|Year : 2020 | Volume
| Issue : 2 | Page : 68-72
Studying the relevance of psoriasis with increased artery intima–media thickness, in patients of skin disease clinics of kashan medical science university in 2016
, Hamid Reza Talari2
, Nushin Moussavi3
, Ahmad Yeganeh Moghaddam4
1 Dermatology Department, Faculty of Dermatology, Kashan University of Medical Sciences, Kashan, Iran
2 Radiology Department, Faculty of Radiology, Kashan University of Medical Sciences, Kashan, Iran
3 Surgery Department, Faculty of Surgery, Kashan University of Medical Sciences, Kashan, Iran
4 ENT Department, Faculty of ENT, Kashan University of Medical Sciences, Kashan, Iran
|Date of Submission||11-Mar-2020|
|Date of Decision||10-Jan-2020|
|Date of Acceptance||08-Apr-2020|
|Date of Web Publication||17-Jun-2020|
Dr. Hamid Reza Talari
Radiology Department, Faculty of Radiology, Kashan University of Medical Sciences, Kashan
Source of Support: None, Conflict of Interest: None
Aim: Psoriasis is a prevalent chronic skin disease, and evidence shows that psoriasis is considered as a risk factor for increased cardiovascular diseases. Consequently, this study purpose is an assessment of the relationship between psoriasis and carotid intima–media thickness (CIMT). Materials and Methods: The case–control study was conducted on 31 patients developed psoriasis, referred to the skin health-care centers of Kashan in 2016, and 31 healthy controls. Demographic data, disease duration, Psoriasis Area and Severity Index, and Carotid Artery Intima–Media Thickness were measured in each group of patients and compared. Data were entered into SPSS 16 software and analyzed using Chi-square, “Kolmogorov–Simonov” “Leven t-test,” univariate analysis of variance, and Pearson correlation tests. Results: The patients aged in case group was 10 ± 33 and in control group was 10 ± 32. CIMT values were obtained higher in patient group than in control group, but the difference was not significant (P = 0.44). CIMT results showed a significant increase in male than female patients (P = 0.02). In the present study, no relationship between CIMT and age of disease development and PASI index was observed which indicated the disease severity. Conclusion: In this study, according to the Pearson's correlation, a positive correlation was observed between the mean CIMT and age and also duration of the disease in patient group. Any correlation between psoriasis and CIMT and also between the CIMT and age of onset of the disease and PASI score was not found.
Keywords: Carotid artery intima–media thickness, psoriasis, psoriasis severity
|How to cite this article:|
Talaee R, Talari HR, Moussavi N, Moghaddam AY. Studying the relevance of psoriasis with increased artery intima–media thickness, in patients of skin disease clinics of kashan medical science university in 2016. Int Arch Health Sci 2020;7:68-72
|How to cite this URL:|
Talaee R, Talari HR, Moussavi N, Moghaddam AY. Studying the relevance of psoriasis with increased artery intima–media thickness, in patients of skin disease clinics of kashan medical science university in 2016. Int Arch Health Sci [serial online] 2020 [cited 2020 Sep 23];7:68-72. Available from: http://www.iahs.kaums.ac.ir/text.asp?2020/7/2/68/286986
| Introduction|| |
Psoriasis is a common chronic inflammatory skin disease, generally characterized by red papules erythematous plaques with specific ranges and silvery scales.,, Diseases associated with psoriasis are increasingly being characterized among the patients. The comorbidities mostly associated with psoriasis include metabolic syndromes, cardiovascular, inflammatory bowel disease, and cancer.
Systemic inflammation plays a vital role in atherosclerosis pathogens of psoriasis patients. Chronic skin inflammation in these patients might lead to early atherosclerosis, such as rheumatoid arthritis and systemic lupus erythematous.,, Inflammatory process is associated with psoriasis and also plays a role in the development of atherosclerotic risk factors and cardiovascular diseases. In terms of histology study, psoriasis and atherosclerosis have common characteristics such as T-cell, monocyte, macrophage, neutrophil, dendritic, and mast cells infiltration. Interleukin-1, IL-6, tumor necrosis factor-α.
Intrinsic antigens introduced into Th-1 and Th-17 cells so caused the inflammatory mechanisms that followed by the IL produced. It seems that these inflammatory mechanisms are responsible for the formation of psoriasis and atherosclerosis plaques.,
To diagnose the symptomless patients with atherosclerotic disease, one accessible screening method is the measurement of carotid intima–media thickness (CIMT) by high-resolution ultrasonography B-mode technique. CIMT is a noninvasive examination alternative for large artery atherosclerosis which is applied for the early diagnosis of atherosclerotic disease. Ultrasonography is a suitable approach and an alternative noninvasive examination for early diagnose of atherosclerotic patients., The increased common carotid artery IMT indicates generalized atherosclerotic.
