Risk Factor For Psoriasis Research Articles

Abstract P6-12-24: Risk and predictors of psoriasis in breast cancer patients: A Swedish population based cohort study

Abstract Background The risk of psoriasis in breast cancer patients is largely unknown, as available evidence is limited to case findings. We systematically examined the incidence and risk factors of psoriasis in breast cancer patients. Methods Using Cox regression models, a Swedish nationwide cohort of 56,235 breast cancer patients (2001-2012) was compared to 280,854 age-matched reference individuals from the general population to estimate the incidence and hazard ratio (HR) of psoriasis. We also calculated HRs for psoriasis according to treatment, genetic and lifestyle factors in a regional cohort of 8,987 patients. Results In the nationwide cohort, 599 breast cancer patients were diagnosed with psoriasis during 307,684 person-years (median: 5.1 years) compared to 2,795 cases in the matched individuals during 1,666,038 person-years. Breast cancer patients were at an increased risk of psoriasis (HR=1.17; 95% CI=1.07-1.28) and its most common subtype (psoriasis vulgaris; HR=1.33; 95% CI =1.17-1.52). The risk of psoriasis vulgaris was long-term increased up to 12 years after diagnosis. Treatment specific analyses indicated an increased risk of psoriasis in patients treated with radiotherapy (HR=2.44; 95% CI=1.44-4.12) and mastectomy (HR=1.54, 95% CI=1.03-2.31). Apart from treatment-specific effects, we identified genetic predisposition, obesity and smoking as independent risk factors for psoriasis in breast cancer patients. Table 1. Hazard ratios for psoriasis according to treatment characteristics HR (95% CI) Total No.No. of CasesModel 1Model 2Endocrine therapy No1533271.00 (REF)1.00 (REF)Yes71001210.90 (0.59-1.36)0.80 (0.52-1.24)Chemotherapy No55441021.00 (REF)1.00 (REF)Yes3070460.82 (0.57-1.19)0.70 (0.47-1.04)Radiotherapy No2061231.00 (REF)1.00 (REF)Yes65741251.78 (1.14-2.78)2.44 (1.44-4.12)Surgery Lumpectomy5203941.00 (REF)1.00 (REF)Mastectomy3459550.96 (0.69-1.34)1.54 (1.03-2.31)Model 1: adjusted for age and calendar period of breast cancer diagnosis. Model 2: model 1 plus all the treatment factors. Table 2. Hazard ratios of psoriasis according to genetic and life style factors HR (95% CI) Total No.No. of casesModel 1Model 2PRS score Tertile 11440131.00 (REF)1.00 (REF)Tertile 21442362.74 (1.45-5.17)2.83 (1.50-5.34)Tertile 31483402.94 (1.57-5.49)2.98 (1.59-5.58)BMI <25 kg/m22331401.00 (REF)1.00 (REF)25-30 kg/m21434281.18 (0.73-1.92)1.15 (0.71-1.87)>30 kg/m2536192.29 (1.32-3.98)2.10 (1.20-3.68)Physical activity per week 0 hours762211.00 (REF)1.00 (REF)0-2 hours1645360.77 (0.45-1.33)0.77 (0.44-1.32)>2 hours1910300.56 (0.32-0.98)0.59 (0.33-1.03)Regular smoker No1773261.00 (REF)1.00 (REF)Yes2546621.65 (1.04-2.61)1.59 (1.00-2.52)Genetic predisposition for psoriasis was defined by a polygenic risk score (PRS) including 35 SNPs for psoriasis susceptibility. Model 1: adjusted for age and calendar period of breast cancer diagnosis. Model 2: all of the risk factors were put into the model, including treatment. Conclusions The incidence of psoriasis is elevated among breast cancer patients, with treatment, lifestyle and genetic factors defining the individual risk profile. Our findings underline the complex etiology of psoriasis in breast cancer patients and may help to assess individual risk of psoriasis after a breast cancer diagnosis. Citation Format: Yang H, Brand JS, Li J, Ludvigsson JF, Ugalde-Morales E, Chiesa F, Hall P, Czene K. Risk and predictors of psoriasis in breast cancer patients: A Swedish population based cohort study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-24.

High-fat diet exacerbates imiquimod-induced psoriasis-like dermatitis in mice.

