|Year : 2015 | Volume
| Issue : 4 | Page : 217-220
Atherogenic lipid profile in psoriasis: Correlation with severity and duration of the disease
Chetana Shenoy1, Manjunath Mala Shenoy1, Manjula Shantaram2, B Vishal1, Malcolm Pinto1, Sowmyashree Krishna1
1 Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
2 Department of PG Studies and Research in Biochemistry, PG Center, Chikka Aluvara, Kodagu, Karnataka; Department of Biochemistry, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, India
|Date of Submission||08-Jun-2015|
|Date of Decision||02-Sep-2015|
|Date of Acceptance||17-Oct-2015|
|Date of Web Publication||2-Dec-2015|
Manjunath Mala Shenoy
Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Psoriasis has been considered of late as a dermatological disorder with systemic inflammation that could contribute to various systemic effects like atherogenic dyslipidemia. Materials and Methods: Eighty patients with psoriasis and 80 age and sex matched controls were included in the study for their serum lipid profiles. The lipid values were compared with special emphasis on the duration and severity of the disease. Results: Serum triglycerides were found to be significantly higher in the psoriasis group than in the control group (P ≤ 0.05). No significant difference was found between serum total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) levels in the two groups. However, Low HDL-C levels were found in patients with disease of more than 2 years (P ≤ 0.05) and elevated total cholesterol (P < 0.05), LDL-C (P < 0.05) was found in severe psoriasis (Psoriasis Area and Severity Index >12). Conclusion: Atherogenic dyslipidemia is observed in psoriasis, but the degree of change may vary based on the duration and severity of psoriasis. More studies with a higher sample size are required to obtain longitudinal data for conclusive evidence about the systemic effects on lipid profiles in psoriasis.
Keywords: Atherogenic lipid profile, duration, dyslipidemia, psoriasis, severity
|How to cite this article:|
Shenoy C, Shenoy MM, Shantaram M, Vishal B, Pinto M, Krishna S. Atherogenic lipid profile in psoriasis: Correlation with severity and duration of the disease. J Obes Metab Res 2015;2:217-20
|How to cite this URL:|
Shenoy C, Shenoy MM, Shantaram M, Vishal B, Pinto M, Krishna S. Atherogenic lipid profile in psoriasis: Correlation with severity and duration of the disease. J Obes Metab Res [serial online] 2015 [cited 2020 Feb 28];2:217-20. Available from: http://www.jomrjournal.org/text.asp?2015/2/4/217/170902
| Introduction|| |
Psoriasis is a chronic inflammatory disorder characterized by increased keratinocyte proliferation and alteration in the T-cells, monocytes-macrophages, and neutrophils. The etiology of psoriasis is complex; there appears to be a significant component of autoimmune dysfunction in its basic pathophysiology. It is more properly designated as a genetic, systemic, inflammatory, and chronic disorder of skin with certain systemic components. Its prevalence and exacerbations/remissions are affected by multiple environmental, immune hormonal and mental factors besides, alcohol and drug abuse., The guidelines of management have to consider these influences.
Although traditionally psoriasis has been considered a dermatologic disease, the contemporary medical evidence supports the assertion that psoriasis is actually a multisystem disease. Exploring the correlations between psoriasis and other disease states is increasingly essential to elucidate the comprehensive pathophysiology of this "skin disease." It has been associated with an increased morbidity and mortality from cardiovascular events, especially those with a severe and long duration of psoriatic skin lesions. The reason possibly lies in the chronic inflammatory nature of psoriasis, with increasing evidence that such inflammation plays a significant role in atherogenesis and coronary artery disease. A substantial number of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), IL-2, IL-6, IL-8, IL-12, IL-18, and interferon-gamma (INF-γ), has already been implicated in the generation of atherosclerotic plaques.