An extensive observation-based study in Miami State of the U. S conducted on 3226 psoriasis patients and 2500 healthy controls demonstrated that diseases such as cardiovascular, cerebrovascular, and peripheral vascular were more prevalent among psoriasis patients than in healthy controls.
A study on psoriasis patients revealed that psoriasis was an independent risk factor for myocardial infarction. A positive association was found between atherosclerosis and the duration of psoriasis; however, there was no relationship between atherosclerosis and the disease severity.
It should be noticed that in some studies, psoriasis has been challenged as the risk factor of cardiovascular diseases, such as the cohort study conducted in Netherland on 15800 psoriasis patients compared to 27,600 healthy controls, in which no significant difference was reported between the two groups  for heart ischemia risks. Another study was also performed on medium severity patients in the Netherlands in 2013 and also demonstrated no association between psoriasis and atherosclerosis.
Cardiovascular risk factor examination is imperative for psoriasis patients. In case of the risk existing, the patients can be persuaded for modifying their lifestyles or balancing risk factors of cardiovascular diseases and regular examinations for early diagnosis and decreased cardiovascular risk factors. Reference to the significance of psoriasis disease and heart ischemia risk and the contradictions about vascular involvements in previous studies by comparing the psoriasis and healthy control subjects, the present study was performed aiming at demonstrating the association between psoriasis and carotid artery media intima thickness in psoriasis patients. In addition, the relationship between psoriasis severity and development duration and carotid artery media–intima thickness was assessed.
| Materials and Methods|| |
The case–control study was conducted on 31 psoriasis patients with skin involvements aged from 15 to 60, who did not develop classic risk factors of cardiovascular diseases, referring to skin care centers of Kashan Medical Science University in 2016 and applied for a medical file (the patient group) and 31 healthy controls among the family members or second- or third-degree relatives of the patients aged from 15 to 60, who were in control group. Physical examinations and estimation of disease severity or psoriasis area were performed according to the Psoriasis Area and Severity Index (PASI) score for each patient and supervised by the dermatologist.
Having compared the findings of similar studies in Turkey in 2012 and using the presented formulas for the case studies, the number of patients in each group was 19 patients. The maximum CIMT in patient group was 0.86 ± 0.09 mm and in control group was 0.77 ± 0.06 mm (P < 0.001). The mean CIMT in patient group was 0.73 ± 0.09 mm and in control group was 0.66 ± 0.06 mm (P < 0.001).
Considering the estimated number of psoriasis patients with skin involvement qualified the requirements for participating in the study in Kashan during 2016, the population size was 31 patients for each group. Data collection tools was the author-made checklist containing features such as gender, age, body mass index (BMI), type of psoriasis, age of development, duration of disease, familial history for psoriasis disease, records of the comorbidity systemic diseases, and systemic or topical treatments the patient has already received. Hypertension of each patient was measured 15 min after their rest. The biochemical parameters of the blood (including triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, blood urea nitrogen, creatinine, erythrocyte sedimentation rate, fasting blood sugar, white blood cell, hemoglobin, and platelet) were measured for each patient after 10 h of fasting from their venous blood sample and recorded.
The healthy controls were selected among the patient family members or their second- or third-degree relatives who were the age range and gender with them.
The participants then lied down on their back and the ultrasonography assessments were performed for right and left carotid arteries, by a radiologist unaware of the clinical details of the patients, using a Medison V 20 equipped with an 11 MHZ inventor.
For each common carotid artery, two segments were scanned including the balboa region, 10 mm proximal to the balboa. The image focused on the back wall and all the taken diastole images saved digitally for the next analyses.[20 The IMT distance was automatically measured and obtained by the computer software estimating several points on the above-mentioned locations and fell in a reasonable mean range which was at least evaluated in 100 points.
Some factors removed from the study are as follows:
- Cardiovascular history of patients, pregnancy, smoking cigarette, estrogen, systemic cyclosporine or retinoid treatment, patients or control subjects with cardiovascular risk factors  systolic blood pressure <140 mmHg, and diastolic blood pressure <90 mmHg), mellitus diabetes (blood glucose <110 mg/dL), hyperlipidemia (total cholesterol and/or fasting plasma triglyceride <240 mg/dL and <260 mg/dL, respectively), renal failure (serum creatinine <1.3 mg/dL), and obesity (BMI) <30 kg/m2).
The patients were assured that their personal information will be kept confidential. Their treatment and care would be never faced with any problem and no excess costs would be incurred by the patients.
