Abstract
Background
Psoriasis, a chronic inflammatory immune disorder, has been linked to increased cardiovascular mortality and morbidity. Leptin, an obesity-related peptide, has been shown to exert direct effects on the vascular endothelium and on vascular smooth muscle cells. Carotid intima-media thickness (IMT) measurement is a promising tool for detecting atherosclerosis in its pre-occlusive/subclinical phase.
Objective
The objective of the study was to evaluate carotid IMT and serum leptin levels in psoriatic patients as an indicator of subclinical atherosclerosis.
Materials and methods
The study was conducted in 50 psoriatic patients and 10 healthy controls. The clinical severity of skin affection in psoriatic patients was estimated using the psoriatic area and severity index (PASI). Serum leptin levels (ng\ml) and lipid profiles [including serum triglyceride (TG), serum low density lipoproteins (LDL) and serum high density lipoproteins (HDL)] were measured from blood samples. Carotid IMT was measured using carotid duplex ultrasonography.
Results
Psoriatic patients showed significantly higher leptin levels and higher IMT than controls. The mean of the intima-media thickness of the four vessels examined (MIMT) showed a positive correlation with patients’ mean ages, disease duration, body mass index, PASI scores, systolic blood pressure, diastolic blood pressure, leptin levels, LDL levels and triglyceride levels and no correlation with the mean HDL level.
Conclusion
Psoriasis is an independent risk factor for subclinical atherosclerosis. This cardiovascular impairment is influenced mainly by disease severity, serum TG levels and serum leptin levels.
Zusammenfassung
Hintergrund
Psoriasis, eine chronisch-entzündliche Autoimmunkrankheit, wird mit erhöhter kardiovaskulärer Mortalität und Morbidität in Verbindung gebracht. Bei Leptin, einem adipositasbezogenen Peptid, wurde nachgewiesen, dass es eine direkte Wirkung auf Endothel und glatte Muskelzellen der Gefäße hat. Die Messung der Karotis-Intima-Media-Dicke („intima-media thickness“, IMT) ist ein vielversprechendes Instrument zur Erkennung der Arteriosklerose und ihrer präokklusiven/subklinischen Phase.
Ziel
Ziel der Studie war die Bestimmung der Karotis-IMT und des Serumleptinspiegels bei Psoriasispatienten als Indikator einer subklinischen Arteriosklerose.
Material und Methoden
Die Studie wurde mit 50 Psoriasispatienten und 10 gesunden Kontrollen durchgeführt. Bei den Patienten wurde der klinische Schweregrad der Hautaffektion anhand des PASI („psoriatic area and severity index“) erhoben. Anhand von Blutproben wurden Serumleptinspiegel (ng\ml) und Lipidprofile [einschließlich Triglyzeride (TG), LDL („low-density lipoprotein“) und HDL („high-density lipoprotein“) im Serum] gemessen. Die Karotis-IMT wurde mit der Karotisduplexsonographie ermittelt.
Ergebnisse
Bei den Psoriasispatienten waren signifikant höhere Leptinspiegel und eine höhere IMT als bei den Kontrollen nachzuweisen. Das Mittel der IMT für die vier untersuchten Gefäße zeigte eine positive Korrelation mit den Durchschnittswerten für Patientenalter, Krankheitsdauer, Body-Mass-Index, PASI, systolischem und diastolischem Blutdruck, Leptin, LDL und TG, aber keine Korrelation mit dem durchschnittlichen HDL-Wert.
Fazit
Psoriasis ist ein unabhängiger Risikofaktor für subklinische Arteriosklerose. Diese kardiovaskuläre Erkrankung wird hauptsächlich durch die Krankheitsschwere sowie die TG- und Leptinwerte im Serum beeinflusst.
