ABC | Volume 113, Nº2, August 2019

Original Article Cardiovascular Risk in Psoriasis Patients: Clinical, Functional and Morphological Parameters Angélica Navarro de Oliveir a, Marcela M. Simões, Ricardo Simões, Marcus Vinicius Bolivar Malachias , Bruno Almeida Rezend e Faculdade de Ciências Medicas de Minas Gerais - Instituto de Pós-Graduação, Belo Horizonte, MG – Brazil Mailing Address: Angélica Navarro Navarro de Oliveira • Faculdade de Ciências Medicas de Minas Gerais - Instituto de Pós- Graduação - Alameda Ezequiel Dias, 275. Postal Code 30130-110, Belo Horizonte, MG – Brazil Email: angelicanavarro@terra.com.br Manuscript received June 17, 2018, revised manuscript October 27, 2018, accepted November 21, 2018 DOI: 10.5935/abc.20190123 Abstract Background: Psoriasis correlates with metabolic disorders, early atheromatosis and increased cardiovascular risk. Objectives: To assess markers of cardiovascular disease in psoriatic patients. Methods: Cross-sectional,observationalstudyinvolving11psoriaticparticipantsand33controls.Anthropometric,biochemical, hemodynamic and imaging parameters were evaluated. Arterial stiffness was assessed by oscillometric measurement of the brachial artery. Intima-media thickness (IMT) and left ventricular diastolic function were assessed by Doppler echography and echocardiography. Between-group comparisons of numerical variables were performed by the Student’s t-test or Wilcoxon Mann-Whitney test for independent samples. Significance level was set at 5%. Results: Psoriatic patients showed increased pulse wave velocity (PWV) (9.1 ± 1.8 vs 8.0 ± 2 m/s, p = 0.033), IMT of the left common carotid artery (p = 0.018) and a higher percentage of patients above the 75 th percentile according to the ELSA table when compared with controls (54.5 vs 18.2%, p = 0.045). Psoriatic patients also showed an increase in peripheral/ central systolic blood pressure (137.1 ± 13.2 vs 122.3 ± 11.6 mmHg, p = 0.004)/(127 ± 13 vs 112.5 ± 10.4 mmHg, p = 0.005), peripheral/central diastolic blood pressure (89.9 ± 8.9 vs 82.2 ± 8, p = 0.022)/(91 ± 9.3 vs 82.2 ± 8.3, p = 0.014), total cholesterol (252 ± 43.5 vs 198 ± 39.8 mg/dL, p < 0.001), LDL cholesterol (167 ± 24 vs 118 ± 40.8 mg/dL, p < 0.001) and C-reactive protein (7.6 ± 35.4 vs 1 ± 1.2 mg/L p < 0.001) compared with controls. Conclusion: Psoriasis patients show increased PWV, IMT, peripheral and central blood pressures, and serum cholesterol and C-reactive protein levels, denoting a higher cardiovascular risk. (Arq Bras Cardiol. 2019; 113(2):242-249) Keywords: Cardiovascular Diseases; Psoriasis; Arterial Stiffness; Hypertension; Hypercholesterolemia; Oscillometry/ mehods; Brachial Artery. Introduction Psoriasis is an immune-mediated, recurrent chronic inflammatory disease of the skin and joints, affecting 2-4% of the adult population in the world. 1,2 Vulgar psoriasis is the most common type and occurs in 85-90% of psoriasis patients. It is phenotypically characterized by dry, red, scaly, silvery‑white, well-defined plaques that appear mainly on elbows, knees, scalp, and the lumbar area. 3 The cause of psoriasis is multifactorial, with numerous key components including genetic susceptibility, environmental triggers in combination with skin barrier disruption and immune dysfunction. 3,4 Similarly to other autoimmune diseases, psoriasis is associated with well-documented systemic changes, including joint, endocrine, and cardiovascular dysfunctions. 5-8 Atherosclerosis is considered a chronic inflammatory disease of blood vessels and one of the most common mechanisms involved in the development of cardiovascular diseases (CVDs). The incidence of atherosclerosis is increased in psoriatic patients and seems to be directly associated with the severity of skin manifestations in these patients. 6 In addition, previous epidemiological studies have shown the high prevalence of cardiovascular risk factors in psoriatics, including metabolic syndrome, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidemia. 6,7,9-11 CVDs are the main cause of mortality in Brazil and in the world. For this reason, it is important to identify and correct their risk factors. 12-14 There are several clinical and subclinical markers for early detection of cardiovascular risk, including physical examination findings, and metabolic, functional and imaging tests. 15 Considering the close relationship between psoriasis and cardiovascular events, this study aimed to investigate subclinical cardiovascular change, measured by arterial stiffness (AS), common carotid artery intima-media thickness (IMT), and left ventricle diastolic dysfunction (LVDD), in addition to clinical and laboratory parameters in patients with moderate-to-severe psoriasis. The detection of these changes would contribute to early preventive and therapeutic measures. 242