The prevalence of cardiovascular diseases risk factors associated with psoriasis in Saudi Arabia
Keywords:
Psoriasis, Cardiovascular disease, Dermatitis, Case-control, Saudi ArabiaAbstract
Background: Extensive studies have revealed an increased risk of major adverse cardiac outcomes in patients with severe psoriasis. However, some studies show conflicting results.
Objective: This study was conducted to assess the CV risk factors in psoriasis patients, and compare it with non-psoriatic patients. In addition, we evaluated if psoriasis is an independent CV risk factor, if its severity can predict CV risk, and if systemic psoriasis treatments modify CV risk.
Methods: This was a case-control study in 200 participants -100 with psoriasis, and 100 with dermatitis who served as the control. The study was carried out from September 2015 to September 2016. Data was collected using self-administered questionnaires, one each for both groups. Questions include body surface area, current psoriasis/dermatitis therapies, presence of diabetes mellitus, hypertension, smoking history, weight, height, body mass index (BMI), elevated cholesterol, Coronary Artery Disease (CAD) history.
Results: Analyses of the associations between psoriasis and CV symptoms has demonstrated that psoriasis was associated with CAD (p<0.001) and hospitalizations (p<0.001) due to CAD. We found that the psoriasis group have the following association: Angina (p=0.005), hypertension (p=0.001), diabetes mellitus (p=0.016), hypercholesterolemia (p=0.015), and “CAD succeeding psoriasis (p=0.001)” (it assesses how many patients with psoriasis had CAD after they are diagnosed with psoriasis). Our study showed that there was no statistically significant risk of CVD in dermatitis patients (p=0.16). There was no association between severity of psoriasis and CV risk (p=0.07).
Conclusions: There is a higher CV risk prevalence among Saudi psoriatic patients and this confirms that psoriasis is an independent CV risk factor in this population.
References
Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann
Rheum Dis. 2005; 64 Suppl 2: ii18-23; discussion ii24-5. doi: 10.1136/ard.2004.033217. PMID: 15708928,
PMCID: PMC1766861.
Ludwig RJ, Herzog C, Rostock A, Ochsendorf FR, Zollner TM, Thaci D, et al. Psoriasis: a possible risk
factor for development of coronary artery calcification. Br J Dermatol. 2007; 156(2): 271-6. doi:
1111/j.1365-2133.2006.07562.x. PMID: 17223866.
World Health Organization, Global Repost on Psoriasis. 2016.
(http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf)
Harden JL, Krueger JG, Bowcock AM. The immunogenetics of psoriasis: a comprehensive review. J
Autoimmun. 2015; 64: 66-73. doi: 10.1016/j.jaut.2015.07.008. PMID: 26215033, PMCID: PMC4628849.
Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin
Dermatol. 2005; 6(6): 383-92. doi: 10.2165/00128071-200506060-00005. PMID: 16343026.
Richard MA, Barnetche T, Horreau C, Brenaut E, Pouplard C, Aractingi S, et al. Psoriasis, cardiovascular
events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and
expert opinion. J Eur Acad Dermatol Venereol. 2013: 27 Suppl 3: 2-11. doi: 10.1111/jdv.12162. PMID:
Pearson KC, Armstrong AW. Psoriasis and cardiovascular disease: epidemiology, mechanisms, and clinical
implications. Psoriasis: Targets and Therapy. 2012; 2: 1-11. doi: 10.2147/PTT.S24015.
Miller IM, Ellervik C, Yazdanyar S, Jemec GB. Meta-analysis of psoriasis, cardiovascular disease, and
associated risk factors. J Am Acad Dermatol. 2013; 69(6): 1014-24. doi: 10.1016/j.jaad.2013.06.053.
PMID: 24238156.
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005; 352(16):
-95. doi: 10.1056/NEJMra043430. PMID: 15843671.
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;
(6): 700-3. doi: 10.1001/archdermatol.2009.94. PMID: 19528427.
Shelleh HH, Al-Hatiti HS. Pattern of skin diseases in a hospital in southwestern Saudi Arabia. Saudi Med J.
; 25(4): 507-10. PMID: 15083226.
