Prevalence and extent of subclinical atherosclerosis in patients with psoriasis
Article first published online: 28 DEC 2012
© 2012 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 273, Issue 3, pages 273–282, March 2013
How to Cite
Prevalence and extent of subclinical atherosclerosis in patients with psoriasis. J Intern Med 2013; 273: 273–282., , , , , , , , , , , (The University of Hong Kong, Queen Mary Hospital, Hong Kong; The University of Hong Kong, Hong Kong; The University of Hong Kong, Queen Mary Hospital, Hong Kong; Queen Mary Hospital, Hong Kong; The University of Hong Kong, Hong Kong, China).
- Issue published online: 15 FEB 2013
- Article first published online: 28 DEC 2012
- Accepted manuscript online: 24 SEP 2012 09:00AM EST
- CRCG Small Project Funding of the University of Hong Kong. Grant Number: 200907176060
- Sun Chieh Yeh Heart Foundation
Patients with psoriasis are prone to premature atherosclerosis and increased risk of cardiovascular disease events. However, the prevalence and extent of atherosclerosis in patients with psoriasis are unknown.
A cross-sectional study.
Setting and subjects
The prevalence and extent of coronary and carotid atherosclerosis were compared in 70 patients with psoriasis (46 ± 9 years, 71% male) without known cardiovascular disease or joint involvement and 51 age- and gender-matched healthy control subjects (45 ± 7 years, 71% male). Systemic inflammation was assessed by the level of high-sensitivity C-reactive protein (hs-CRP). Coronary atherosclerosis was determined by the coronary calcification score (CCS) measured by multi-detector computed tomography. Carotid atherosclerosis was assessed by high-resolution ultrasound-derived carotid intima–media thickness (cIMT).
Patients with psoriasis had a higher prevalence of coronary atherosclerosis (CCS > 0; 28.6% vs. 3.9%, P < 0.01), and a higher degree of coronary atherosclerosis estimated by the mean CCS (67.4 ± 349.2 vs. 0.5 ± 3.0, P < 0.05) compared with controls. Similarly, cIMT was significantly greater in patients with psoriasis than in control subjects (0.73 ± 0.11 mm vs. 0.67 ± 0.08 mm, P < 0.01). Multiple logistic regression revealed that psoriasis [odd ratio (OR): 10.54, 95% confidence interval (CI) 1.89–58.67, P < 0.01] and serum total cholesterol level (OR 2.10, 95% CI 1.01–4.37) were associated with the presence of coronary atherosclerosis (CCS > 0). By contrast, only age was independently associated with increased cIMT. Amongst participants with no traditional cardiovascular disease risk factors, hs-CRP level was higher in patients with psoriasis than in controls.
The present results demonstrate early-onset, diffuse arterial atherosclerosis in coronary and carotid arteries in patients with psoriasis, but not in age- and gender-matched control subjects. Low-grade inflammation could explain the presence of premature atherosclerosis in patients with psoriasis.