New Link Is Found Between Psoriasis and Heart Disease

MANCHESTER, ENGLAND — The latest piece of evidence linking psoriasis with cardiovascular disease suggests that patients with the skin disease are at high risk of having elevated serum levels of homocysteine, Dr. Anne-Marie Tobin said at the annual meeting of the British Association of Dermatologists.

In the general population, hyperhomocysteinemia has been shown to be an independent risk factor for the development of cardiovascular disease, with a magnitude of risk similar to that of smoking and hyperlipidemia. Elevated levels of homocysteine have been linked to atherosclerosis, endothelial damage, and thrombogenesis.

Cardiovascular disease is the leading cause of mortality among patients with psoriasis. The precise reasons why patients with psoriasis are at risk for cardiovascular disease remain unclear, although several possible contributory factors exist. Some of the excess cardiovascular risk may relate to increased rates of smoking and hypertension, risk factors that have been documented in this patient population.

“Moreover, there has been a suggestion from the rheumatology literature that chronic inflammation elevates cardiovascular risk, although this has yet to be confirmed in psoriasis,” said Dr. Tobin of the department of dermatology, Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin.

Patients with psoriasis also have raised levels of lipoprotein A, which further increases risk for coronary heart disease and ischemic stroke. Moreover, small uncontrolled studies have suggested patients with psoriasis may have low levels of folate, which helps break down homocysteine. The accelerated rate of keratinocyte turnover seen in psoriasis is thought to lower levels of folate, she said.

“Based on these observations, we undertook a study to assess homocysteine levels in outpatients with moderate to severe psoriasis who were not on systemic treatment, and to assess the homocysteine levels in the context of major conventional cardiovascular risk factors,” Dr. Tobin said.

Twenty patients, of whom 11 were women, were recruited. Mean age was 42 years, and mean Psoriasis Area and Severity Index (PASI) was 12.8. Twenty age- and sex-matched controls were also enrolled. The patients were evaluated for body mass index (BMI), blood pressure, and levels of glucose, lipids, homocysteine, and folate.

One patient with psoriasis had extremely low levels of folate and also had atrophic gastritis and pernicious anemia and was excluded from further analysis.

Five patients with psoriasis had homocysteine levels of 12 μmol/L or higher, compared with only one control subject. Population-based studies suggest that slightly more than 5% of the general population has elevated homocysteine, which was similar to the figure for the controls in this study. “But with more than 27% of our patients with psoriasis having raised levels of homocysteine, the odds ratio of their having hyperhomocysteinemia was greater than 7,” compared with controls, Dr. Tobin reported.

There was no correlation between levels of homocysteine and PASI. Patients with psoriasis also had a trend for low levels of red-cell folate, but this was not statistically significant. “Hyperhomocysteinemia was not related to either folate status or disease severity in psoriasis patients, as had been supposed,” she said.

Likelihood of high BMI also was increased among psoriasis patients: A total of 17 patients with psoriasis had a BMI greater than 25, compared with only 4 controls. Three of the 17 were clinically obese and 2 were morbidly obese, she noted.

Patients with psoriasis also had significantly raised systolic blood pressure. “However, because diastolic blood pressure was normal and the fact that blood pressure readings were not repeated, we were unsure of the significance of this result,” Dr. Tobin said. She said the significance of the results warrants a large population-based study to identify the risk factors that should be routinely measured in patients with psoriasis.

MANCHESTER, ENGLAND — The latest piece of evidence linking psoriasis with cardiovascular disease suggests that patients with the skin disease are at high risk of having elevated serum levels of homocysteine, Dr. Anne-Marie Tobin said at the annual meeting of the British Association of Dermatologists.

In the general population, hyperhomocysteinemia has been shown to be an independent risk factor for the development of cardiovascular disease, with a magnitude of risk similar to that of smoking and hyperlipidemia. Elevated levels of homocysteine have been linked to atherosclerosis, endothelial damage, and thrombogenesis.

Cardiovascular disease is the leading cause of mortality among patients with psoriasis. The precise reasons why patients with psoriasis are at risk for cardiovascular disease remain unclear, although several possible contributory factors exist. Some of the excess cardiovascular risk may relate to increased rates of smoking and hypertension, risk factors that have been documented in this patient population.

“Moreover, there has been a suggestion from the rheumatology literature that chronic inflammation elevates cardiovascular risk, although this has yet to be confirmed in psoriasis,” said Dr. Tobin of the department of dermatology, Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin.

Patients with psoriasis also have raised levels of lipoprotein A, which further increases risk for coronary heart disease and ischemic stroke. Moreover, small uncontrolled studies have suggested patients with psoriasis may have low levels of folate, which helps break down homocysteine. The accelerated rate of keratinocyte turnover seen in psoriasis is thought to lower levels of folate, she said.

“Based on these observations, we undertook a study to assess homocysteine levels in outpatients with moderate to severe psoriasis who were not on systemic treatment, and to assess the homocysteine levels in the context of major conventional cardiovascular risk factors,” Dr. Tobin said.

