A prospective case-controlled cohort study of endothelial function in patients with moderate to severe psoriasis.
BACKGROUND
There is well-documented evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular disease (CVD). While this risk can, at least in part, be attributed to the high prevalence of traditional risk factors in the population with psoriasis, some epidemiological evidence suggests it may be independent of these.


OBJECTIVE
This prospective, case-controlled study investigates whether psoriasis is a risk factor for CVD using two, validated, sensitive markers of CVD, endothelial dysfunction and high-sensitivity C-reactive protein (hsCRP).


METHODS
Patients were recruited from a tertiary referral psoriasis clinic and exclusion criteria included established CVD and/or conventional risks for CVD. Preclinical CVD was assessed using flow-mediated brachial artery dilatation, which measures endothelial dysfunction, and hsCRP, a serological marker of atherosclerosis.


RESULTS
Sixty-four patients (22%) out of a total of 285 consecutive patients attending the severe psoriasis clinic were entered into the study. One hundred and sixty-one (56%) were excluded following identification of cardiovascular risk; 39 of the 161 (24%) had at least two cardiovascular risk factors. A further 16 (6%) patients were excluded because of established CVD. No statistically significant difference in endothelial dysfunction was observed between patients with psoriasis (n = 60) and healthy controls (n = 117) (P = 0·508). The hsCRP level was, however, significantly elevated in the psoriasis group (2·828 mg L(-1), SEM 0·219; controls 0·728 mg L(-1), SEM 0·142; P < 0·05).


CONCLUSIONS
This large, investigative study is the first to assess endothelial function in patients with psoriasis after exclusion of traditional risk factors for CVD. These data suggest that psoriasis per se is not a risk factor for CVD and that elevated hsCRP is possibly independent of atheroma risk. There was a high prevalence of traditional risk factors in our population with severe psoriasis.
Martyn-Simmons
C L
CL
St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, King's College London, Guy's Hospital, London SE1 9RT, UK.
Ranawaka
R R
RR
Chowienczyk
P
P
Crook
M A
MA
Marber
M S
MS
Smith
C H
CH
Barker
J N W N
JN
D015415:Biomarkers / Q000032:analysis; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology
D015415:Biomarkers; D008055:Lipids; D002097:C-Reactive Protein