Abstract
Journal of Lipid Research Volume 53, 2012 1427 Psoriasis is a skin disease that is accompanied by systemic infl ammation and is one of the most common infl ammatory disorders, estimated to effect between 1 and 3% of the population ( 1 ). It is characterized by epidermal hyperproliferation and dermal infl ammation. The etiology of psoriasis is unknown but genetic factors play a role. Psoriasis may begin at any age but has two peak periods of onset: between 15 and 25 and between 50 to 60 years of age. In many patients, psoriasis affects only a small area of the skin (<2% of body surface area) whereas in other patients, the disease can be quite severe, affecting a large portion of the skin. The cutaneous manifestations lead to considerable morbidity and the emotional burden of severe psoriasis has been shown to be similar to that seen in patients with cancer, diabetes, and heart disease. However, it is important to recognize that psoriasis is associated with systemic metabolic disorders including an increased prevalence of the metabolic syndrome, obesity, diabetes, dyslipidemia, and cardiovascular disease (CVD) ( 2 ‐ 4 ). The increased risk of CVD in patients with psoriasis was fi rst reported by McDonald and Calabresi in 1978 ( 5 ). They observed that patients with psoriasis had a 2.2-fold increase in CVD compared with controls. Since then, a large number of additional epidemiological studies have also shown that the risk of CVD is increased in patients with psoriasis [see Tobin et al. ( 4 ) for an excellent review of the literature] ( 2 ‐ 5 ). Of note psoriasis still conferred an increased risk even when the studies controlled for the usual CVD risk factors such as age, sex, diabetes, hypertension, hyperlipidemia, smoking, and obesity, implying that psoriasis causes abnormalities that increase the risk of CVD that are not dependent on the usual risk factors ( 2 ‐ 4 ). Moreover, studies have suggested that the more severe the psoriasis the greater the risk of CVD. Further, supporting the link of psoriasis with atherosclerosis are studies showing that patients with psoriasis have an increase in coronary artery calcium measured by CT and carotid intima media thickness measured by ultrasound ( 6 ‐ 8 ). A very large number of studies have compared serum lipid levels in patients with psoriasis to control subjects ( 2 ‐ 4 ). Most of these reports included only a small number
Highlights
Psoriasis is a skin disease that is accompanied by systemic inflammation and is one of the most common inflammatory disorders, estimated to effect between 1 and 3% of the population [1]
Of note psoriasis still conferred an increased risk even when the studies controlled for the usual cardiovascular disease (CVD) risk factors such as age, sex, diabetes, hypertension, hyperlipidemia, smoking, and obesity, implying that psoriasis causes abnormalities that increase the risk of CVD that are not dependent on the usual risk factors [2,3,4]
Psoriasis can be considered an ideal disease to study the effects of chronic inflammation on CVD, as the disease is localized to the skin, but there is systemic inflammation
Summary
Psoriasis is a skin disease that is accompanied by systemic inflammation and is one of the most common inflammatory disorders, estimated to effect between 1 and 3% of the population [1]. It is important to recognize that psoriasis is associated with systemic metabolic disorders including an increased prevalence of the metabolic syndrome, obesity, diabetes, dyslipidemia, and cardiovascular disease (CVD) [2,3,4]. A large number of additional epidemiological studies have shown that the risk of CVD is increased in patients with psoriasis [see Tobin et al [4] for an excellent review of the literature] [2,3,4,5].
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