ABC | Volume 113, Nº2, August 2019

Original Article Oliveira et al Cardiovascular risk in psoriasis patients Arq Bras Cardiol. 2019; 113(2):242-249 Table 1 – Anthropometric and lifestyle data, comorbidities, and laboratory test results of patients with psoriasis (n=11) and control subjects (n = 33) Variables Control group (n = 33) Psoriatic group (n = 11) p-value Age (years) 60 ± 9 64 ± 12.5 0.391* Ethnicity 0.479 † White 21 (63.6%) 5 (45.5%) Pardo (multiracial)/Black 12 (36.4%) 6 (54.5%) BSA (m 2 ) 1.92 ± 0.20 1.94 ± 0.23 0.835 ‡ Weight (kg) 79.8 ± 15.1 84.7 ± 21.6 0.494 ‡ BMI (kg/m 2 ) 27.2 ± 4.7 30.9 ± 5.9 0.079 ‡ Waist-hip ratio 0.96 ± 0.06 0.97 ± 0.05 0.576 ‡ Habits Smoking 7 (21.2%) 6 (54.5%) 0.086 † Alcohol consumption 10 (30.3%) 3 (27.3%) 1.000 § Comorbidities Hypertension 11 (33.3%) 7 (63.6%) 0.093 § Dyslipidemia 10 (30.3%) 3 (27.3%) 1.000 § Diabetes mellitus 6 (18.2%) 3 (27.3%) 0.669 § Laboratory tests Total Cholesterol (mg/dL) 198 ± 39.8 252 ± 43.5 < 0.001* HDL Cholesterol (mg/dL) 46 ± 13.5 38 ± 16.5 0.283* LDL Cholesterol (mg/dL) 118 ± 40.8 167 ± 24 < 0.001* C-reactive protein (mg/L) 1 ± 1.2 7.6 ± 35.4 < 0.001* *Wilcoxon Mann-Whitney test for independent samples (mean ± SD), † chi-square test of independence; ‡ Student’s t-test for independent samples (mean ± SD), § Fisher’s exact test; BMI: body mass index; BSA: body surface area. lipoproteins, even with reduced C-reactive protein levels. Thus, in light of the conflicting results of these studies and the low percentage of patients using methotrexate, we infer that the possible influence of medications is not relevant on our result. 37 Among the hemodynamic changes in the PG, the increase in AS, illustrated by an increased PWV, indicates an early vascular aging. 38 Our results are in accordance with previous studies that reported an increase in PWV in psoriasis patients. 39-45 Increased PWV has been considered an important predictive factor for cardiovascular outcomes and higher mortality. 38 Carotid atherosclerosis can be assessed by the IMT measurement and presence of plaques. In our study, we also used imaging test, which confirmed the increased left IMT in the PG. This is in agreement with other studies that showed similar results regardless of other risk factors. 43,44 Comparison of our results with reference values obtained in the ELSA, we showed a higher percentage of patients above the 75 th percentile in the PG. However, this was not true when the results were compared with the MESA. This finding highlights the need for the use of reference tables developed in specific populations. Regarding the presence of plaques, the apparently higher incidence of plaques in PG compared with the CG was not statistically significant, probably due to the sample size. Also, although a higher incidence of diastolic dysfunction in patients with psoriasis was found in the study by Shang et al., 45 we did not find significant differences in echocardiographic parameters between the groups. The increased peripheral and central SBP and DBP values found in the PG may be related to the vascular changes observed in these patients, which has also been described in other studies. 46,47 Although the small number of patients in the PG is a limitations of the study, because of the difficulty in detecting patients who met the inclusion criteria including a PASI>7, we were able to show a close relationship between psoriasis and the factors associated with higher probability to develop cardiovascular outcomes. Such associations, found in moderate-to-severe psoriasis patients, are significantly greater than those reported in the general population. More comprehensive studies, including larger sample sizes are suggested, to demonstrate the importance of other predictive factors of CVDs, including an increased AIx@75 and the IMT of the right carotid artery, which did not show statistical difference in our study. Current guidelines recognize the increased risk for CVDs in patients with psoriasis and the need for its early identification and better stratification. 48 However, predictive algorithms of cardiovascular risk, such as the Framingham risk score, do not consider the systemic inflammatory effect secondary to psoriasis. 9,49 Functional parameters, such as the measurement of the AS, as well as structural parameters, such as the use of cardiac and vascular imaging tests, and laboratory biomarkers could be used to improve the sensitivity of traditional algorithms of risk stratification in patients with psoriasis. 245