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Psoriasis Therapy and Cardiovascular Risk Factors

A 12-Week Follow-Up Study

  • Original Research Article
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American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background: Psoriatic patients present with an increased frequency of cardiovascular events.

Objective: To study the impact of psoriasis duration and therapy on traditional and new cardiovascular risk factors.

Study Design: A longitudinal study performed between 2005 and the first trimester of 2008. Each patient was followed up for 12 weeks, and was observed before and 3, 6, and 12 weeks after starting therapy.

Setting: Patients attending the Dermatology Service, University Hospital of Coimbra, Coimbra, Portugal were enrolled.

Subjects: Thirty-four patients with psoriasis vulgaris and 37 healthy volunteers as controls.

Main Outcome Measures: Psoriasis Area and Severity Index (PASI); lipid profile, oxidized low-density lipoprotein (oxLDL), oxLDL/low-density lipoprotein (LDL), total antioxidant status, lipid peroxidation, C-reactive protein (CRP), and circulating levels of adiponectin.

Intervention: Ten patients started therapy with topical treatment, 11 with narrow-band UVB radiation (NB-UVB), and 13 with psolaren plus UVA (PUVA).

Results: Before starting therapy, psoriatic patients presented with several risk changes in their lipid profiles, and significantly higher CRP, oxLDL, and oxLDL/LDL, and lower adiponectin levels (vs control subjects), which may further contribute to inflammation and atherogenesis. After treatment of the patients, although no significant differences were observed in the lipid profile compared with baseline, some changes suggested that the treatment could somehow alter lipid metabolism, as the reduction in high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A and the increase in the atherogenic index cholesterol/HDL-C maintained an even higher significance (as shown by p-values) when compared with the control group.

After topical therapy, there was a significant reduction in thiobarbituric acid reactivity only, suggesting that the reduction in the hyperproliferative process within the lesions is important for lipid peroxidation. After NB-UVB therapy, oxLDL/LDL, cholesterol/HDL-C, lipoprotein (a) [Lp(a)], and CRP remained higher than in the control subjects, reflecting persistent inflammation and atherogenic risk. After PUVA treatment, there was a significant reduction in Lp(a), associated with an almost significant increase in apolipoprotein-B (p = 0.054); these changes were not observed after NB-UVB treatment. However, after PUVA and NB-UVB treatment, CRP and, in the NB-UVB group, oxLDL/LDL were persistently higher than controls.

Conclusion: Our data show that psoriatic patients present with several lipid profile changes that seem to be related to the severity of the disease and/or the treatment used. Mild psoriasis patients receiving topical treatment presented before starting therapy with a lipid profile similar to controls, whereas those undergoing NB-UVB and PUVA, who had higher PASI scores, presented with several risk factors. Moreover, PUVA therapy seems to interact in a different way with lipids that might result from an interaction of psoralen with plasma lipids, namely Lp(a). Inflammation, a hallmark of psoriasis, also seems to be related to psoriasis severity. Both NB-UVB and PUVA were effective, as shown by the reduction in PASI score, as well as in the oxidative and inflammatory stress markers. However, after NB-UVB and PUVA, a low-grade inflammatory process still persisted, which might be related to the duration of remission of the disease.

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References

  1. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370: 263–71

    Article  PubMed  CAS  Google Scholar 

  2. Garcia-Diez A, Foraster CF, Sebastian FV, et al. What characterizes the severity of psoriasis? Results from an epidemiological study of over 3300 patients in the Iberian region. Dermatology 2008; 216: 137–51

    Article  PubMed  Google Scholar 

  3. Ferrandiz C, Bordas X, Garcia-Patos V, et al. Prevalence of psoriasis in Spain (Epiderma Project: phase I). J Eur Acad Dermatol Venereol 2001; 15: 20–3

    Article  PubMed  CAS  Google Scholar 

  4. Vanizor Kural B, Orem A, Cimsit G, et al. Evaluation of the atherogenic tendency of lipids and lipoprotein content and their relationshipswith oxidant-antioxidant system in patients with psoriasis. Clin Chim Acta 2003; 328: 71–82

