A study of cardio-metabolic risk profile in patients with psoriasis

Psoriasis is a chronic immune mediated inflammatory disorder of the skin and joints. Recent studies have shown increased prevalence of traditional cardiovascular risk factors such as diabetes mellitus, hypertension and metabolic syndrome. Since atherosclerosis and psoriasis share a common link of inflammation, different workers have shown psoriasis to be a risk factor for atherosclerosis. The aim of our study was assessment of cardiovascular risk factors and evidence of subclinical atherosclerosis in patients of psoriasis.

In a hospital based, cross-sectional study, 96 patients with psoriasis and 100 age, sex and weight matched controls were enrolled. Prevalence of diabetes, hypertension, metabolic syndrome was studied. They were also assessed for endothelial dysfunction by brachial artery flow mediated dilatation(FMD) and carotid intima media thickness (CIMT).

There was higher prevalence of hypertension, hypertriglyceridaemia, diabetes mellitus and metabolic syndrome in patients with psoriasis than in controls. FMD was lower in patients with psoriasis than in controls (5.6 +/- 2 vs7.5 +/- 2.8, P = 0.02). The mean CIMT was significantly increased (0.78 +/- 0.12 vs 0.62 +/- 0.08, P = 0.001) in patients with psoriasis compared with controls. In psoriasis patients, CIMT was associated with hypertension, hypertriglyceridaemia, diabetes, insulin resistance, increased severity and duration of psoriasis while in multivariate analysis insulin resistance (OR 2.8, 95% CI 1.92-6.34 P = 0.02) and increased duration of disease (OR 3.12, 95% CI 2.34-7.56) a were the independent risk factors associated with higher CIMT.

Patients of psoriasis have higher prevalence of metabolic syndrome, cardiovascular risk factors and subclinical atherosclerosis than general population. As a routine, individuals with moderate to severe psoriasis of long duration should be recognised as being at increased cardio vascular risk and thus encouraged for therapeutic interventions to reduce the modifiable risk factors.