engleski

The potential of utilizing laser doppler flowmetry and serum levels of homocysteine for the assessment of cardiovascular risk in psoriasis patients

Background: Psoriasis is a common chronic inflammation-driven skin disease associated to various comorbidities, including hypertension, diabetes, hyperlipidemia, atherosclerosis, inflammatory bowel disease etc. These comorbidities additionally deteriorate general health of psoriasis patients and can lead to increased cardiovascular disease (CVD) morbidity and mortality. Study design: This is a pilot study including psoriasis patients (n=9) and sex- and age- matched healthy controls (n=4). Group of psoriasis patients included 4 patients receiving adalimumab for more than 6 months and 5 patients currently without any systemic therapy. Patients were selected from the register of psoriasis patients. During outpatient visit we have assessed psoriasis area and severity index (PASI) and dermatology life quality index (DLQI) and the blood was taken for the assessment of inflammation parameters. Laser Doppler flowmetry (LDF) (MoorVMS-LDF, Axminster, UK) was used to assess microvascular function by evaluation of endothelium-dependent (post- occlusive reactive hyperemia (PORH), acetylcholine (ACh)-induced vasodilation) and endothelium-independent (sodium nitroprusside (SNP)-induced) vasodilation. Homocysteine, high sensitive C- reactive protein, fibrogen levels and the sedimentation rate were determined in the routine biochemical laboratory of the University Hospital Osijek. The study was approved by the Ethical Committee of the University Hospital Osijek, and all participants signed informed consent. Results: Psoriasis patients had significantly higher levels of homocysteine compared with their age- and sex- matched controls (p=0.038). Their homocysteine levels, in most of the cases, fell within the reference range of our laboratory (4.45 to 12.42 µmol/L). Furthermore, homocysteine levels positively correlated to sedimentation rate (r=0.618 ; p=0.043, Persons correlation). We have failed to show a significant difference in microvascular reactivity in psoriasis patients compared with healthy controls ; however, there was a significant positive correlation between sedimentation rate and PORH (r=0.703, p=0.023, Persons correlation), and sedimentation rate and ACh-mediated vasodilatation (r=0.730, p=0.16, Persons correlation). Similarly, a positive correlation was also found between fibrinogen and PORH (r=0.601, p=0.05, Persons correlation). Conclusions: Microvascular reactivity determined by LDF and serum homocysteine levels positively correlated with systemic inflammation assessed by sedimentation rate and fibrinogen, thus LDF and homocysteine levels have the potential for the utilization in the assessment and follow-up of cardiovascular risk in psoriasis patients. An additional effort is needed for increasing the awareness of dermatologists, general practitioners and cardiologist about the increased risk for CVD and the beneficial effects of early adaptation of preventive measures and better control of primary disease.

psoriasis, endothelial function, inflammation

nije evidentirano