Twenty patients, of whom 11 were women, were recruited. Mean age was 42 years, and mean Psoriasis Area and Severity Index (PASI) was 12.8. Twenty age- and sex-matched controls were also enrolled. The patients were evaluated for body mass index (BMI), blood pressure, and levels of glucose, lipids, homocysteine, and folate.

One patient with psoriasis had extremely low levels of folate and also had atrophic gastritis and pernicious anemia and was excluded from further analysis.

Five patients with psoriasis had homocysteine levels of 12 μmol/L or higher, compared with only one control subject. Population-based studies suggest that slightly more than 5% of the general population has elevated homocysteine, which was similar to the figure for the controls in this study. “But with more than 27% of our patients with psoriasis having raised levels of homocysteine, the odds ratio of their having hyperhomocysteinemia was greater than 7,” compared with controls, Dr. Tobin reported.

There was no correlation between levels of homocysteine and PASI. Patients with psoriasis also had a trend for low levels of red-cell folate, but this was not statistically significant. “Hyperhomocysteinemia was not related to either folate status or disease severity in psoriasis patients, as had been supposed,” she said.

Likelihood of high BMI also was increased among psoriasis patients: A total of 17 patients with psoriasis had a BMI greater than 25, compared with only 4 controls. Three of the 17 were clinically obese and 2 were morbidly obese, she noted.

Patients with psoriasis also had significantly raised systolic blood pressure. “However, because diastolic blood pressure was normal and the fact that blood pressure readings were not repeated, we were unsure of the significance of this result,” Dr. Tobin said. She said the significance of the results warrants a large population-based study to identify the risk factors that should be routinely measured in patients with psoriasis.

MANCHESTER, ENGLAND — The latest piece of evidence linking psoriasis with cardiovascular disease suggests that patients with the skin disease are at high risk of having elevated serum levels of homocysteine, Dr. Anne-Marie Tobin said at the annual meeting of the British Association of Dermatologists.

In the general population, hyperhomocysteinemia has been shown to be an independent risk factor for the development of cardiovascular disease, with a magnitude of risk similar to that of smoking and hyperlipidemia. Elevated levels of homocysteine have been linked to atherosclerosis, endothelial damage, and thrombogenesis.

Cardiovascular disease is the leading cause of mortality among patients with psoriasis. The precise reasons why patients with psoriasis are at risk for cardiovascular disease remain unclear, although several possible contributory factors exist. Some of the excess cardiovascular risk may relate to increased rates of smoking and hypertension, risk factors that have been documented in this patient population.

“Moreover, there has been a suggestion from the rheumatology literature that chronic inflammation elevates cardiovascular risk, although this has yet to be confirmed in psoriasis,” said Dr. Tobin of the department of dermatology, Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin.

Patients with psoriasis also have raised levels of lipoprotein A, which further increases risk for coronary heart disease and ischemic stroke. Moreover, small uncontrolled studies have suggested patients with psoriasis may have low levels of folate, which helps break down homocysteine. The accelerated rate of keratinocyte turnover seen in psoriasis is thought to lower levels of folate, she said.

“Based on these observations, we undertook a study to assess homocysteine levels in outpatients with moderate to severe psoriasis who were not on systemic treatment, and to assess the homocysteine levels in the context of major conventional cardiovascular risk factors,” Dr. Tobin said.

Twenty patients, of whom 11 were women, were recruited. Mean age was 42 years, and mean Psoriasis Area and Severity Index (PASI) was 12.8. Twenty age- and sex-matched controls were also enrolled. The patients were evaluated for body mass index (BMI), blood pressure, and levels of glucose, lipids, homocysteine, and folate.

One patient with psoriasis had extremely low levels of folate and also had atrophic gastritis and pernicious anemia and was excluded from further analysis.

Five patients with psoriasis had homocysteine levels of 12 μmol/L or higher, compared with only one control subject. Population-based studies suggest that slightly more than 5% of the general population has elevated homocysteine, which was similar to the figure for the controls in this study. “But with more than 27% of our patients with psoriasis having raised levels of homocysteine, the odds ratio of their having hyperhomocysteinemia was greater than 7,” compared with controls, Dr. Tobin reported.

There was no correlation between levels of homocysteine and PASI. Patients with psoriasis also had a trend for low levels of red-cell folate, but this was not statistically significant. “Hyperhomocysteinemia was not related to either folate status or disease severity in psoriasis patients, as had been supposed,” she said.

Likelihood of high BMI also was increased among psoriasis patients: A total of 17 patients with psoriasis had a BMI greater than 25, compared with only 4 controls. Three of the 17 were clinically obese and 2 were morbidly obese, she noted.

Patients with psoriasis also had significantly raised systolic blood pressure. “However, because diastolic blood pressure was normal and the fact that blood pressure readings were not repeated, we were unsure of the significance of this result,” Dr. Tobin said. She said the significance of the results warrants a large population-based study to identify the risk factors that should be routinely measured in patients with psoriasis.