Atherogenic dyslipidemia comprises a triad of increase in the small, dense low-density lipoprotein-cholesterol (LDL-C), decreased high-density lipoprotein-cholesterol (HDL-C), and increased triglycerides (TGs) in the blood. Multiple factors like pro-atherogenic lipoprotein profile which includes hypertriglyceridemia raised plasma concentrations of LDL-C, and a lowered HDL-C concentration have been reported to be associated with psoriasis.,, However, the findings of some studies are inconsistent, because of the heterogeneous nature of the study sample and not factoring in the severity and duration of the disease.,,, The studies on the correlation of dyslipidemia with severity and duration of psoriasis are scarce.
The present study was carried out to evaluate the atherogenic lipid profile in patients with psoriasis vis-a-vis a group of controls. In addition, to further evaluate the correlation between atherogenic lipid levels with severity and duration in the groups of psoriasis patients divided accordingly.
| Materials and Methods|| |
The study was conducted in the Department of Dermatology, Yenepoya Medical College hospital, Yenepoya University, Deralakatte, Mangalore, Karnataka, India.
Eighty patients above the age of 18 years who were clinically diagnosed with psoriasis were included in the study. Eighty healthy age and sex matched controls were also studied over this period. Patients with acute febrile illness, active systemic diseases, or events such as arthritis, hepatic disease, renal disease, hypothyroidism, history of hypertension, diabetes and dyslipidemia, malignancies, pregnancy, and patients on lipid-lowering drugs were excluded. Patients on systemic therapy or phototherapy for psoriasis for the past 1 month were also excluded from the study.
An informed consent was taken from the patients and controls willing to participate in the study. Institutional ethics permission was granted. A detailed history was taken. Clinical examination including general, systemic, and dermatological examination was carried out. A detailed history taking included duration of the disease, its severity, joint pains, smoking, alcohol consumption, diet, presence of other systemic illness, past intake of systemic agents for psoriasis, and concomitant intake of medicines for other illnesses. Duration and severity of psoriasis were recorded. The degree of severity of psoriasis was clinically assessed by Psoriasis Area and Severity Index (PASI) score for each patient. Based on the severity, patients were divided into two groups as mild to moderate (PASI ≤ 12) and severe (PASI > 12). Based on the duration of the disease, patients were divided into two groups as ≤2 years and >2 years.
Blood was collected by venipuncture from the patients and controls after they had fasted overnight. Serum was separated, and fasting lipid profile was estimated.
Serum total cholesterol, TGs, and HDL-C levels were measured by a standard enzymatic-colorimetric method. The LDL-C was calculated by the formula LDL-C (mg/dl) = total cholesterol (mg/dl) − HDL-C (mg/dl) − TGs/5 (mg/dl).
The statistical significance was evaluated using Student's unpaired t-test. P < 0.05 was considered as significant.
| Results|| |
The study included 80 psoriatic patients and 80 controls matched for age and gender. Thirty-seven patients had a short duration of the disease, i.e., <2 years, 43 patients had the disease for more than 2 years. Patients had mild psoriasis to severe psoriasis with PASI score ranging from 0.9 to 70.8. Thirty-eight (47.5%) patients had mild to moderate psoriasis (PASI ≤ 12), and 42 (52.5%) had severe psoriasis (PASI > 12).
The values of the lipid profile for the control and psoriasis patient groups are presented in [Table 1]. Serum TGs was found to be significantly higher in the psoriasis group than in the control group (P ≤ 0.05). No significant difference was found between serum total cholesterol, LDL-C and HDL-C levels in the two groups.
|Table 1: Comparison of lipid profile values between controls and psoriasis patients group|
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The values of the lipid profile as compared between the mild to moderate and severe psoriasis patient groups is presented in [Table 2]. Serum total cholesterol (P < 0.05) and LDL-C (P < 0.05) were found to be significantly higher in severe psoriasis group than in mild to the moderate group. No statistically significant differences were found in HDL-C and TG levels between the two groups.
|Table 2: Comparison of lipid profile values between mild to moderate psoriasis and severe psoriasis groups|
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The values of the lipid profile as compared between the patients having short duration of the disease, i.e. <2 years and patients having the disease for more than 2 years is presented in [Table 3]. Serum HDL-C was found to be significantly lower (P ≤ 0.05) in psoriasis patients having a long duration of the disease (>2 years). However, no statistically significant differences were found in other lipid values between the two groups.
