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Measuring Psoriasis Severity at Home
Published on: March 1, 2024
Cumulative Duration of Severe Psoriasis: A Novel Cardiovascular Risk Predictor for Dermatologists
Bernadett B Huszti1, Noémi Á Galajda1, Seo-Ho Cho1,2,3,4
1Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Mária u. 41, Budapest, 1085, Hungary.
Insights
Cumulative duration of severe psoriasis (CDSP) exceeding 60.5 months is linked to increased cardiovascular disease (CVD) risk. This metric helps identify high-risk psoriasis patients early.
Area of Science:
- Dermatology
- Cardiology
- Medical Diagnostics
Background:
- Psoriasis is associated with increased cardiovascular (CV) risk.
- A clear link between disease duration and CV risk in psoriasis patients is lacking.
- Early identification of high CV risk in asymptomatic psoriasis patients is needed.
Purpose of the Study:
- To investigate the relationship between moderate-to-severe psoriasis and cardiovascular disease (CVD).
- To introduce and determine the cutoff value for cumulative duration of severe psoriasis (CDSP) as a predictor of CVD risk.
Main Methods:
- Cross-sectional study of 98 asymptomatic patients with moderate-to-severe psoriasis.
- Assessed CDSP using a questionnaire and determined its threshold for CVD risk using ROC analysis.
- Utilized coronary artery calcium scoring (CACS), segment involvement score (SIS), CAD-RADS™, and intima-media thickness (IMT) for CVD assessment.
Main Results:
- Patients with psoriasis had significantly higher CACS than controls.
- The CDSP threshold was identified as 60.5 months.
- Long-CDSP (over 60.5 months) was associated with significantly higher CACS, SIS, and CAD-RADS™ scores.
Conclusions:
- Long-CDSP indicates a greater extent and severity of CVD in psoriasis patients.
- CDSP is a novel, easily determined predictor for early identification of high CV risk in asymptomatic psoriasis patients.
Introduction:
The association between moderate-to-severe psoriasis and cardiovascular (CV) risk is well known. No clear link between disease activity, disease duration, and CV risk has been established thus far to identify high CV risk patients with psoriasis without CV symptoms. We aimed to investigate the relationship between moderate-to-severe psoriasis and cardiovascular disease (CVD) by introducing and determining the cutoff value for a new tool, the cumulative duration of severe psoriasis (CDSP), reflecting the total duration of severe psoriasis skin symptoms.
Methods:
Ninety-eight asymptomatic patients with moderate-to-severe psoriasis were enrolled in this cross-sectional study, without cardiac symptoms. CDSP was recorded using a structured questionnaire. CDSP threshold, defined as Coronary Artery Calcium Score (CACS) > 0, was determined using receiver operating characteristic curve analysis. Ultrasound (intima-media thickness (IMT) and carotid, brachial, and femoral artery plaque burden) and cardiac computed tomography (CACS, segment involvement score (SIS), and coronary artery disease-reporting and data system severity (CAD-RADS™)) were performed. Controls (n = 248) were matched for age, sex, body mass index, and, where possible, comorbidities.
Results:
CACS was significantly higher in psoriasis (mean 159.02, standard deviation 365.60) compared to controls (73.12, 166.08), P = 0.029. The CDSP threshold was 60.5 months. Patients with long-CDSP (> 60.5 months) had significantly higher CACS (214.63, 430.11) than patients with short-CDSP (57.61, 162.53), P = 0.012. SIS and CAD-RADS were also significantly higher in the long-CDSP group compared to the short-CDSP group (4.50, 3.85 vs. 1.39, 2.06), P = 0.002 and (2.06, 1.63 vs. 0.71, 1.08), P = 0.003, respectively. Patients with long-CDSP showed a non-significant trend towards higher IMT and peripheral plaque burden.
Conclusion:
Patients with long-CDSP had a greater extent and severity of CVD. This innovative predictor is easily determined by dermatologists and assists in the early identification of asymptomatic high CV risk patients with psoriasis. Graphical abstract available for this article.
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