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Psoriasis therapy and cardiovascular risk factors: a 12-week follow-up study.

Abstract

BACKGROUND

Psoriatic patients present with an increased frequency of cardiovascular events.

OBJECTIVE

To study the impact of psoriasis duration and therapy on traditional and new cardiovascular risk factors.

STUDY DESIGN

A longitudinal study performed between 2005 and the first trimester of 2008. Each patient was followed up for 12 weeks, and was observed before and 3, 6, and 12 weeks after starting therapy.

SETTING

Patients attending the Dermatology Service, University Hospital of Coimbra, Coimbra, Portugal were enrolled.

SUBJECTS

Thirty-four patients with psoriasis vulgaris and 37 healthy volunteers as controls.

MAIN OUTCOME MEASURES

Psoriasis Area and Severity Index (PASI); lipid profile, oxidized low-density lipoprotein (oxLDL), oxLDL/low-density lipoprotein (LDL), total antioxidant status, lipid peroxidation, C-reactive protein (CRP), and circulating levels of adiponectin.

INTERVENTION

Ten patients started therapy with topical treatment, 11 with narrow-band UVB radiation (NB-UVB), and 13 with psolaren plus UVA (PUVA).

RESULTS

Before starting therapy, psoriatic patients presented with several risk changes in their lipid profiles, and significantly higher CRP, oxLDL, and oxLDL/LDL, and lower adiponectin levels (vs control subjects), which may further contribute to inflammation and atherogenesis. After treatment of the patients, although no significant differences were observed in the lipid profile compared with baseline, some changes suggested that the treatment could somehow alter lipid metabolism, as the reduction in high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A and the increase in the atherogenic index cholesterol/HDL-C maintained an even higher significance (as shown by p-values) when compared with the control group. After topical therapy, there was a significant reduction in thiobarbituric acid reactivity only, suggesting that the reduction in the hyperproliferative process within the lesions is important for lipid peroxidation. After NB-UVB therapy, oxLDL/LDL, cholesterol/HDL-C, lipoprotein (a) [Lp(a)], and CRP remained higher than in the control subjects, reflecting persistent inflammation and atherogenic risk. After PUVA treatment, there was a significant reduction in Lp(a), associated with an almost significant increase in apolipoprotein-B (p = 0.054); these changes were not observed after NB-UVB treatment. However, after PUVA and NB-UVB treatment, CRP and, in the NB-UVB group, oxLDL/LDL were persistently higher than controls.

CONCLUSION

Our data show that psoriatic patients present with several lipid profile changes that seem to be related to the severity of the disease and/or the treatment used. Mild psoriasis patients receiving topical treatment presented before starting therapy with a lipid profile similar to controls, whereas those undergoing NB-UVB and PUVA, who had higher PASI scores, presented with several risk factors. Moreover, PUVA therapy seems to interact in a different way with lipids that might result from an interaction of psoralen with plasma lipids, namely Lp(a). Inflammation, a hallmark of psoriasis, also seems to be related to psoriasis severity. Both NB-UVB and PUVA were effective, as shown by the reduction in PASI score, as well as in the oxidative and inflammatory stress markers. However, after NB-UVB and PUVA, a low-grade inflammatory process still persisted, which might be related to the duration of remission of the disease.

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  • Authors+Show Affiliations

    ,

    Serviço de Bioquímica, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal. ssn.coimbra@gmail.com

    , , , , , , , , ,

    Source

    American journal of clinical dermatology 11:6 2010 Dec 01 pg 423-32

    MeSH

    Adiponectin
    Adult
    Betamethasone
    Biomarkers
    C-Reactive Protein
    Calcitriol
    Cardiovascular Diseases
    Combined Modality Therapy
    Dermatologic Agents
    Follow-Up Studies
    Glucocorticoids
    Humans
    Lipid Metabolism
    Lipids
    Longitudinal Studies
    Male
    Middle Aged
    Oxidative Stress
    PUVA Therapy
    Psoriasis
    Risk Factors
    Severity of Illness Index
    Ultraviolet Therapy

