Mahyoodeen Nasrin Goolam, Crowther Nigel J, Tikly Mohammed
Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Email:
Department of Chemical Pathology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa.
Cardiovasc J Afr. 2018;29(3):189-194. doi: 10.5830/CVJA-2017-055. Epub 2017 Dec 13.
Psoriasis (PsO) is a chronic immune-mediated inflammatory skin disorder associated with numerous co-morbidities. This descriptive review focuses on the cardiometabolic co-morbidities of PsO with reference to the epidemiology and pathogenetic mechanisms linking PsO and cardiometabolic disease (CMD). Registry-based studies have shown PsO to be associated with an increased risk of cardiovascular morbidity and mortality. Factors linking PsO and CMD include: chronic inflammation, obesity, classic cardiovascular risk factors, and the effects of systemic therapy used to treat PsO. Chronic inflammation is associated with PsO itself, and with obesity. Adipose tissue is responsible for the secretion of various adipokines, which together with pro-inflammatory cytokines arising from the psoriatic plaque, contribute to the pro-inflammatory and pro-atherogenic environment. Systemic therapy aimed at decreasing inflammation has been shown to improve CMD in PsO. Screening for and treating CMD and initiating lifestyle modifications will remain the most important interventions until further data emerge regarding the effect of systemic therapy on CMD progression.
银屑病(PsO)是一种慢性免疫介导的炎症性皮肤病,与多种合并症相关。本描述性综述聚焦于PsO的心脏代谢合并症,参考了将PsO与心脏代谢疾病(CMD)联系起来的流行病学和发病机制。基于登记处的研究表明,PsO与心血管疾病发病率和死亡率增加有关。将PsO和CMD联系起来的因素包括:慢性炎症、肥胖、经典心血管危险因素以及用于治疗PsO的全身治疗的影响。慢性炎症与PsO本身以及肥胖有关。脂肪组织负责分泌各种脂肪因子,这些脂肪因子与银屑病斑块产生的促炎细胞因子一起,促成了促炎和促动脉粥样硬化环境。旨在减轻炎症的全身治疗已被证明可改善PsO患者的CMD。在关于全身治疗对CMD进展影响的更多数据出现之前,筛查和治疗CMD以及启动生活方式改变仍将是最重要的干预措施。