ABSTRACT: Introduction:Psoriasis is a chronic inflammatory skin disease associated with increased risk of cardiovascular disease (CVD). We have previously shown that psoriasis is associated with atherogenic lipoprotein particle concentration and size. However, it is unknown whether this association is independent of traditional CVD risk factors or insulin resistance (IR).
Methods: We prospectively enrolled a consecutive sample of patients with psoriasis (n=122) and compared cardiometabolic risk factors with an asymptomatic sample without psoriasis from our practice (n=129). Fasting lipids, insulin, glucose were measured by standard assays, and lipoprotein concentration and size were measured by nuclear magnetic resonance (NMR) (LipoScience, North Carolina). HOMA-IR, an estimation of IR, was calculated by standard methods. Multivariable linear regression for adjusted models was performed using STATA12 software.
Results: LDL-C and HDL-C were lower in psoriasis compared to controls [106.9 mg/dL (90-132.5) vs 128 (110.2-145.6), p<0.01 and 43 mg/dL (36-58) vs 50 (42-62), p<0.01] with no difference in triglycerides. However, NMR showed an atherogenic profile in psoriasis similar to that observed in diabetes, with significant increase in LDL [1210.5 (1002-1498) vs 1115 (935-1291), p=0.03] particle concentration with a concomitant decrease in LDL size [20.6 (20.3-21.1) vs 21.3 (20.6-21.1), p<0.001] even after adjusting for obesity, tobacco use, hypertension, lipids, and HOMA-IR (p=0.001). An increase in VLDL particle concentration was also seen before [61.9 (38.3-95.3) vs 53.4 (30.4-84.5), p=0.05] and after adjusting for cardiometabolic risk factors (p=0.018).
Conclusions: Despite normal lipids, we demonstrate a more atherogenic lipoprotein profile by NMR in psoriasis compared to healthy controls after adjustment for CVD risk factors and IR. These findings suggest that traditional risk factor analysis and lipid testing may not ideally capture the increased CVD risk observed in psoriasis.
Circulation 03/2012; 125(10):A012. · 14.74 Impact Factor