    Article  PubMed  CAS  Google Scholar 

  5. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al. Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease. Clin Chim Acta 2001; 303: 33–9

    Article  PubMed  CAS  Google Scholar 

  6. Akhyani M, Ehsani AH, Robati RM, et al. The lipid profile in psoriasis: a controlled study. J Eur Acad Dermatol Venereol 2007; 21: 1330–2

    Article  PubMed  CAS  Google Scholar 

  7. Coimbra S, Oliveira H, Reis F, et al. Circulating levels of adiponectin, oxidized LDL and C-reactive protein in Portuguese patients with psoriasis vulgaris, according to body mass index, severity and duration of the disease. J Dermatol Sci 2009; 55: 202–4

    Article  PubMed  CAS  Google Scholar 

  8. Bajaj DR, Mahesar SM, Devrajani BR, et al. Lipid profile in patients with psoriasis presenting at Liaquat University Hospital Hyderabad. J Pak Med Assoc 2009; 59: 512–5

    PubMed  Google Scholar 

  9. Hashemi M, Daliri M, Mehrabifar H, et al. Lipid profile in patients with psoriasis in Zahedan, south-east Iran. J Eur Acad Dermatol Venereol 2009; 23: 461–2

    Article  PubMed  CAS  Google Scholar 

  10. Mallbris L, Larsson P, Bergqvist S, et al. Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases. J Invest Dermatol 2005; 124: 499–504

    Article  PubMed  CAS  Google Scholar 

  11. Sterry W, Strober BE, Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications: report of an interdisciplinary conference and review. Br J Dermatol 2007; 157: 649–55

    Article  PubMed  CAS  Google Scholar 

  12. Clark L, Lebwohl M. The effect of weight on the efficacy of biologic therapy in patients with psoriasis. J Am Acad Dermatol 2008; 58: 443–6

    Article  PubMed  Google Scholar 

  13. Rondinone CM. Adipocyte-derived hormones, cytokines, and mediators. Endocrine 2006; 29: 81–90

    Article  PubMed  CAS  Google Scholar 

  14. Mallika V, Goswami B, Rajappa M. Atherosclerosis pathophysiology and the role of novel risk factors: a clinicobiochemical perspective. Angiology 2007; 58: 513–22

    Article  PubMed  CAS  Google Scholar 

  15. Chapman MJ. Metabolic syndrome and type 2 diabetes: lipid and physiological consequences. Diab Vasc Dis Res 2007; 4 Suppl. 3: S5–8

    Google Scholar 

  16. Takemura Y, Walsh K, Ouchi N. Adiponectin and cardiovascular inflammatory responses. Curr Atheroscler Rep 2007; 9: 238–43

    Article  PubMed  CAS  Google Scholar 

  17. Ahima RS. Adipose tissue as an endocrine organ. Obesity (Silver Spring) 2006; 14 Suppl. 5: 242S–9S

    Article  CAS  Google Scholar 

  18. Tanaka T, Tsutamoto T, Nishiyama K, et al. Impact of oxidative stress on plasma adiponectin in patients with chronic heart failure. Circ J 2008; 72: 563–8

    Article  PubMed  CAS  Google Scholar 

  19. Takahashi H, Tsuji H, Takahashi I, et al. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Br J Dermatol 2008; 159: 1207–8

    PubMed  CAS  Google Scholar 

  20. Kaur S, Zilmer K, Kairane C, et al. Clear differences in adiponectin level and glutathione redox status revealed in obese and normal-weight patients with psoriasis. Br J Dermatol 2008; 159: 1364–7

    Article  PubMed  CAS  Google Scholar 

  21. Shibata S, Saeki H, Tada Y, et al. Serum high molecular weight adiponectin levels are decreased in psoriasis patients. J Dermatol Sci 2009; 55: 62–3