Data were entered into SPSS 16 software and analyzed by Chi-square, “Kolmogorov–Simonov,” “Leven t-test,” univariate analysis of variance, and Pearson Correlation tests. A significance level of 0.05 was used for α.
| Results|| |
The groups were aged between 15 and 60 years and the overall mean and standard deviation obtained was 32.8 ± 9.9 for the two groups. In patient group, the average age of disease development was 20.1 ± 9.9 years and the average duration of disease obtained was 152 ± 100 months and the mean standard deviation of PASI was obtained 16.8 ± 12.5. The details are shown in [Table 1] and [Table 2].
The mean and standard deviation of mean CIMT was obtained in patients and control groups, 0.51 ± 0.06 and 0.49 ± 0.08 mm, respectively. The mean and standard deviation of maximum CIMT was obtained for patients and control groups, 0.59 ± 0.06 and 0.56 ± 0.08 mm, respectively.
As it can be seen from [Table 3], the mutual variance test results on the mean CIMT showed that there was no statistically significant difference between mean CIMT results for patients and control groups in view of statistical point (Pv = 0.44).
|Table 3: Comparison of mean carotid intima media thickness and maximum mean carotid intima-media thickness between two groups of patients and healthy|
Click here to view
As it is indicated in [Table 3], there was a statistically significant difference between the mean CIMT results for males and females (Pv = 0.026), and CIMT is significantly higher for men than for women.
Furthermore, the counter effect for Pv was not considered as significant for 0.46 (the significant effect between the gender and group (patients and controls)). The statistical data for the maximum CIMT revealed that there was no significant relationship between the maximum CIMT results of the patients and control groups in view of statistical points (Pv = 0.14). Moreover, no significant difference between men and women for the maximum CIMT (Pv = 0.069) was observed and the counter effect amount of Pv = 0.82 was not considered significant (the significance level between the gender and group [patients and controls]) [Table 3].
According [Table 4], the Pearson correlation between the mean CIMT and age and disease duration in the case group was significant.
|Table 4: The relationship of mean carotid intima-media thickness with age, development age, disease duration, and Psoriasis Area and Severity Index Score for patient group|
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Furthermore, the Pearson correlation between the mean CIMT and disease development age and PASI score was not significant.
| Discussion|| |
The results showed that CIMT was higher in case group than control group, but this difference was not significant (Pv = 0.44).
Furthermore, CIMT was significantly increased in men compared to women (Pv = 0.026).
There was a positive correlation between the mean CIMT and age in the case group (Pv = 0.001).
There was also a positive correlation between mean CIMT and duration of disease involvement in the case group which was statistically significant (P = 0.012).
In this study, no relationship was found between CIMT and age at onset of the disease and the PASI criterion, which represents the severity of the disease.
Given the above, the chronic and systemic inflammation that occurs in psoriasis makes patients susceptible to atherosclerotic diseases, and CIMT is a useful and noninvasive marker for early detection and measurement of atherosclerosis. Different studies are used.
Although at first sight many people thought that psoriasis as an inflammatory disease would be associated with increased CIMT, this study did not support this hypothesis.
In the present study, the association between CIMT and gender, age, and disease duration was confirmed and it was failed for the association between disease development age and PASI.
The cohort study of Balci et al. found that there was a significant relation between the mean CIMT findings in the right and left carotid arteries and the mean CIMT values obtained for psoriasis patients compared to healthy control group which was not in consistence with the present study results; also, the relation between disease duration and PASI was failed which was in accordance with the results of our study.
A similar study found a significant association in CIMT results between psoriasis patients and healthy controls (0.9 ± 0.2 mm versus 0.7 ± 0.1 mm, P < 0.001) and a positive significant correlation was observed between CIMT results and the patients' age, disease duration, and disease severity. In this study, the findings of the association CIMT results with age and disease duration were in consistence with the present study results.
Altekin et al. also reported in their study that the mean and maximum CIMT results were obtained higher for patients group than for the healthy control group (P < 0.001). In addition, for patients group, there was a significant association between CIMT results and patient age. As in patients group, no association was found between CIMT results and PASI index and disease duration.
The study of Yiu et al. reported that carotid artery atherosclerosis values in patients was measured higher than for the healthy control group (13.64 ± 0.0 versus 0.59 ± 0.07 mm). In this study, there was no independent factor indicating the association CIMT with disease duration and PASI results. The above-mentioned study was performed on 70 psoriasis patients without any cardiovascular disease background and 51 healthy controls who were similar in age and gender to the patient group. Having eliminated the patients with known cardiovascular risk factor background in the two groups, and comparison of CIMT results in patients (n = 34) and healthy control (n = 40) groups, the CIMT values showed no significant increase in patients group than in control group (0.64 ± 0.13 mm versus 0.59 ± 0.07 mm, Pv < 0.01), which is in consistence with the results of the present study.
| Conclusion|| |
In this study, no relationship was found between psoriasis and CIMT, as well as no relationship was found between CIMT and disease development age and the PASI criterion (indicating disease severity).