Psoriasis, a chronic inflammatory skin disease, is closely related to systemic metabolism. An elevated body mass index (BMI) is a risk factor for psoriasis; inflammasomes are activated by adipose tissue macrophages in obese subjects. We hypothesized that hyperlipidaemia is involved in the pathogenesis of psoriasis and examined the role of a high-fat diet (HFD) in the development of psoriasis in imiquimod (IMQ)-treated mice. The body weight and serum level of cholesterol were significantly higher in mice fed an HFD than in a regular diet (RD). HFD mice had higher psoriasis skin scores, and the number of neutrophils infiltrating into the lesional skin was elevated. IL-17A mRNA expression was significantly increased in the skin of IMQ-treated HFD mice; the expression of IL-22, IL-23 and TNF-α mRNA was not enhanced. Caspase-1 and IL-1β were activated in the skin of IMQ-treated HFD mice, and their serum level of IL-17A, TNF-α and IL-1β was significantly upregulated. Our findings strongly suggest that hyperlipidaemia is involved in the development and progression of psoriasis via systemic inflammation and inflammasome activation.

Association between Vitamin D Deficiency and Psoriasis: A Case-Control Study

The immunomodulatory effect of vitamin D is well known, and some previous studies have found a potential association between vitamin D deficiency and psoriasis. If this is the case, correction of vitamin D levels could provide a simple, cost-effective treatment method for psoriasis patients. The aim of this case-control study was to confirm whether there was such an association. We also investigated several potential risk factors of psoriasis. We recruited 68 consecutive psoriasis outpatients at three hospitals in Saudi Arabia, as well as 68 control patients with dermatological conditions, and compared serum 25-hydroxycalciferol levels. However, we found no significant differences in vitamin D levels between the two groups. This finding supports similar negative findings of some previous studies, but further studies are needed to resolve this matter.

Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.

Psoriasis is a complex chronic inflammatory cutaneous disorder. To date, robust molecular mechanisms of psoriasis have been reported. Among diverse aberrant immunopathogenetic mechanisms, the current model emphasizes the role of Th1 and the IL-23/Th17 axis, skin-resident immune cells and major signal transduction pathways involved in psoriasis. The multiple genetic risk loci for psoriasis have been rapidly revealed with the advent of a novel technology. Moreover, identifying epigenetic modifications could bridge the gap between genetic and environmental risk factors in psoriasis. This review will provide a better understanding of the pathogenesis of psoriasis by unraveling the complicated interplay among immunological abnormalities, genetic risk foci, epigenetic modification and environmental factors of psoriasis. With advances in molecular biology, diverse new targets are under investigation to manage psoriasis. The recent advances in treatment modalities for psoriasis based on targeted molecules are also discussed.

Effects of secukinumab on serum adipocytokines: preliminary data.

Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects joints, connective tissues and the axial skeleton. Metabolic syndrome is an independent risk factor for psoriasis (Pso) development and is associated with more severe forms of Pso. Adipocytokines are secreted by white adipose tissue and are thought to link obesity with the development of metabolic and cardiovascular diseases. Secukinumab is a new monoclonal antibody with a different mechanism of action. This antibody selectively binds to and neutralizes interleukin-17 (IL-17) and it has shown efficacy in the treatment of PsA. The aim of this study was to evaluate the possible interferences of secukinumab on different adipocytokines. We enrolled 28 patients with PsA, classified with the CASPAR criteria. Serum samples were stored at baseline and then at the first, the third and the sixth month of therapy. Resistin, chemerin, adiponectin and C-reactive protein (CRP) were dosed. When tested globally, none of the adipokine tested showed any statistically significant variation. However, when the male group was tested, both resistin and chemerin at M6 showed a significant decrease from baseline. CRP did not show any variation at any time point. Our study demonstrated that treatment with secukinumab has little influence on the levels of adipokines tested within the first six months of treatment even though it might exert different influence between males and females from a metabolic perspective. Further studies with greater numbers of patients are needed to determine whether these preliminary results have clinical relevance.

Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study

BackgroundThe risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings. We systematically examined the incidence and risk factors of psoriasis in patients with breast cancer.MethodsA Swedish nationwide cohort of 56,235 breast cancer patients (2001–2012) was compared to 280,854 matched reference individuals from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated HRs for psoriasis according to treatment, genetic, and lifestyle factors in a regional cohort of 8987 patients.ResultsIn the nationwide cohort, 599 patients with breast cancer were diagnosed with psoriasis during a median follow-up of 5.1 years compared to 2795 cases in the matched reference individuals. This corresponded to an incidence rate of 1.9/1000 person-years in breast cancer patients vs. 1.7/1000 person-years in matched reference individuals. Breast cancer patients were at an increased risk of psoriasis (HR = 1.17; 95% confidence interval (CI) = 1.07–1.28), especially its most common subtype (psoriasis vulgaris; HR = 1.33; 95% CI = 1.17–1.52). The risk of psoriasis vulgaris was highest shortly after diagnosis but remained increased up to 12 years. Treatment-specific analyses indicated a higher risk of psoriasis in patients treated with radiotherapy (HR = 2.44; 95% CI = 1.44–4.12) and mastectomy (HR = 1.54, 95% CI = 1.03–2.31). Apart from treatment-specific effects, we identified genetic predisposition, obesity, and smoking as independent risk factors for psoriasis in breast cancer patients.ConclusionsThe incidence of psoriasis is slightly elevated among patients with breast cancer, with treatment, lifestyle, and genetic factors defining the individual risk profile.

Abstract 549: Visceral Adipose Tissue Associates With Coronary Plaque Burden Beyond Cardiovascular Risk Factors in Psoriasis

Background: Psoriasis (PSO), a chronic inflammatory disease associated with increased cardiovascular (CV) risk, provides a reliable human model to study inflammatory atherogenesis. PSO has been known to be associated with cardiometabolic dysfunction including adipose tissue dysfunction. Recently, visceral adiposity (VAT) was shown to be associated with increased CV events, but whether VAT is associated with subclinical atherosclerosis as assessed by coronary plaque burden has not been characterized. Hypothesis: We hypothesized that VAT volume by CT is associated with total burden (TB) and more specifically with non-calcified burden (NCB) by CCTA. Methods: Consecutive PSO patients (N=68) underwent CT scans to measure abdominal adiposity. VAT volume was quantified from the level of the diaphragm to the pubic symphysis and reported in volume. Coronary plaque characterization was performed by CCTA (Toshiba 30 slice) via QAngio CT software (Medis, The Netherlands). The relationship of VAT with TB and NCB was analyzed using unadjusted and adjusted multivariable regression models (STATA 12). Results: The cohort was middle-aged, predominantly male, at low CV risk by FRS with mild to moderate PSO by skin disease severity (Table 1). VAT volume associated with both TB (beta coefficient= 0.49, p-value <0.001) and NCB (beta coefficient= 0.51, p-value <0.001). This relationship remained significant after adjustment for cardiovascular risk factors for TB (beta coefficient= 0.28, p-value = 0.004) and NCB (beta coefficient = 0.34, p-value <0.001). Conclusions: Directly quantified VAT directly associated with TB and NCB independent of cardiovascular risk factors. These findings suggest that adipose tissue dysfunction may in part contribute to the high CV events observed in psoriasis and support efforts to provide weight control as a strategy to reduce CV disease in psoriasis.

Effect of Diet and Exercise on Plaque Psoriasis in Children

Increased Body Mass Index, unhealthy diet regime full of saturated fats are risk factors for psoriasis in children and the prevalence of obesity in children on plaque psoriasis is higher than in the general population. Limited data exist regarding the role of diet in and exercise on plaque psoriasis in children.

Overweight and Weight Gain Predict Psoriasis Development in a Population-based Cohort.

Overweight is a proposed risk factor for psoriasis. How-ever, evidence from prospective studies is limited. The aim of this study was to investigate the association be-tween overweight, weight gain and risk of psoriasis, and potential synergism with smoking, within a population-based cohort including 8,752 individuals followed from 1994 up to 2008. There was a 32% increased odds of psoriasis from a body mass index (BMI) of 27 kg/m2, in multi-variable logistic regression analysis, further increasing to 43% at BMI 28 kg/m2, and to 71% at BMI ≥ 30 kg/m2 in non-smokers. There was a dose-response association between weight gain from age 25 years, with up to 90% higher odds of psoriasis from middle age, independent of weight category. There was no indication of a synergism between overweight and smoking, and no interaction with sex. Overweight and weight gain represent modifiable risk factors that may be targets for primary prevention of psoriasis.

The -2518 A/G MCP-1 and -403 G/A RANTES promoter gene polymorphisms are associated with psoriasis vulgaris.

