|Year : 2016 | Volume
| Issue : 1 | Page : 37-40
Association of dyslipidemia with psoriasis: A case-control study
Tushyata Arora1, Arvind Krishna1, Bhagirath Singh Rathore1, Divya Srivastava2
1 Department of Dermatology, Venereology and Leprology, Swami Vivekanand Subharti University, Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India
2 Department of Physiology, Subharti Medical College, Swami Vivekanand Subharti University, Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India
|Date of Submission||12-Jul-2015|
|Date of Decision||20-Dec-2015|
|Date of Acceptance||20-Apr-2016|
|Date of Web Publication||16-Jun-2016|
B 20, Saket, Meerut - 250 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Psoriasis has recently been recognized as a systemic disease associated with several comorbidities such as obesity and dyslipidemia. These markers have a profound effect on cardiovascular morbidity. Objectives: We aim to evaluate the lipid profiles in patients of psoriasis and compare them with healthy controls to determine any association between psoriasis and lipid abnormalities. Materials and Methods: A case-control study was performed on a study group including 33 patients of clinically proven psoriasis and an equal number of age- and sex-matched healthy volunteers, taken as controls. The fasting serum lipid profile was estimated using J & J Vitros 250 Chemical Analyser (Ortho-Clinical Diagnostics), fully automated analyzer, after a period of 8-12 h of fasting. The data were analyzed by applying t-test for independent samples and Pearson's correlation by using GraphPad. Results: High-density lipoprotein cholesterol levels were found to be significantly lower in cases than in the control group (P = 0.028). There was a significant positive correlation between triglyceride (TG) levels and Psoriasis Area Severity Index or severity of the disease (r = 0.36, P = 0.036). No significant statistical difference was observed between total cholesterol, TGs, and low-density lipoprotein levels of the cases and control groups. Conclusion: The findings demonstrated a possible association between psoriasis and dyslipidemia which underlines the need for early screening of psoriasis patients for this cardiovascular risk factor.
Keywords: Cardiovascular risk factors, cholesterol, dyslipidemia, high-density lipoprotein, lipid, low-density lipoprotein, psoriasis, triglycerides
|How to cite this article:|
Arora T, Krishna A, Rathore BS, Srivastava D. Association of dyslipidemia with psoriasis: A case-control study. J Obes Metab Res 2016;3:37-40
| Introduction|| |
Psoriasis is a chronic and recurrent inflammatory skin disease that affects 1-3% of the world population. , In the recent years, psoriasis has been recognized as a systemic disease associated with numerous multisystem abnormalities and complications. There is an increasing evidence that psoriasis is associated with various diseases such as hypertension, dyslipidemia, diabetes mellitus, atherosclerosis, obesity, and multiple other comorbidities. These comorbidities increase the risk of cardiovascular disease to many folds in such patients, especially when there is an associated atherogenic lipid profile. ,
There is growing evidence in literature that suggests that lipid metabolism plays an important role in the pathogenesis of psoriasis. Various changes in serum lipids, qualitative as well as quantitative, have been observed in the patients of psoriasis that cause an increased risk of atherosclerosis. Since dyslipidemia is an important risk factor for cardiovascular disease, its presence in psoriasis will result in higher morbidity and mortality in these patients.  In addition, if lipid metabolism does prove to be associated with psoriasis, it will immensely affect the management and hence prognosis of the disease. 
There have been many studies conducted on this association of dyslipidemia and psoriasis, but there have been conflicting results in these studies on the above-mentioned issue. ,, Therefore, to address the relationship between psoriasis and the potentially atherogenic lipid profile, we conducted a study to assess the serum lipid levels in psoriasis patients and to investigate the association of dyslipidemia with the disease severity.
| Materials and methods|| |
The study group comprised 33 patients of clinically proven psoriasis of above 18 years of age and an equal number of healthy volunteers, taken as controls, who consented to undergo the required investigations. The patients of both the groups were matched for age and sex. All patients were assessed by a complete medical history and examination. Patients who had taken oral retinoids or oral steroids for the management of psoriasis or other diseases in the last 3 months were excluded from the study. Patients who had taken any medications known to affect carbohydrate or lipid metabolisms, including hormonal contraception or statins, in the last 3 months were also excluded from the study. Other exclusion criteria included pregnant and lactating females and patients with advanced renal, hepatic, metabolic, and endocrinal diseases, which may have possible cardiovascular risk/association or dyslipidemia. A detailed examination including morphological type of psoriasis and area of involvement by the rule of nines was performed. Psoriasis Area Severity Index (PASI) was calculated for all patients. A written informed consent was taken from all patients fulfilling the inclusion criteria. Institutional Ethical Committee clearance was obtained prior to the commencement of the study.
Fasting serum lipid profile was estimated using Vitros 250, fully automated analyzer, after a period of 8-12 h of fasting.
