屑病患者和对照组均从我们的三级医疗皮肤科诊所招募。根据CAC和CIMT成像中的有效数值定义动脉粥样硬化的存在。使用韦尔奇t检验和皮尔逊卡方检验分析比较组间的描述性数据。采用逻辑回归分析与动脉粥样硬化相关的临床因素，采用线性回归评估银屑病与hsCRP之间的关系。
共纳入296例患者，其中283例（207例银屑病患者和76例对照）有hsCRP和动脉粥样硬化分析的所有数据。银屑病患者中动脉粥样硬化的发生率为67.6%，而对照组为52.6%；在调整年龄、性别、种族、体重指数、吸烟、高密度脂蛋白和hsCRP后，发现银屑病患者发生动脉粥样硬化的几率比对照组高2.67倍[95%可信区间（1.2，5.92）；p = 0.016]。此外，在调整混杂因素后，再次发现hsCRP与银屑病严重程度（通过PASI、PGA或BSA测量）之间存在非显著趋势。
一组三级医疗银屑病患者早期动脉粥样硬化患病率高，hsCRP升高，即使在调整关键混杂临床因素后，银屑病仍是动脉粥样硬化存在的危险因素。银屑病可能导致全身炎症级联反应加速，从而增加CVD和心血管事件的风险。