Polymorphic variants of the genes encoding monocyte chemoattractant protein-1 (MCP-1/CCL2) and regulated upon activation normal T-cell expressed and secreted (RANTES/CCL5) and their protein serum levels have not been widely explored in psoriasis. To clarify the effect of the MCP-1 (-2518 A/G) and RANTES (-403 G/A) promoter gene polymorphisms on the risk and clinical manifestation of psoriasis. We enrolled 160 unrelated patients with psoriasis vulgaris and 160 healthy, unrelated, age- and sex-matched volunteers. The promoter gene polymorphisms were analysed using amplification refractory mutation system (ARMS)-PCR and single specific primer (SSP)-PCR. Serum levels of cytokines were measured using ELISA. The presence of the MCP-1-2518 GG genotype was statistically more frequent in patients and it was associated with an increased risk of psoriasis (OR = 1.94; P = 0.04). In patients with late-onset (≥ 40 years) psoriasis, the presence of the RANTES -403 AA genotype was statistically more frequent (OR = 3.65; P < 0.01) while -403 GG was less frequent (OR = 0.44; P < 0.01). Moreover, the A allele (AA or AG) in the -403 RANTES polymorphism was associated with an increased risk of developing severe psoriasis (OR = 2.02; P = 0.03). Serum levels of both chemokines were elevated. RANTES serum concentration was significantly higher in patients with Psoriasis Area and Severity Index > 15. The results of our analysis suggest that the -2518 A/G MCP-1 and -403 G/A RANTES promoter gene polymorphisms may be risk factors for psoriasis and may influence its clinical presentation.

GlycA Is a Novel Biomarker of Inflammation and Subclinical Cardiovascular Disease in Psoriasis.

GlycA, an emerging inflammatory biomarker, predicted cardiovascular events in population-based studies. Psoriasis, an inflammatory disease associated with increased cardiovascular risk, provides a model to study inflammatory biomarkers in cardiovascular disease (CVD). Whether GlycA associates with psoriasis and how it predicts subclinical CVD beyond high-sensitivity C-reactive protein in psoriasis is unknown. To investigate the relationships between GlycA and psoriasis and between GlycA and subclinical CVD. Patients with psoriasis and controls (n=412) participated in a 2-stage study. We measured GlycA by nuclear magnetic resonance spectroscopy. National Institutes of Health (NIH) participants underwent 18-F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (18-FDG PET/CT) scans to assess vascular inflammation (VI) and coronary computed tomographic angiography to quantify coronary artery disease burden. Psoriasis cohorts were young (mean age=47.9), with low cardiovascular risk and moderate skin disease. high-sensitivity C-reactive protein and GlycA were increased in psoriasis compared with controls (GlycA: [PENN: 408.8±75.4 versus 289.4±60.2, P<0.0001; NIH: 415.8±63.2 versus 346.2±46, P<0.0001]) and demonstrated a dose-response with psoriasis severity. In stage 2, VI (β=0.36, P<0.001) and coronary artery disease (β=0.29, P=0.004) associated with GlycA beyond CV risk factors in psoriasis. In receiver operating characteristic analysis, GlycA added value in predicting VI (P=0.01) and coronary artery disease (P<0.01). Finally, initiating anti-tumor necrosis factor therapy (n=16) reduced psoriasis severity (P<0.001), GlycA (463.7±92.5 versus 370.1±78.5, P<0.001) and VI (1.93±0.36 versus 1.76±0.19, P<0.001), whereas GlycA remained associated with VI (β=0.56, P<0.001) post treatment. GlycA associated with psoriasis severity and subclinical CVD beyond traditional CV risk and high-sensitivity C-reactive protein. Moreover, psoriasis treatment reduced GlycA and VI. These findings support the potential use of GlycA in subclinical CVD risk assessment in psoriasis and potentially other inflammatory diseases.

Epidemiological Assessments of Skin Outcomes in the Nurses' Health Studies.

To review the contribution of the Nurses' Health Studies (NHSs) to identifying epidemiological factors associated with multiple skin diseases, including skin cancer, psoriasis, and other inflammatory and autoimmune skin diseases. We carried out a narrative review of NHS articles published between 1976 and 2016. The NHSs have identified environmental and lifestyle factors related to psoriasis, supporting obesity and smoking as psoriasis risk factors; associations between psoriasis and diabetes, myocardial infarction, and Crohn's disease, supporting psoriasis as a systemic disorder; and associations of pigmentary traits, ultraviolet radiation, and lifestyle factors such as citrus consumption with risk of skin cancer. Genetic studies have identified novel genetic loci for skin pigmentation (e.g., IRF4, SLC24A4, NID1, and EDNRB) and skin cancer (e.g., TET2 and HERC2-OCA2). Work continues on highly prevalent but less studied skin conditions such as rosacea, acne, and atopic dermatitis. The NHS results have influenced public health policies on indoor tanning devices. The NHSs have provided invaluable resources on skin disease population science and contributed to the etiological understanding of multiple skin disorders.

