title: Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center.
abstract: Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation.
  
  
  
  We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch's t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP.
  
  
  
  296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders.
  
  
  
  A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: S
authors.initials: S
authors.lastname: Santilli
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Kast
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: I
authors.initials: I
authors.lastname: Grozdev
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: L
authors.initials: L
authors.lastname: Cao
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Feig
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.|Department of Pathology, Case Western Reserve University, Cleveland, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Golden
authors.affiliation: Center For Clinical Investigation, Case Western Reserve University, Cleveland, USA.|Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Debanne
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Gilkeson
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.|University of Miami, Miller School of Medicine, Miami, FL, 33125, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Orringer
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA. tsm4@case.edu.|The Murdough Family Center for Psoriasis, Cleveland, USA. tsm4@case.edu.
authors.forename: T S
authors.initials: TS
authors.lastname: McCormick
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Ward
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.|Louis Stokes VA Medical Center, Cleveland, OH, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Cooper
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.|The Murdough Family Center for Psoriasis, Cleveland, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Korman
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D003331:Coronary Vessels / Q000378:metabolism* / Q000473:pathology*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011565:Psoriasis / Q000150:complications*; D062606:Tertiary Care Centers
chemical_list: D002097:C-Reactive Protein; D002118:Calcium
keywords: Cardiovascular disease; Carotid intima-media thickness; Coronary artery calcium; Psoriasis; Psoriatic arthritis; Vascular inflammation; hs-CRP