Background. Psoriasis is a common inflammatory and immune-mediated skin disease. There is growing controversy as to whether cardiovascular risk is elevated in psoriasis. A number of studies suggest a high prevalence of cardiovascular risk factors as well as cardiovascular diseases in psoriasis patients. Objective. The objective of this study was to estimate cardiovascular risk score in psoriasis patients and the relation between cardiovascular risk and psoriasis features. Cardiovascular risk was assessed by CUORE project risk score built within the longitudinal study of the Italian CUORE project and suited to populations with a low rate of coronary heart disease. Results. A case-control study in 210 psoriasis outpatients and 111 controls with skin diseases other than psoriasis was performed. CUORE project risk score was higher in patients than controls ( versus , ). Compared to controls, psoriasis patients have higher risk of developing major cardiovascular events. Cardiovascular risk was not related to psoriasis characteristics. Conclusion. Increased focus on identifying cardiovascular risk factors and initiation of preventive lifestyle changes or therapeutic interventions in patients with psoriasis is warranted. 1. Introduction Psoriasis is a common inflammatory, immune-mediated skin disease [1]. It affects approximately 2-3% of the Western population, with varying prevalence among different ethnic groups and a similar prevalence in men and women [2]. Although psoriasis can present at any age, it has two peak periods of onset: at 15 to 25 years of age (type I psoriasis) and at 40 to 60 years of age (type II psoriasis) [3]. In addition to its cutaneous manifestations, psoriasis has been associated with inflammatory arthritis, depression, anger, anxiety, frustration, and considerable health-related quality of life impairment, which appear independent of objective disease severity [4, 5]. Once symptoms occur, the disease is characterized by a chronic course; spontaneous, long-term remissions occur in a minority of patients. Clinical manifestations are heterogeneous, ranging from limited to very extensive disease [1]. Approximately 80% to 85% of patients have limited skin involvement, whereas 15% to 20% have more extensive skin involvement that may require systemic therapy [6]. The exact etiology of psoriasis is not entirely elucidated; there is strong evidence that the interaction of multiple genetic, immunologic, and environmental factors contribute to its pathogenesis. As the understanding of psoriasis has evolved, so has the perception of disease
References
[1]
I. McDonald, M. Connolly, and A. M. Tobin, “A review of psoriasis, a known risk factor for cardiovascular disease and its impact on folate and homocysteine metabolism,” Journal of Nutrition and Metabolism, vol. 2012, Article ID 965385, 4 pages, 2012.
[2]
J. M. Hernánz, M. Sánchez-Rega?a, R. Izu, et al., “Clinical and therapeutic evaluation of patients with moderate to severe psoriasis in Spain: the secuence study,” Actas Dermosifiliogr, vol. 103, no. 10, pp. 897–904, 2012.
[3]
R. J. Ludwig, C. Herzog, A. Rostock et al., “Psoriasis: a possible risk factor for development of coronary artery calcification,” British Journal of Dermatology, vol. 156, no. 2, pp. 271–276, 2007.
[4]
R. V. Patel, M. L. Shelling, S. Prodanovich, D. G. Federman, and R. S. Kirsner, “Psoriasis and vascular disease-risk factors and outcomes: a systematic review of the literature,” Journal of General Internal Medicine, vol. 26, no. 9, pp. 1036–1049, 2011.
[5]
D. Siegel, S. Devaraj, A. Mitra, S. P. Raychaudhuri, S. K. Raychaudhuri, and I. Jialal, “Inflammation, atherosclerosis, and psoriasis,” Clinical Reviews in Allergy and Immunology, vol. 44, no. 2, pp. 194–204, 2013.
[6]
A. L. Neimann, D. B. Shin, X. Wang, D. J. Margolis, A. B. Troxel, and J. M. Gelfand, “Prevalence of cardiovascular risk factors in patients with psoriasis,” Journal of the American Academy of Dermatology, vol. 55, no. 5, pp. 829–835, 2006.
[7]
S. P. Raychaudhuri, “A cutting edge overview: psoriatic disease,” Clinical Reviews in Allergy and Immunology, vol. 44, no. 2, pp. 109–113, 2013.
[8]
S. Prodanovich, R. S. Kirsner, J. D. Kravetz, F. Ma, L. Martinez, and D. G. Federman, “Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality,” Archives of Dermatology, vol. 145, no. 6, pp. 700–703, 2009.