Alakloby OM. Pattern of skin disease in eastern Saudi Arabia. Saudi Med J. 2005; 26(10): 1607-10. PMID:
Fatani MI, Abdulghani MH, Al-Afif KA. Psoriasis in the eastern Saudi Arabia. Saudi Med J. 2002; 23(2):
-7. PMID: 11938399.
Al-Zoman AY, Al-Asmari AK. Pattern of skin diseases in Riyadh Military Hospital. Egyptian Dermatology
Online Journal. 2008; 4(2): 4.
Mehta NN, Yu Y, Pinnelas R, Krishnamoorthy P, Shin DB, Troxel AB, et al. Attributable risk estimate of
severe psoriasis on major cardiovascular event. Am J Med. 2011; 124(8): 775, e1-6. doi:
1016/j.amjmed.2011.03.028. PMID: 21787906, PMCID: PMC3146037.
Wakkee M, Herings RM, Nijsten T. Psoriasis may not be an independent risk factor for acute ischemic
heart disease hospitalizations: Results of a large population-based Dutch cohort. J Invest Dermatol. 2010;
(4): 962-7. doi: 10.1038/jid.2009.321. PMID: 19812600.
Marshall VD, Moustafa F, Hawkins SD, Balkrishnan R, Feldman SR. Cardiovascular Disease Outcomes
Associated with Three Major Inflammatory Dermatologic Diseases: A Propensity-Matched Case Control
Study. Dermatol Ther (Heidelb). 2016; 6(4): 649-58. doi: 10.1007/s13555-016-0144-3. PMID: 27659680,
PMCID: PMC5120633.
Ahlehoff O, Skov L, Gislason G, Lindhardsen J, Kristensen SL, Iversen L, et al. Cardiovascular disease
event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: a Danish real- world cohort study. J Intern Med. 2013; 273(2): 197-204. doi: 10.1111/j.1365-2796.2012.02593.x. PMID:
Fry L, Baker BS. Triggering psoriasis: the role of infections and medications. Clin Dermatol. 2007; 25(6):
-15. doi: 10.1016/j.clindermatol.2007.08.015. PMID: 18021899.
Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in
patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146(8): 891-5. doi:
1001/archdermatol.2010.186. PMID: 20713823, PMCID: PMC2928071.
Mahiques-Santos L, Soriano-Navarro CJ, Perez-Pastor G, Tomas-Cabedo G, Pitarch-Bort G, Valcuende- Cavero F. Psoriasis and ischemic coronary artery disease. Actas Dermosifiliogr. 2015; 106(2): 112-6. doi:
1016/j.ad.2014.08.002. PMID: 25304822.
Baeta IG, Bittencourt FV, Gontijo B, Goulart EM. Comorbidities and cardiovascular risk factors in patients
with psoriasis. An Bras Dermatol. 2014; 89(5): 735-44. doi: 10.1590/abd1806-4841.20142874. PMID:
, PMCID: PMC4155951.
Wan J, Wang S, Haynes K, Denburg MR, Shin DB, Gelfand JM. Risk of moderate to advanced kidney
disease in patients with psoriasis: population based cohort study. Br J Dermatol. 2013; 347: f5961. doi:
1136/bmj.f5961. PMID: 24129480, PMCID: PMC3805477.
Ma C, Harskamp CT, Armstrong EJ, Armstrong AW. The association between psoriasis and dyslipidaemia:
a systematic review. Br J Dermatol. 2013; 168(3): 486-495. doi: 10.1111/bjd.12101. PMID: 23106411.
Granata M, Skarmoutsou E, Trovato C, Rossi GA, Mazzarino MC, D'Amico F. Obesity, Type 1 Diabetes,
and Psoriasis: An Autoimmune Triple Flip. Pathobiology. 2017; 84(2): 71-9. doi: 10.1159/000447777.
PMID: 27639922.
Prodanovich S, Ma F, Taylor JR, Pezon C, Fasihi T, Kirsner RS. Methotrexate reduces incidence of
vascular diseases in veterans with psoriasis or rheumatoid arthritis. J Am Acad Dermatol. 2005; 52: 262-7.
doi: 10.1016/j.jaad.2004.06.017. PMID: 15692471.
Vena GA, Vestita M, Cassano N. Psoriasis and cardiovascular disease. Dermatol Ther. 2010; 23(2): 144- 51. doi: 10.1111/j.1529-8019.2010.01308.x. PMID: 20415821.
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