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20429617

    Citation

    Coimbra, Susana, et al. "Psoriasis Therapy and Cardiovascular Risk Factors: a 12-week Follow-up Study." American Journal of Clinical Dermatology, vol. 11, no. 6, 2010, pp. 423-32.
    Coimbra S, Oliveira H, Reis F, et al. Psoriasis therapy and cardiovascular risk factors: a 12-week follow-up study. Am J Clin Dermatol. 2010;11(6):423-32.
    Coimbra, S., Oliveira, H., Reis, F., Belo, L., Rocha, S., Quintanilha, A., ... Santos-Silva, A. (2010). Psoriasis therapy and cardiovascular risk factors: a 12-week follow-up study. American Journal of Clinical Dermatology, 11(6), pp. 423-32. doi:10.2165/11319310-000000000-00000.
    Coimbra S, et al. Psoriasis Therapy and Cardiovascular Risk Factors: a 12-week Follow-up Study. Am J Clin Dermatol. 2010 Dec 1;11(6):423-32. PubMed PMID: 20429617.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Psoriasis therapy and cardiovascular risk factors: a 12-week follow-up study. AU - Coimbra,Susana, AU - Oliveira,Hugo, AU - Reis,Flávio, AU - Belo,Luís, AU - Rocha,Susana, AU - Quintanilha,Alexandre, AU - Figueiredo,Américo, AU - Teixeira,Frederico, AU - Castro,Elisabeth, AU - Rocha-Pereira,Petronila, AU - Santos-Silva,Alice, PY - 2010/5/1/entrez PY - 2010/5/1/pubmed PY - 2011/1/6/medline SP - 423 EP - 32 JF - American journal of clinical dermatology JO - Am J Clin Dermatol VL - 11 IS - 6 N2 - BACKGROUND: Psoriatic patients present with an increased frequency of cardiovascular events. OBJECTIVE: To study the impact of psoriasis duration and therapy on traditional and new cardiovascular risk factors. STUDY DESIGN: A longitudinal study performed between 2005 and the first trimester of 2008. Each patient was followed up for 12 weeks, and was observed before and 3, 6, and 12 weeks after starting therapy. SETTING: Patients attending the Dermatology Service, University Hospital of Coimbra, Coimbra, Portugal were enrolled. SUBJECTS: Thirty-four patients with psoriasis vulgaris and 37 healthy volunteers as controls. MAIN OUTCOME MEASURES: Psoriasis Area and Severity Index (PASI); lipid profile, oxidized low-density lipoprotein (oxLDL), oxLDL/low-density lipoprotein (LDL), total antioxidant status, lipid peroxidation, C-reactive protein (CRP), and circulating levels of adiponectin. INTERVENTION: Ten patients started therapy with topical treatment, 11 with narrow-band UVB radiation (NB-UVB), and 13 with psolaren plus UVA (PUVA). RESULTS: Before starting therapy, psoriatic patients presented with several risk changes in their lipid profiles, and significantly higher CRP, oxLDL, and oxLDL/LDL, and lower adiponectin levels (vs control subjects), which may further contribute to inflammation and atherogenesis. After treatment of the patients, although no significant differences were observed in the lipid profile compared with baseline, some changes suggested that the treatment could somehow alter lipid metabolism, as the reduction in high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A and the increase in the atherogenic index cholesterol/HDL-C maintained an even higher significance (as shown by p-values) when compared with the control group. After topical therapy, there was a significant reduction in thiobarbituric acid reactivity only, suggesting that the reduction in the hyperproliferative process within the lesions is important for lipid peroxidation. After NB-UVB therapy, oxLDL/LDL, cholesterol/HDL-C, lipoprotein (a) [Lp(a)], and CRP remained higher than in the control subjects, reflecting persistent inflammation and atherogenic risk. After PUVA treatment, there was a significant reduction in Lp(a), associated with an almost significant increase in apolipoprotein-B (p = 0.054); these changes were not observed after NB-UVB treatment. However, after PUVA and NB-UVB treatment, CRP and, in the NB-UVB group, oxLDL/LDL were persistently higher than controls. CONCLUSION: Our data show that psoriatic patients present with several lipid profile changes that seem to be related to the severity of the disease and/or the treatment used. Mild psoriasis patients receiving topical treatment presented before starting therapy with a lipid profile similar to controls, whereas those undergoing NB-UVB and PUVA, who had higher PASI scores, presented with several risk factors. Moreover, PUVA therapy seems to interact in a different way with lipids that might result from an interaction of psoralen with plasma lipids, namely Lp(a). Inflammation, a hallmark of psoriasis, also seems to be related to psoriasis severity. Both NB-UVB and PUVA were effective, as shown by the reduction in PASI score, as well as in the oxidative and inflammatory stress markers. However, after NB-UVB and PUVA, a low-grade inflammatory process still persisted, which might be related to the duration of remission of the disease. SN - 1179-1888 UR - https://www.unboundmedicine.com/medline/citation/20429617/Psoriasis_therapy_and_cardiovascular_risk_factors:_a_12_week_follow_up_study_ L2 - https://dx.doi.org/10.2165/11319310-000000000-00000 DB - PRIME DP - Unbound Medicine ER -