Similar content being viewed by others
References
Naldi L, Chatenoud L, Linder D et al (2005) Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 125:61–67
Otero M, Lago R, Lago F et al (2005) Leptin from fat to inflammation: old questions and new insights. FEBS Lett 579:295–301
Fujita Y, Murakami M, Ogawa Y et al (2002) Leptin inhibits stress-induced apoptosis of T lymphocytes. Clin Exp Immunol 128:21–26
Conus C, Bruno A, Simon HU (2005) Leptin is an eosinophil survivor factor. J Allergy Clin Immunol 116:1128–1134
Aktan F, Rota S, Erdogan BS et al (2007) A Role of leptin in psoriasis? Turk J Med Sci 37(3):135–138
Parhami F, Tintut Y, Ballard A et al (2001) Leptin enhances the calcification of vascular cells: artery wall as a target of leptin. Circ Res 88:954–960
Reilly MP, Iqbal N, Schutta M et al (2004) Plasma leptin levels are associated with coronary athero-sclerosis in type 2 diabetes. J Clin Endocrinol Metab 89:3872–3878
Van der Vleuten GM, Veerkamp MJ, Tits LJ van et al (2005) Elevated leptin levels in subjects with familial combined hyperlipidemia are associated with the increased risk for CVD. Atherosclerosis 183:355–360
Wallace AM, McMahon AD, Packard CJ, Kelly A et al (2001) Plasma leptin and the risk of cardiovascular disease in the west of Scotland coronary prevention study (WOSCOPS). Circulation 104:3052–3056
Kremers H, McEvoy M, Dann F et al (2007) Heart disease in psoriasis. J Am Acad Dermatol 57:347–354
Hansa G, Bhargava K, Bansal M et al (2003) Carotid intima-media thickness and coronary artery disease: an indian perspective. Asian Cardiovasc Thorac Ann 11:217–221
Trigaux JP, Delchambre F, Van Beers (1990) B Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography. Br J Radiol 63:181–185
Patel MR, Kuntz KM, Klufas RA et al (1995) Preoperative assessment of the carotid bifurcation. Can magnetic resonance angiography and duplex ultrasonography replace contrast arteriography? Stroke 26:1753–1758
Moll J, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78
Fredricksson T, Petterson U (1978) Severe psoriasis: oral therapy with a new retinoid. Dermatologica 157:238–244
Shikiar R, William MK, Okun MM et al (2006) The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of phase II study. Health Qual Life Outcomes 4:71
Wikstrand J, Windelhag I (1994) Methodological considerations of ultrasound investigation of intima-media thickness and lumen diameter. J Int Med 236:555–559
Mazlan SA, Bin Mohamed Said MS, Hussein H et al (2009) A study of intima media thickness and their cardiovascular risk factors in patients with psoriatic arthritis. Acta Medica (Hradec Kralove) 52(3):107–116
Peters MJ, Van der Horst-Bruinsma IE, Dijkmans BA et al (2004) Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 34:585–592
Sattar N, McInnes IB (2005) Vascular comorbidity in rheumatoid arthritis: potential mechanisms and solutions. Curr Opin Rheumatol 17:286–292
Youssef SS, Hosny S, Bakr I et al (2009) Susceptibility to atherosclerosis in patients with psoriasis and psoriatic arthritis as determined by increased carotid artery intima-media thickness. J Pan-Arab League of Dermatologists 20:159–172
Tanaka S, Inoue S, Isoda F et al (1993) Impaired immunity in obesity: suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord 17:631–636
Tanaka S, Isoda F, Ishihara Y et al (2001) T lymphopaenia in relation to body mass index and TNF-alpha in human obesity: adequate weight reduction can be corrective. Clin Endocrinol 54:347–354
Chen Y, Wu C, Shen J et al (2008) Psoriasis independently associated with hyperleptinemia contributing to metabolic syndrome. Arch Dermatol 144:1571–1575
Cerman AA, Bozkurt S, Sav A et al (2008) Serum leptin levels, skin leptin and leptin receptor expression in psoriasis. Br J Dermatol 159:820–826
Wakkee M, Thio HB, Prens EP et al (2007) Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients. Atherosclerosis 190:1–9
O’Leary DH, Polak, JF, Kronmal, RA et al (1999) Carotid- artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group. N Engl J Med 340:14–22
Iribarren C, Husson G, Go AS et al (2007) Plasma leptin levels and coronary artery calcification in older adults. J Clin Endocrinol Metab 92:729–732
Singhal A, Farooqi IS, Cole TJ et al (2002) Influence of leptin on arterial distensibility: a novel link between obesity and cardiovascular disease? Circulation 106:1919–1924
Sierra-Honigmann MR, Nath AK, Murakami C, Garcia-Cardena G et al (1998) Biological action of leptin as an angiogenic factor. Science 281:1683–1686
Bouloumie A, Marumo T, Lafontan M et al (1999) Leptin induces oxidative stress in human endothelial cells. FASEB J 13:1231–1238
Kang SM, Kwon HM, Hong BK et al (2000) Expression of leptin receptor (Ob-R) in human atherosclerotic lesions: potential role in intimal neovascularization. Yonsei Med J 41:68–75
El-Mongy S, Fathy H, Abdelaziz A et al (2009) Subclinical atherosclerosis in patients with chronic psoriasis: a potential association. J Eur Acad Dermatol Venereol 24:661–666
Tam LS, Shang Q, Li EK et al (2008) Subclinical carotid atherosclerosis in patients with psoriatic arthritis. Arthritis Care Res 59:1322–1331
Eder L, Zisman D, Barzilat M et al (2008) Subclinical atherosclerosis in psoriatic arthritis: a case-control study. J Rheumatol 35:877–882
Hokanson JE, Austin MA (1996) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population based prospective studies. J Cardiovasc Risk 3:213–219
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Enany, B., El Zohiery, A., Elhilaly, R. et al. Carotid intima-media thickness and serum leptin in psoriasis. Herz 37, 527–533 (2012). https://doi.org/10.1007/s00059-011-3547-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-011-3547-z