Environmental Risk Factors in Psoriasis: The Point of View of the Nutritionist.

Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activation, where both environmental and genetic factors contribute to its pathogenesis. Among the risk factors for psoriasis, evidence is accumulating that nutrition plays a major role, per se, in psoriasis pathogenesis. In particular, body weight, nutrition, and diet may exacerbate the clinical manifestations, or even trigger the disease. Understanding the epidemiological relationship between obesity and psoriasis is also important for delineating the risk profile for the obesity-related comorbidities commonly found among psoriatic patients. Moreover, obesity can affect both drug’s pharmacokinetics and pharmacodynamics. Additionally, the overall beneficial effects on the obesity-associated comorbidities, clinical recommendations to reduce weight and to adopt a healthy lifestyle could improve the psoriasis severity, particularly in those patients with moderate to severe disease, thus exerting additional therapeutic effects in the conventional treatment in obese patients with psoriasis. Education regarding modifiable environmental factors is essential in the treatment of this disease and represents one of the primary interventions that can affect the prognosis of patients with psoriasis. The goal is to make psoriatic patients and health care providers aware of beneficial dietary interventions. The aim of this review is to assess the relevance of the environmental factors as modifiable risk factors in psoriasis pathogenesis, with particular regard to the involvement of obesity and nutrition in the management of psoriasis, providing also specific nutrition recommendations.

Abstract 588: Glyc-A, a Novel Inflammatory Biomarker, is Associated With Total and Non-Calcified Coronary Plaque Burden Beyond Traditional Cardiovascular Risk Factors

Introduction: Recent studies suggest that hsCRP may inaccurately predict coronary heart disease (CHD) in patients with chronic inflammatory disorders. GlycA, a novel inflammatory biomarker measured by nuclear magnetic resonance, was associated with future cardiovascular events in a large cohort study. Whether GlycA predicts CHD beyond hsCRP in chronic inflammatory patients is unknown. Psoriasis (PSO), a chronic inflammatory disease associated with increased cardiovascular risk, provides a clinical human model to assess the utility of GlycA as a risk marker of CHD. Hypothesis: We hypothesized that GlycA would associate with CHD, by total (TB) and non-calcified burden (NCB) assessed by coronary CT angiography, beyond traditional risk factors in PSO. Methods: 151 consecutive PSO patients and 40 controls underwent coronary CT angiography (320 detector row) as part of a large cohort study (NCT01778569). Coronary plaque burden was assessed by QAngio (Medis). We measured GlycA by nuclear magnetic resonance (LabCorp). A physician ascertained clinical parameters. Labs were measured in a certified clinical research facility. Statistical analyses include multivariate regression and ROC modeling. Results: PSO patients were older, at low Framingham risk, but had significant cardiometabolic dysfunction and increased CHD by TB and NCB (Table). While hsCRP significantly associated with CHD in controls, it showed no relationship in PSO. GlycA, however, strongly associated with TB (β=0.14, p=0.01) and NCB (β=0.12, p=0.01) beyond traditional risk factors in PSO. Finally, ROC analyses demonstrated greater AUC for GlycA in predicting TB and NCB (Figure), suggesting GlycA adds incremental value to traditional cardiovascular risk factors. Conclusion: In conclusion, GlycA associates with coronary plaque burden in PSO. Our study suggests a role for GlycA beyond hsCRP in assessing CHD in inflammatory states. Larger prospective studies are needed to confirm these findings.