The data were presented as mean ± standard deviation and analyzed by applying Student's t-test for independent samples using SPSS software version 11 (Chicago, Illinois, USA). Pearson's correlation by using GraphPad (GraphPad Software Inc, Version 6, CA, USA) was calculated to assess any association between lipid profile parameters and PASI. The level of significance was taken as 0.05.
| Results|| |
Clinical characteristics of patients in both the groups are shown in [Table 1]. They do not differ with respect to age or sex. The mean duration of disease of psoriasis patients was 8.04 ± 8.72, the range varying from 4 months to 30 years. The mean body surface area was 24.8% ± 20.8 and the mean PASI was 15.58 ± 9.8. Chronic plaque psoriasis was the most common type observed (79%) and the rest of the types corresponded to guttate (9%), flexural (3%), pustular (3%), erythrodermic (3%), and palmo-plantar psoriasis (3%).
High-density lipoprotein (HDL) cholesterol levels were found to be significantly lower in the case group than in the control group [Table 2], P value being 0.028. A higher trend was seen in total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL) cholesterol, and very LDL (VLDL) cholesterol among cases, but the data were not statistically significant.
Upon calculating Pearson's correlation [Table 3], there was a significant positive correlation between TG levels and PASI or severity of the disease (r = 0.36, P = 0.036). This indicated that with increasing PASI score in patients, increasing levels of serum TGs were seen.
|Table 3: Pearson's correlation between lipid parameters and psoriasis area and severity index in patients of psoriasis |
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| Discussion|| |
Lipid metabolism studies in psoriasis were started at the beginning of the 20 th century. The studies primarily concentrated on skin surface lipids, stratum corneum lipids, epidermal phospholipids, dermal LDLs in the psoriatic skin, lipid metabolism, oxidative stress, serum lipids and correlations between inflammatory parameters, lipid parameters, and clinical symptoms of the disease. Psoriasis, hereby, may be described as an immunometabolic disease.  Dyslipidemia encompasses both the abnormalities of serum lipid concentration as well as its composition. Several mechanisms have been proposed regarding the association between dyslipidemia and psoriasis. These include the activation of Th1 cells, autoantibodies recognizing oxidized LDL, cytokines interleukin 1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-α). These cytokines that mediate psoriasis may alter the function of hepatocytes resulting in altered lipoprotein composition. Some studies suggest that these cytokines may elevate the lipid levels by augmenting lipolysis and stimulating de novo fatty acid synthesis in the liver. Psoriasis has been associated with diverse findings in plasma lipid concentrations in various different studies. ,, Reynoso-von Drateln et al.  conducted a study on 22 psoriasis patients and 22 controls, they observed that HDL levels were significantly lower in the psoriasis group than in the control. In another study conducted by Rocha-Pereira et al., risk changes in the whole spectrum of lipid profile were observed in psoriasis patients including a rise in TC (P < 0.01), TG (P < 0.001), LDL (P < 0.01), VLDL (P < 0.01), apolipoprotein B (P < 0.001), and a reduction in HDL (P < 0.001).  In our study, we observed significantly lower HDL concentrations in psoriasis cases as compared to controls (P = 0.028). These findings are concordant with the above-mentioned studies. HDL exerts antioxidant, anti-inflammatory, antithrombotic, and fibrinolytic actions; it is a very important factor in the reversal of cholesterol transport and takes part in the transport of cholesterol produced or accumulated in the peripheral tissues to the liver or other steroidogenic tissues. Psoriatic HDL has been found to contain reduced quantity of phospholipid and cholesterol. These alterations in its composition impair the ability of psoriatic HDL to promote cholesterol efflux from macrophages. This change in its composition also reflects a shift to a proinflammatory profile seen in psoriatic patients.  Holzer et al.  demonstrated in an open-label, uncontrolled study that not only the function of HDL is impaired in psoriasis, it has also been seen to improve after the successful treatment of psoriasis. However, some studies have observed no statistical difference between HDL levels of cases and controls while others have observed even significantly elevated levels of the same in psoriasis. , Therefore, further studies on this association of HDL and psoriasis are needed. Studies also show higher levels of TC, LDL, and TGs in psoriasis patients. , Although we did observe dyslipidemia in our study, the data were not statistically significant. This may be due to the limitation of the study, i.e., having a small sample size. We observed a significant positive correlation between TGs and PASI. Studies have found a dose-dependent rise in TGs with an increase in body surface area of patients suffering from psoriasis. ,,,, The proposed underlying mechanisms for this are the presence of increased levels of Th1 cell cytokines including IL-1, IL-6, and TNF-α. These cytokines are involved in the inhibition of lipoprotein lipase activity, which results in decreased TG clearance and increased plasma TG levels. ,,
| Conclusion|| |
The results of this study firmly establish that lipid abnormalities, especially in the HDL component, are an important comorbidity with psoriasis. In addition, vigilance and enhanced screening may be important in psoriasis patients, particularly with the severity of the disease. The role of drugs such as statins and lifestyle modification (diet, exercise, and yoga) may improve the serum lipid levels, especially HDL may be correlated with psoriasis in future studies.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]