Abstract
In a subset of psoriasis (PsO) and psoriatic arthritis (PsA) patients, the skin and/or joint lesions appear to generate biologically significant systemic inflammation. Red cell distribution width (RDW) and mean platelet volume (MPV) are readily available clinical tests that reflect responses of the bone marrow and/or plasma thrombogenicity (e.g., inflammation), and can be markers for major adverse cardiac events (MACE). We aimed to evaluate if RDW and MPV may be employed as inexpensive, routinely obtained biomarkers in predicting myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) in psoriatic and psoriatic arthritis patients. The study was divided into two parts: (a) case control study employing big data (Explorys) to assess MPV and RDW in psoriasis, psoriatic arthritis and control cohorts; (b) a clinical observational study to validate the predictive value of RDW and to evaluate RDW response to anti-psoriatic therapies. We used Explorys, an aggregate electronic database, to identify psoriatic patients with available MPV and RDW data and compared them to gender and age matched controls. The incidence of myocardial infarction (MI), atrial fibrillation (AF), and chronic heart failure (CHF) was highest among patients with both elevated RDW and MPV, followed by patients with high RDW and normal MPV. RDW elevation among PsA patients was associated with an increased risk of MI, AF, and CHF. In a local clinical cohort, high RDWs were concentrated in a subset of patients who also had elevated circulating resistin levels. Among a small subset of participants who were treated with various systemic and biologic therapies, and observed over a year, and in whom RDW was elevated at baseline, a sustained response to therapy was associated with a decrease in RDW. RDW and MPV, tests commonly contained within routine complete blood count (CBC), may be a cost-effective manner to identify PsO and PsA patients at increased risk of MACE.
Highlights
Psoriasis is a chronic systemic inflammatory disease affecting approximately 2–3% of the population
The highest cardiovascular disease (CVD) risk was seen in the patients with a combination of elevated mean platelet volume (MPV) and Red cell distribution width (RDW), in which psoriasis patients with high values of both had more than 3-fold risk of myocardial infarction (MI) and >7 fold risk of atrial fibrillation (AF) or chronic heart failure (CHF) than psoriasis patients with normal/low values of both RDW and MPV
The findings presented here indicate that a simple, inexpensive complete blood count (CBC) can identify a subset of psoriasis and psoriatic arthritis patients who should receive close clinical attention for cardiovascular event occurrence and consideration of preventive interventions
Summary
Psoriasis is a chronic systemic inflammatory disease affecting approximately 2–3% of the population. It is unlikely that each and every psoriasis patient has to be managed for increased cardiovascular risk, so there is a pressing need to enable dermatologists to more precisely identify and counsel the subset of psoriasis patients, referred to as an endotype, who do have significant risk for developing accelerated cardiovascular disease (CVD). This latter group is the subset who experience effects of their psoriasis on distant organs such as the systemic vasculature or bone marrow, which enables a mechanistic opportunity to identify those psoriasis patients with endotypic markers of an extreme phenotype (i.e., increased MACE risk)
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