|Table 3: Comparison of lipid profile values between psoriasis patients having short duration (<2 years) and long duration (>2 years) of the disease|
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| Discussion|| |
Psoriasis is a chronic inflammatory dermatological condition characterized by increased T-helper-1 and T-helper-17 cell activity. It has been suggested that psoriasis, like atherosclerosis, could have autoimmunity to play a role in its pathogenesis. There are certain immunological similarities between psoriasis and atherosclerosis. In addition, there are similarities in the co-morbidities of both conditions. It is likely that several genes are commonly involved in psoriasis and other complex disorders like atherosclerosis. Furthermore, the cytokines implicated in psoriases such as IL-6, IL-8, INF-γ, IL-1, and IL-17 are also implicated in the generation of pro-atheromatous abnormalities. Dyslipidemia, insulin resistance, endothelial dysfunction, clotting system activation, and pro-oxidative stress are also some of the common factors between these two conditions.
Several studies have shown an association between psoriasis and abnormal metabolism of plasma lipids. However, the association between psoriasis and dyslipidemia is a matter of debate with some inconsistent findings. There have been studies reporting either increased decreased or similar levels for total cholesterol, TG, LDL-C, and HDL-C in psoriatic patients in comparison to the control subjects.,,,,
In our study, we have observed higher total cholesterol, TG and LDL-C levels, and lower HDL-C levels in psoriasis as compared to the control group, but the difference was statistically significant only for TG levels (P ≤ 0.05).
High TGs levels are often seen in some acquired diseases such as uncontrolled diabetes, obesity, smoking, alcoholism, and renal disease., These conditions may share some common pathogenic mechanisms with psoriasis while causing the lipid abnormalities. The factors leading to dyslipidemia in psoriasis may be of a multiple nature; the immune mechanisms involving IL-6 and TNF, C-reactive protein, and cellular oxidative stress may be responsible for the altered lipid metabolism. It has been suggested that continuous separation of psoriatic scales may cause a permanent loss of lipids which may affect serum lipid abnormalities.,
Cardiovascular events occur frequently particularly in psoriasis patients with a severe pattern and a long duration of the disease. However, the severity and duration in most of the studies were not considered. Considering the importance of an altered lipid profile with these determinants, we tried to evaluate lipid values in mild to moderate and severe psoriasis and also in patients with a long and short duration. Correlation between the severity and duration of psoriasis with lipid profile could possibly throw light on dyslipidemia in psoriasis. There is also a need to conduct long-term studies in a large sample.
When lipid profile was compared between various groups based on severity, we observed that serum total cholesterol (P < 0.05) and LDL-C (P < 0.05) were found to be significantly higher in the severe psoriasis group than in the mild to moderate group. No statistically significant differences were found in HDL-C and TG levels between the two groups. This was partially in agreement with a study by Rocha-Pereira et al., 2001 where they found significant differences between total cholesterol, TG, HDL-C and LDL-C in severe psoriasis and mild psoriasis.
However, when lipid profile was compared in groups based on the duration of the disease, only serum HDL-C was found to be significantly lower in patients having a long duration of the disease (>2 years). No statistically significant differences were found in other lipid values between the two groups suggesting that lipid profile abnormalities could be found in psoriasis right from the onset of the disease. A study done by Mallbris et al., which supports the notion that psoriasis could be associated with lipid abnormalities at the onset of the skin disease and lipid abnormalities in psoriasis may be genetically determined rather than acquired. However, psoriasis being a disease with a genetic background with multiple acquired precipitation factors; lipid abnormality may also be influenced by multiple acquired factors.
| Conclusion|| |
Our findings suggest that psoriasis patients must be considered as a group at high risk for cardiovascular disease. These factors may vary based on multiple variables such as duration and severity of the disease. We recommend early screening (from the onset of the disease) for lipid abnormalities and early treatment, which may reduce the risk of atherosclerosis and cardiovascular events in psoriasis patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]