Ramos Sofia, Daya Sheetal, Crowther Nigel J, Pillay Lushen, Tikly Mohammed, Goolam Mahyoodeen Nasrin
Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Chemical Pathology, National Health Laboratory Services, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Front Med (Lausanne). 2022 Jun 30;9:890195. doi: 10.3389/fmed.2022.890195. eCollection 2022.
Psoriasis is associated with a high prevalence of cardiovascular disease in Caucasians, but only a few studies from sub-Saharan Africa have investigated the prevalence of cardiovascular disease in patients with psoriasis. Abdominal aortic calcification (AAC) is a strong predictor of future cardiovascular events and all-cause mortality in the general population. We investigated the prevalence and risk factors for AAC in a predominantly non-Caucasian cohort of South African patients with psoriasis.
A cross-sectional case-control study of adult psoriasis patients ( = 69) and controls ( = 80), matched for gender, ethnicity and body mass index, attending tertiary Dermatology and Rheumatology clinics in Johannesburg, South Africa. Demographic, anthropometric, clinical and biochemical data were recorded. All participants underwent non-contrast abdominal CT scans. Images were assessed for AAC at the supra-coeliac aorta, supra-mesenteric aorta and aortic bifurcation using Horos DICOM viewer software.
Abdominal aortic calcification at any site was more prevalent in the psoriasis than control group (47.8% vs 22.5%, < 0.005). The aortic bifurcation was the commonest site for AAC in both groups, but more prevalent in the psoriasis group (42.0% vs 21.3%, < 0.005). The psoriasis group was also more likely to smoke, have hypertension and type 2 diabetes (56.5% vs 25.0%, < 0.005; 72.0% vs 55.0%, < 0.005; 24.6% vs 3.80%, < 0.0005, respectively). Multivariable logistic regression analysis demonstrated that age, smoking and type 2 (T2DM) diabetes were independently associated with AAC (odds ratio (95% CIs): 1.16 (1.07, 1.20), 4.30 (2.15, 8.61) and 3.45 (1.09, 15.7) respectively), but psoriasis was not. Forward regression analysis demonstrated that smoking attenuated the association of psoriasis with AAC.
Our findings show AAC to be more common in psoriasis patients compared to controls. Age, T2DM and smoking were independent predictors of AAC. Smoking cessation is essential in psoriatic patients to reduce the risk of cardiovascular events. The clinical utility of AAC detection by CT imaging to risk stratify for hard cardiovascular outcomes needs to be explored.
在高加索人群中，银屑病与心血管疾病的高患病率相关，但撒哈拉以南非洲地区仅有少数研究调查了银屑病患者中心血管疾病的患病率。腹主动脉钙化（AAC）是普通人群未来心血管事件和全因死亡率的有力预测指标。我们在以非高加索人为主的南非银屑病患者队列中调查了AAC的患病率及其危险因素。
在南非约翰内斯堡的三级皮肤科和风湿病诊所进行了一项横断面病例对照研究，纳入成年银屑病患者（n = 69）和对照组（n = 80），根据性别、种族和体重指数进行匹配。记录人口统计学、人体测量学、临床和生化数据。所有参与者均接受非增强腹部CT扫描。使用Horos DICOM查看软件评估腹腔干上方主动脉、肠系膜上动脉和主动脉分叉处的AAC情况。
银屑病组中任何部位的腹主动脉钙化均比对照组更常见（47.8%对22.5%，P < 0.005）。两组中主动脉分叉处都是AAC最常见的部位，但在银屑病组中更普遍（42.0%对21.3%，P < 0.005）。银屑病组也更有可能吸烟、患有高血压和2型糖尿病（分别为56.5%对25.0%，P < 0.005；72.0%对55.0%，P < 0.005；24.6%对3.80%，P < 0.0005）。多变量逻辑回归分析表明，年龄、吸烟和2型糖尿病（T2DM）与AAC独立相关（比值比（95%置信区间）：分别为1.16（1.07，1.20）、4.30（2.15，8.61）和3.45（1.09，15.7）），但银屑病与AAC无关。向前回归分析表明，吸烟减弱了银屑病与AAC之间的关联。
我们的研究结果表明，与对照组相比，AAC在银屑病患者中更常见。年龄、T2DM和吸烟是AAC的独立预测因素。银屑病患者戒烟对于降低心血管事件风险至关重要。需要探索通过CT成像检测AAC以对严重心血管结局进行风险分层的临床实用性。