    Article  PubMed  CAS  Google Scholar 

  22. Takahashi H, Tsuji H, Takahashi I, et al. Prevalence of obesity/adiposity in Japanese psoriasis patients: adiposity is correlated with the severity of psoriasis. J Dermatol Sci 2009; 55: 74–6

    Article  PubMed  Google Scholar 

  23. Gounopoulos P, Merki E, Hansen LF, et al. Antibodies to oxidized low density lipoprotein: epidemiological studies and potential clinical applications in cardiovascular disease. Minerva Cardioangiol 2007; 55: 821–37

    PubMed  CAS  Google Scholar 

  24. Tekin NS, Tekin IO, Barut F, et al. Accumulation of oxidized low-density lipoprotein in psoriatic skin and changes of plasma lipid levels in psoriatic patients. Mediators Inflamm 2007; 2007: 78454

    PubMed  Google Scholar 

  25. Vanizor Kural B, Orem A, Cimsit G, et al. Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients. Clin Chim Acta 2003; 332: 23–30

    Article  PubMed  CAS  Google Scholar 

  26. Takahashi H, Tsuji H, Takahashi I, et al. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Br J Dermatol 2008 Nov; 159 (5): 1207–8

    Google Scholar 

  27. Strober B, Teller C, Yamauchi P, et al. Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis. Br J Dermatol 2008; 159: 322–30

    Article  PubMed  CAS  Google Scholar 

  28. Chodorowska G, Wojnowska D, Juszkiewicz-Borowiec M. C-reactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis. J Eur Acad Dermatol Venereol 2004; 18: 180–3

    Article  PubMed  CAS  Google Scholar 

  29. Biljan D, Situm M, Kostovic K, et al. Acute phase proteins in psoriasis. Coll Antropol 2009; 33: 83–6

    PubMed  Google Scholar 

  30. Corbetta S, Angioni R, Cattaneo A, et al. Effects of retinoid therapy on insulin sensitivity, lipid profile and circulating adipocytokines. Eur J Endocrinol 2006; 154: 83–6

    Article  PubMed  CAS  Google Scholar 

  31. Chodorowska G, Juszkiewicz-Borowiec M, Czelej D, et al. Activity of tumor necrosis factor-alfa (TNF-alpha) and selected acute phase proteins in plasma of psoriatic patients receiving local treatment. Ann Univ Mariae Curie Sklodowska Med 2001; 56: 165–9

    PubMed  CAS  Google Scholar 

  32. Naldi L, Griffiths CE. Traditional therapies in the management of moderate to severe chronic plaque psoriasis: an assessment of the benefits and risks. Br J Dermatol 2005; 152: 597–615

    Article  PubMed  CAS  Google Scholar 

  33. Fredriksson T, Pettersson U. Severe psoriasis: oral therapy with a new retinoid. Dermatologica 1978; 157: 238–44

    Article  PubMed  CAS  Google Scholar 

  34. Niehaus Jr WG, Samuelsson B. Formation of malonaldehyde from phospholipid arachidonate during microsomal lipid peroxidation. Eur J Biochem 1968; 6: 126–30

    Article  PubMed  CAS  Google Scholar 

  35. Uyanik BS, Ari Z, Onur E, et al. Serum lipids and apolipoproteins in patients with psoriasis. Clin Chem Lab Med 2002; 40: 65–8

    Article  PubMed  CAS  Google Scholar 

  36. Reynoso-von Drateln C, Martinez-Abundis E, Balcazar-Munoz BR, et al. Lipid profile, insulin secretion, and insulin sensitivity in psoriasis. J Am Acad Dermatol 2003; 48: 882–5

    Article  PubMed  Google Scholar 

  37. Piskin S, Gurkok F, Ekuklu G, et al. Serum lipid levels in psoriasis. Yonsei Med J 2003; 44: 24–6

    PubMed  CAS  Google Scholar 

  38. Farshchian M, Zamanian A, Farshchian M, et al. Serum lipid level in Iranian patients with psoriasis. J Eur Acad Dermatol Venereol 2007; 21: 802–5