However, the considerable findings indicating the association between CIMT and age or disease duration suggest that despite dismissing the cardiovascular disease risk factors, psoriasis patients are more exposed to atherosclerosis disease compared to healthy controls. Therefore, it is suggested to evaluate the association between other inflammatory factors as well as CPR and nondermal types of psoriasis such as arteritis psoriasis with CIMT value.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Habif TP, Chapman MS, Campbell JL Jr., Dinulos JG, Zug KA. Skin Disease: Diagnosis and Treatment. Hanover and Lebanon, New Hampshire, USA: Elsevier Health Sciences; 2011.
Griffiths CE, Barker JN. Psoriasis. In: Rook's Textbook of Dermatology. Manchester, UK : Wiley-Blackwell; 2010. p. 1-60.
Laxer RM, Shore AD, Manson D, King S, Silverman ED, Wilmot DM. Chronic recurrent multifocal osteomyelitis and psoriasis – A report of a new association and review of related disorders. Semin Arthritis Rheum 1988;17:260-70.
Reich K. The concept of psoriasis as a systemic inflammation: Implications for disease management. J Eur Acad Dermatol Venereol 2012;26 Suppl 2:3-11.
Asanuma Y, Oeser A, Shintani AK, Turner E, Olsen N, Fazio S, et al
. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N
Engl J Med 2003;349:2407-15.
del Rincón ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001;44:2737-45.
Späh F. Inflammation in atherosclerosis and psoriasis: Common pathogenic mechanisms and the potential for an integrated treatment approach. Br J Dermatol 2008;159 Suppl 2:10-7.
Albanesi C, De Pità O, Girolomoni G. Resident skin cells in psoriasis: A special look at the pathogenetic functions of keratinocytes. Clin Dermatol 2007;25:581-8.
Ghazizadeh R, Shimizu H, Tosa M, Ghazizadeh M. Pathogenic mechanisms shared between psoriasis and cardiovascular disease. Int J Med Sci 2010;7:284-9.
Baldassarre D, Veglia F, Hamsten A, Humphries SE, Rauramaa R, de Faire U, et al
. Progression of carotid intima-media thickness as predictor of vascular events: Results from the IMPROVE study. Arterioscler Thromb Vasc Biol 2013;33:2273-9.
Kadota A, Miura K, Okamura T, Fujiyoshi A, Ohkubo T, Kadowaki T, et al
. Carotid intima-media thickness and plaque in apparently healthy Japanese individuals with an estimated 10-year absolute risk of CAD death according to the Japan Atherosclerosis Society (JAS) guidelines 2012: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA). J Atheroscler Thromb 2013;20:755-66.
Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol 2009;145:700-3.
Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296:1735-41.
Yiu KH, Yeung CK, Siu CW, Tse HF. Prevalence and extent of systemic atherosclerosis in patients with psoriasis and the relationship with duration of disease. J Am Coll Cardiol 2012;59:273-82.
Wakkee M, Meijer W, Neumann HA, Herings RM, Nijsten T. Psoriasis may not be an independent predictor for the use of cardiovascular and anti-diabetic drugs: A 5-year prevalence study. Acta Derm Venereol 2009;89:476-83.
Abel EA, DiCicco LM, Orenberg EK, Fraki JE, Farber EM. Drugs in exacerbation of psoriasis. J Am Acad Dermatol 1986;15:1007-22.
Björkstén B, Gustavson KH, Eriksson B, Lindholm A, Nordström S. Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris. J Pediatr 1978;93:227-31.
Altekin ER, Koç S, Karakaş MS, Yanıkoǧlu A, Başarıcı I, Demir I, et al
. Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis. Turk Kardiyol Dern Ars 2012;40:574-80.
Margolis D, Bilker W, Hennessy S, Vittorio C, Santanna J, Strom BL. The risk of malignancy associated with psoriasis. Arch Dermatol 2001;137:778-83.
Pignoli P. Ultrasound B-mode imaging for arterial wall thickness measurement. Atheroscler Rev 1984;12:177-84.
El-Mongy S, Fathy H, Abdelaziz A, Omran E, George S, Neseem N, et al
. Subclinical atherosclerosis in patients with chronic psoriasis: A potential association. J Eur Acad Dermatol Venereol 2010;24:661-6.
Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, et al
. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol 2009;23:1-6.
Yiu KH, Yeung CK, Zhao CT, Chan JC, Siu CW, Tam S, et al.
Prevalence and extent of subclinical atherosclerosis in patients with psoriasis. J Intern Med 2013;273:273-82.
[Table 1], [Table 2], [Table 3], [Table 4]