Association between rs6887695 and 3′-untranslated region polymorphisms within the interleukin-12B gene and susceptibility to autoimmune diseases in Asian and European population: A meta-analysis

Background: The associations between rs6887695 and 3′-untranslated region (3′-UTR) single-nucleotide polymorphisms (SNPs) within interleukin-12B (IL-12B) and autoimmune diseases (ADs) remain controversial and inconclusive. The aim of this study was to evaluate the association between IL-12B (3′-UTR A/C and rs6887695 C/G SNPs) and ADs by meta-analysis. Methods: PubMed and EMBASE were exhaustively searched for studies on the association between IL-12B SNPs and ADs. Publication bias was examined by a funnel plot and Egger’s test. The robustness of the pooled results was assessed by sensitivity analysis. A fixed- or a random-effects model was applied to calculate the pooled odds ratios (ORs). Results: A total of 34 studies were included in this meta-analysis. The pooled results demonstrated that IL-12B rs6887695 SNPs were significantly associated with the risk of ADs. However, there was no significant association between IL-12B 3′-UTR SNPs and ADs. When the studies were stratified by ethnicity, significant association between IL-12B 3′-UTR SNPs and ADs was observed in both Asian and European population. In addition, allele A within 3′-UTR of IL-12B gene was found to be a protective factor for T1DM, but a risk factor for psoriasis. Conclusion: The IL-12B 3′-UTR and rs6887695 SNPs are associated with susceptibility to ADs.

HLA-C*18:01: A Rare Allele in the European Caucasian Population Coinciding with Difficult-to-Treat Plaque Psoriasis

Advances in knowledge about the metabolic pathways involved in the pathogenesis of psoriasis and related diseases have led to a search for new therapeutic targets and the development of new biological drugs. Several studies have focused on HLA-C*06 and investigated correlations between the genetic risk factors of psoriasis and clinical parameters such as the severity of the disease and the response to treatment. Our objective is to share experience from our institution in the observation of two patients with severe chronic plaque psoriasis who were unresponsive to any anti-TNF-α treatment and only partially responsive to ustekinumab. The patients are carriers of a rare allele of HLA-C that occurs in Caucasians. The patients with moderate-to-severe chronic plaque psoriasis, and candidates for biological therapy were typed for the HLA-C locus at high resolution via polymerase chain reaction sequence-specific oligonucleotide probes (PCR-SSOP) using a commercial kit (LAB(®)Type, One Lambda Inc., Canoga Park, CA, USA). The socio-demographic variables and clinical data were collected. In our cohort of 134 patients, only two showed the presence of the allele HLA-C*18:01. To our knowledge, a coincidence between HLA-C*18 and severe psoriasis in Caucasian patients has not previously been described. The fact that both of these patients showed the same clinical history (unresponsive to any anti-TNF-α treatment and partially responsive to ustekinumab) cannot be attributed to a random observation because HLA-C*18 is extremely rare in Europe. As a consequence, at this latitude, it probably indicates a severe disease for which the proper therapy has still not been identified.

Abstract P215: Presence of Comorbid Psychiatric Illness is Associated with Aortic Vascular Inflammation and Coronary Heart Disease Beyond Traditional Cardiovascular Risk Factors in Psoriasis

Introduction: Psoriasis is a chronic inflammatory disorder associated with vascular inflammation (VI), measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and increased risk of MI. Coronary plaque composition by coronary computed tomography angiography (CCTA) predicts both CV risk and outcomes. Patients with psoriasis are more likely to suffer from comorbid depression and anxiety. Whether these comorbidities may accelerate the development of CVD in psoriasis is not well characterized. Hypothesis: We hypothesized that aortic VI and coronary plaque burden would be increased in patients with psoriasis who have depression and/or anxiety when compared to those with psoriasis who do not. Methods: Psoriasis patients were derived from an ongoing psoriasis study cohort. Patients who reported a history of depression and/or anxiety (n=40) on survey and age- and gender- matched patients who reported no history of psychiatric illness (n=40) were selected. Target-to-background ratio from FDG PET/CT was used to assess aortic VI and CCTA scans were analyzed for coronary plaque composition. Multivariate linear regression was performed to understand the effect of psychiatric diagnoses on VI and plaque burden after adjustment for CV risk factors (standardized β reported). Results: In unadjusted analyses, both aortic VI and coronary plaque burden were higher in psoriasis patients with comorbid depression or anxiety compared to those without (Table 1). After adjustment for Framingham Risk Score, body mass index, and statin use, VI (β=0.24, p=0.02), total plaque burden (β=0.13, p=0.04), and non-calcified burden (β=0.13, p=0.04) were associated with comorbid depression or anxiety. Conclusions: Patients with psoriasis who have comorbid depression or anxiety have increased aortic VI and coronary plaque burden, suggesting that identification of psychiatric diagnoses in psoriasis may be warranted for future CV risk reduction in this high risk population.