    Article  PubMed  CAS  Google Scholar 

  39. Pietrzak A, Lecewicz-Torun B. Activity of serum lipase [EC 3.1.1.3] and the diversity of serum lipid profile in psoriasis. Med Sci Monit 2002; 8: CR9–13

    Google Scholar 

  40. Franz H, Wendler D. A controlled study of maternal serum concentrations of lipoproteins in pregnancy-induced hypertension. Arch Gynecol Obstet 1992; 252: 81–6

    Article  PubMed  CAS  Google Scholar 

  41. Mallbris L, Granath F, Hamsten A, et al. Psoriasis is associated with lipid abnormalities at the onset of skin disease. J Am Acad Dermatol 2006; 54: 614–21

    Article  PubMed  Google Scholar 

  42. Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation 2004; 109: II2–10

    Article  Google Scholar 

  43. Pietrzak A, Kadzielewski J, Janowski K, et al. Lipoprotein (a) in patients with psoriasis: associations with lipid profiles and disease severity. Int J Dermatol 2009; 48: 379–87

    Article  PubMed  CAS  Google Scholar 

  44. Anuurad E, Boffa MB, Koschinsky ML, et al. Lipoprotein(a): a unique risk factor for cardiovascular disease. Clin Lab Med 2006; 26: 751–72

    Article  PubMed  Google Scholar 

  45. Merki E, Graham MJ, Mullick AE, et al. Antisense oligonucleotide directed to human apolipoprotein B-100 reduces lipoprotein(a) levels and oxidized phospholipids on human apolipoprotein B-100 particles in lipoprotein(a) transgenic mice. Circulation 2008; 118: 743–53

    Article  PubMed  CAS  Google Scholar 

  46. dos Santos DJ, Eriksson LA. Permeability of psoralen derivatives in lipid membranes. Biophys J 2006; 91: 2464–74

    Article  PubMed  Google Scholar 

  47. Trenkwalder E, Gruber A, Konig P, et al. Increased plasma concentrations of LDL-unbound apo(a) in patients with end-stage renal disease. Kidney Int 1997; 52: 1685–92

    Article  PubMed  CAS  Google Scholar 

  48. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al. The inflammatory response in mild and in severe psoriasis. Br J Dermatol 2004; 150: 917–28

    Article  PubMed  CAS  Google Scholar 

  49. Coimbra S, Oliveira H, Reis F, et al. C-reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. J Eur Acad Dermatol Venereol. Epub ahead of print

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Acknowledgments

This study was supported by FCT (P0CI/SAU-0BS/58600/2004) and by FEDER. No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Serviço de Bioquímica, Faculdade de Farmácia, Universidade do Porto, 4050-047, R Aníbal Cunha 164, Porto, Portugal

    Susana Coimbra, Luís Belo, Susana Rocha, Elisabeth Castro & Alice Santos-Silva PhD

  2. Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal

    Susana Coimbra, Luís Belo, Susana Rocha, Alexandre Quintanilha, Elisabeth Castro, Petronila Rocha-Pereira & Alice Santos-Silva PhD

  3. Centro de Investigação das Tecnologias da Saúde (CITS) — Instituto Politécnico da Saúde Norte, Gandra-Paredes, Portugal

    Susana Coimbra

  4. Serviço de Dermatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal

    Hugo Oliveira & Américo Figueiredo

  5. Instituto de Farmacologia e Terapêutica Experimental, IBILI, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal

    Flávio Reis & Frederico Teixeira

  6. Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal

    Alexandre Quintanilha

  7. Centro de Investigação em Ciências da Saúde (CICS), Universidade da Beira Interior, Covilhã, Portugal

    Petronila Rocha-Pereira

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  1. Susana Coimbra
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Correspondence to Susana Coimbra or Alice Santos-Silva PhD.

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Coimbra, S., Oliveira, H., Reis, F. et al. Psoriasis Therapy and Cardiovascular Risk Factors. Am J Clin Dermatol 11, 423–432 (2010). https://doi.org/10.2165/11319310-000000000-00000

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  • DOI: https://doi.org/10.2165/11319310-000000000-00000

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