Abstract
We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD was assessed by echocardiography as the presence of increased left ventricular (LV) relative wall thickness (RWT), LV hypertrophy or dilated left atrium. Psoriasis severity was graded using the psoriasis area and severity index (PASI). The prevalence of hypertension was 66% in psoriasis vs. 61% in controls (p = 0.54) and cardiac OD seen in 51 and 73%, respectively (p = 0.007). Psoriasis was associated with a lower prevalence of cardiac OD (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.13–0.77, p = 0.01) independent of age, sex, smoking, body mass index, and hypertension. Among psoriasis patients, hypertension was associated with increased risk of subclinical cardiac OD (OR 6.88, 95% CI 1.32–35.98, p = 0.02) independent of age, sex, and body mass index. PASI at treatment initiation was associated with a higher RWT at follow-up, independent of sex, age, and hypertension (β 0.36, p = 0.006) while no association with current PASI was found. In conclusion, cardiac OD was less prevalent in psoriasis patients on infliximab treatment than controls. Hypertension was the major covariable for subclinical cardiac OD in psoriasis.
Highlights
Psoriasis is a chronic, immune mediated, dermatological disease with a prevalence of 1.5–5% in Western countries [1]
This study demonstrates that patients with psoriasis treated with infliximab have a lower prevalence of subclinical cardiac organ damage compared to control subjects without psoriasis, independent of high prevalence of CV risk factors such as hypertension, obesity, and smoking
Hypertension was the strongest correlate of subclinical cardiac organ damage in psoriasis patients, while a higher psoriasis area and severity index (PASI) at the start of infliximab treatment predicted the presence of concentric left ventricular (LV) geometry even after 4.9 years of treatment
Summary
Immune mediated, dermatological disease with a prevalence of 1.5–5% in Western countries [1]. In varying degree, been associated with an elevated risk of cardiovascular (CV) disease [5] This is in part related to the high prevalence of CV risk factors in psoriasis, in particular hypertension and obesity [5,6]. In a British registry of patients with moderate to severe psoriasis receiving biological systemic treatment, 73% of patients were overweight or obese and 31% had hypertension [7]. The prevalence of subclinical cardiac organ damage has been rarely studied, including in patients with moderate to severe psoriasis on biological systemic therapy. The aim of the current study was to assess if the prevalence of subclinical cardiac organ damage was increased in patients with moderate to severe psoriasis independent of CV risk factors compared to control subjects without psoriasis
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