Genetic Risk Factors for Psoriasis in Turkish Population: -1540 C/A, -1512 Ins18, and +405 C/G Polymorphisms within the Vascular Endothelial Growth Factor Gene.

BackgroundEvidence regarding the vascular endothelial growth factor A (VEGFA) as a potent mediator of angiogenesis and inflammation in psoriasis has revealed variations in this gene as surrogate markers of psoriasis.ObjectiveVEGFA gene polymorphisms (-1540 C/A, -1512 Ins18, -460 T/C, and +405 C/G) in psoriasis susceptibility in Turkish population were investigated.MethodsA total of 200 age, sex and ethnicity-matched psoriatic and healthy individuals were examined for clinical type, response to therapy, serum VEGFA and its receptor levels, genotypes and haplotypes.ResultsThe +405 GG, +405 CG, -1540 CA, and -1512 +Ins18 genotypes conferred a significant risk for developing psoriasis. The C-InsTC haplotype in the controls and C+InsTG, A+InsTC, and A-InsTG haplotypes in psoriatic patients were observed to be significantly high. Increased serum levels of VEGFA were detected in psoriatic patients with the C-InsTC haplotype than that in the controls. The +405 GG genotype was significantly more frequent in psoriatic patients with a positive family history, and the moderate form of psoriasis was more frequent among C+InsTG haplotype carriers than that among the other patients. The +405 GG genotype was found to be more frequent in patients responding to oral retinoids. Serum VEGFR1/FLT1 and VEGFR2/KDR levels were not significantly different when psoriatic patients and controls were stratified based on the risk polymorphic variants.ConclusionVEGFA gene +405 GG and CG, -1512+Ins18, and -1540 CA genotypes are associated with an increased risk of psoriasis in Turkish population. The G allele at +405 and an 18-bp insertion at -1512 are primarily the risk factors for psoriasis, and this risk is potentiated by the presence of the A allele at the -1540 locus.

The heartbreak of psoriasis: a review of cardiovascular risk in patients with psoriasis.

Psoriasis is a common, chronic, autoimmune condition characterized by excessive growth and differentiation of keratinocytes that affects approximately 1% to 3% of the general population in the United States. Mounting evidence has led to an increasing awareness that psoriasis as a disease is more than "skin deep" and that it shares systemic manifestations with other chronic inflammatory diseases such as Crohn's and diabetes mellitus. Recent studies have not only shown an increased prevalence of cardiovascular risk factors in psoriasis but have also identified psoriasis as an independent risk factor for developing cardiovascular disease. This calls for an approach beyond managing traditional risk factors, which remain the standard guidelines at present.

Identifying Performance Gaps in Comorbidity and Risk Factor Screening, Prevention, and Counseling Behaviors of Providers Caring for Children with Psoriasis.

Comorbidities and risk factors are associated with pediatric psoriasis. It is unknown whether pediatricians and dermatologists ask about, record, or counsel on pediatric psoriasis risk factors and comorbidities. The aim of our study was to assess the rate at which pediatricians and dermatologists inquire about, counsel on, and document pediatric psoriasis risk factors and comorbidities in a stable population. This was a retrospective chart review from 2011 to 2013 in a large, rural multidisciplinary clinic, the Marshfield Epidemiologic Study Area. Participants were children ages 18 years and younger with plaque psoriasis. Rates of counseling and screening for pediatric psoriasis risk factors and comorbidities by pediatricians and dermatologists were determined. Thirty patients qualified for the study. Data were collected on body mass index (BMI) and tobacco exposure. Caregiver counseling rates on these factors were low; 66.7% and 60% did not receive counseling on BMI reduction or family member smoking cessation, respectively. Counseling on stress as a risk factor was performed at only one patient's dermatology visit (3.3%). Lipid panels were collected for 40% of patients and fasting glucose levels for 33.3% since the date of first psoriasis diagnosis. Blood pressure was collected for all patients. Only 13.3% of patients were counseled on the psoriasis comorbidity hyperlipidemia, 10% on hypertension, and 3.3% on diabetes mellitus. Dermatologists and pediatricians have a low rate of counseling, documenting, and screening for pediatric psoriasis risk factors and comorbidities, suggesting that psoriasis comorbidity education is an aspect of the patient visit that may need improvement. Pediatric psoriasis counseling and screening guidelines are needed.