[9]
A. W. Armstrong, S. W. Lin, C. J. Chambers, M. E. Sockolov, and D. L. Chin, “Psoriasis and hypertension severity: results from a case-control study,” PLoS ONE, vol. 6, no. 3, Article ID e18227, 2011.
[10]
M. Wakkee, W. Meijer, H. A. M. Neumann, R. M. C. Herings, and T. Nijsten, “Psoriasis may not be an independent predictor for the use of cardiovascular and anti-diabetic drugs: a 5-year prevalence study,” Acta Dermato-Venereologica, vol. 89, no. 5, pp. 476–483, 2009.
[11]
R. M. Conroy, K. Py?r?l?, A. P. Fitzgerald et al., “Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project,” European Heart Journal, vol. 24, no. 11, pp. 987–1003, 2003.
[12]
R. Fernández-Torres, S. Pita-Fernández, and E. Fonseca, “Psoriasis and cardiovascular risk. Assessment by different cardiovascular risk scores,” Journal of the European Academy of Dermatology and Venereology, vol. 2012, 2012.
[13]
S. Giampaoli, L. Palmieri, A. Mattiello, and S. Panico, “Definition of high risk individuals to optimise strategies for primary prevention of cardiovascular diseases,” Nutrition, Metabolism and Cardiovascular Diseases, vol. 15, no. 1, pp. 79–85, 2005.
[14]
U. Mrowietz and K. Reich, “Psoriasis—new insights into pathogenesis and treatment,” Deutsches Arzteblatt, vol. 106, no. 1-2, pp. 11–19, 2009.
[15]
K. M. Wittkowski, C. Leonardi, A. Gottlieb et al., “Clinical Symptoms of Skin, Nails, and Joints Manifest Independently in Patients with Concomitant Psoriasis and Psoriatic Arthritis,” PLoS ONE, vol. 6, no. 6, Article ID e20279, 2011.
[16]
M. R. Bongiorno, S. Doukaki, D. Rizzo, and M. Aricò, “The prevalence of the obesity in patients with moderate to severe psoriasis in Sicily populations,” Journal of the European Academy of Dermatology and Venereology, vol. 24, no. 1, pp. 92–93, 2010.
[17]
H. Maradit-Kremers, M. Icen, F. C. Ernste, R. A. Dierkhising, and M. T. McEvoy, “Disease severity and therapy as predictors of cardiovascular risk in psoriasis: a population-based cohort study,” Journal of the European Academy of Dermatology and Venereology, vol. 26, no. 3, pp. 336–343, 2012.
[18]
J. M. Gelfand, A. B. Troxel, J. D. Lewis et al., “The risk of mortality in patients with psoriasis: results from a population-based study,” Archives of Dermatology, vol. 143, no. 12, pp. 1493–1499, 2007.
[19]
P. Gisondi, S. Farina, M. V. Giordano, and G. Girolomoni, “Usefulness of the framingham risk score in patients with chronic psoriasis,” American Journal of Cardiology, vol. 106, no. 12, pp. 1754–1757, 2010.
[20]
D. J. F. Rosa, R. F. MacHado, F. A. T. Matias et al., “Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis,” Journal of the European Academy of Dermatology and Venereology, vol. 26, no. 3, pp. 348–353, 2012.
[21]
W. J. Choi, E. J. Park, I. H. Kwon, K. H. Kim, and K. J. Kim, “Association between psoriasis and cardiovascular risk factors in korean patients,” Annals of Dermatology, vol. 22, no. 3, pp. 300–306, 2010.
[22]
A. B. Kimball, P. Szapary, U. Mrowietz et al., “Underdiagnosis and undertreatment of cardiovascular risk factors in patients with moderate to severe psoriasis,” Journal of the American Academy of Dermatology, vol. 67, no. 1, pp. 76–85, 2011.
[23]
A. B. Kimball, D. Robinson Jr., Y. Wu et al., “Cardiovascular disease and risk factors among psoriasis patients in two US healthcare databases, 2001-2002,” Dermatology, vol. 217, no. 1, pp. 27–37, 2008.
[24]
O. Ahlehoff, L. Skov, G. Gislason et al., “Pharmacological undertreatment of coronary risk factors in patients with psoriasis: observational study of the danish nationwide registries,” PLoS ONE, vol. 7, no. 4, Article ID e36342, 2012.
[25]
D. Di Lisi, F. Macaione, E. Corrado et al., “Cardiovascular risk profile of patients with psoriasis,” Recenti Progressi in Medicina, vol. 104, no. 3, pp. 102–105, 2013.