Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis.

OZET soriasis is a chronic, multigenic immune/inflammatory-mediated disorder associated with serious medical comorbidities. In previous clinical studies, the relationship between psoriasis and an increased risk of cardiovascular disease has already been demonstrated.[1,2] Inflammation and the accompanying elevation in the homocysteine and C-reactive protein (CRP) levels, the increased platelet activation, and cytokine imbalance between coagulation-fibrinolysis seem to be responsible for this relationship. The increase in the incidence of classic atherosclerotic risk factors and treatment with immunosuppressive agents contribute to the development of atherosclerosis in patients with psoriasis.[3,4] Carotid intima-media thickness (CIMT), flowmediated dilation (FMD) and pulse wave velocity (PWV) measurements are methods used to determine subclinical atherosclerosis in inflammatory diseases such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).[5-7] Endothelial dysfunction is a marker of the vascular damage preceding the development of the atherosclerotic plaques. The inhibition of nitric oxide (NO) synthesis by chemical or mechanical stimulation or of the vascular response to NO is the mechanism responsible for the endothelial dysfunction. Endothelial injury results in reduced arterial elasticity and increased arterial stiffness. Arterial stiffness is assessed by the degree of increase in the PWV. Previous studies have demonstrated that increased arterial stiffness is a marker of increased cardiovascular mortality and morbidity.[8,9] The increase in the CIMT develops subsequent to intimal smooth muscle proliferation and the accumulation of atherogenic particles. Measurement of the CIMT can be used for an early diagnosis of atherosclerosis, risk stratification and the assessment of the response to treatment. CIMT was found to be increased in patients with psoriatic arthritis independently from the atherosclerotic risk factors. However, the presence of coexisting atherosclerotic risk factors may further increase the CIMT. Proinflammatory cytokines produced by type 1 T-helper lymphocytes such as TNF-α and interferon are important participants in plaque formation and in the development of endothelial dysfunction and atherosclerosis in patients with psoriasis.[10-12] This study aimed to investigate the relationship between subclinical atherosclerosis and plaque-type psoriasis without the traditional risk factors for atherosclerosis. In addition, the contribution of the atherosclerotic risk factors within the normal range to the condition using the PWV analysis and CIMT measurement methods were investigated. PATIENTS AND METHODS For the purposes of this study, 57 consecutive patients with plaque-type psoriasis (31 males, 26 females; mean age 41±10.8 years) and 60 healthy, sexand agematched individuals (32 males, 28 females; mean age 40±9.4 years) were enrolled between October 2008 and November 2009. The psoriatic patients were clinically diagnosed, and the diagnosis was confirmed through a histopathological examination in rare cases. Informed consent forms were obtained from every individual included in the study. The study was approved by the local ethics committee of the university. The exclusion criteria for the study included hypertension, hyperlipidemia, diabetes mellitus, any malignancies, systemic inflammation associated with the disease, previous history of cardiovascular disease, renal and liver insufficiency, psoriatic arthritis, severe forms of psoriasis such as erythrodermic psoriasis, systemic immunosuppressive therapy within the last 6 months, smoking, and a body mass index (BMI) >30 kg/m2. In the patient group, the severity of the psoriasis was evaluated using the psoriasis area and severity index (PASI) score. The blood pressure and heart rate of all the individuals were measured after a 15-minute rest. The biochemical parameters were obtained from venous blood samples drawn after an 8-hour fasting period. Pulse wave velocity and carotid intima-media thickness measurement CIMT measurements of the individuals were performed by a physician blinded to the patients and the obtained PWV values. Both common carotid arteries were visualized using the Toshiba Powervision 7500 (Toshiba AG) ultrasound device with a 7.5 MHz linear probe. The maximum and mean thicknesses were calculated based on the values obtained from a pre-deDetermination of subclinical atherosclerosis in plaque type psoriasis patients 575