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Liu YC, Chuang SH, Chen YP, Shih YH. Associations of novel complete blood count-derived inflammatory markers with psoriasis: a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:228. [PMID: 38787437 DOI: 10.1007/s00403-024-02994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
Psoriasis is an immune-mediated disorder which primarily affects skin and has systemic inflammatory involvement. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR) are novel complete blood count (CBC)-derived markers which can reflect systemic inflammation. This study aimed to systematically investigate the associations of NLR, PLR, SII, and MLR with psoriasis. This study was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. A comprehensive search of Pubmed, Embase, Scopus, and Google Scholar was conducted for relevant studies. Observational studies evaluating the correlations of NLR, PLR, SII, or MLR with psoriasis were included. The primary outcomes were the associations of these inflammatory markers with the presence and severity of psoriasis. The random-effect model was applied for meta-analysis. 36 studies comprising 4794 psoriasis patients and 55,121 individuals in total were included in the meta-analysis. All inflammatory markers were significantly increased in psoriasis groups compared to healthy controls (NLR: MD = 0.59, 95% CI: 0.47-0.7; PLR: MD = 15.53, 95% CI: 8.48-22.58; SII: MD = 111.58, 95% CI: 61.49-161.68; MLR: MD = 0.034, 95% CI: 0.021-0.048; all p < 0.001). Between-group mean differences in NLR and PLR were positively correlated with the mean scores of Psoriasis Area Severity Index (NLR: p = 0.041; PLR: p = 0.021). NLR, PLR, SII, and MLR are associated with the presence of psoriasis. NLR and PLR serve as significant indicators of psoriasis severity. These novel CBC-derived markers constitute potential targets in the screening and monitoring of psoriasis.
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Affiliation(s)
- Yu-Cheng Liu
- Department of General Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei, 23561, Taiwan
| | - Shu-Han Chuang
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua, 50006, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Taipei Municipal Wan Fang Hospital, Taipei, 11696, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Yi-Hsien Shih
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
- Department of Dermatology, Taipei Medical University Shuang Ho Hospital, New Taipei City, 23561, Taiwan.
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2
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Ye JH, Zhang Y, Naidoo K, Ye S. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in psoriasis: a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:85. [PMID: 38329632 DOI: 10.1007/s00403-024-02823-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 08/28/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Psoriasis is a chronic, inflammatory skin disorder characterized by well-demarcated erythematous lesions with surface scaling. The disease is underpinned by a dysregulated immune response with a shift in the balance of neutrophils, lymphocytes and platelets. We sought to evaluate the novel systemic inflammatory markers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as psoriatic indicators. Pubmed, Web of Science and Scopus were systematically searched for relevant studies. Twenty-four studies consisting of a total of 2,275 psoriatic patients (1,301 males and 974 females) and 2,334 healthy controls (1,401 males and 933 females) were identified for inclusion in the quantitative analysis. The NLR and PLR were found to be significantly increased in psoriatic patients [standardized mean difference (SMD) = 0.68, 95% CI 0.56-0.80, p < 0.01, and SMD = 0.37, 95% CI 0.14-0.60, p < 0.01, respectively]. However, no association between the NLR and PLR with psoriasis severity was detected (p = 0.93, and p = 0.83, respectively). In conclusion, the NLR and PLR are simple and cost-effective markers of psoriatic presence, but their value as severity markers requires further study.
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Affiliation(s)
- John Han Ye
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, Oxfordshire, UK.
- University College London Hospitals NHS Foundation Trust, London, UK.
| | | | - Karmella Naidoo
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Shu Ye
- Shantou University Medical College, Shantou, China
- Cardiovascular-Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Krajina I, Stupin A, Šola M, Mihalj M. Oxidative Stress Induced by High Salt Diet—Possible Implications for Development and Clinical Manifestation of Cutaneous Inflammation and Endothelial Dysfunction in Psoriasis vulgaris. Antioxidants (Basel) 2022; 11:antiox11071269. [PMID: 35883760 PMCID: PMC9311978 DOI: 10.3390/antiox11071269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Although oxidative stress is recognized as an important effector mechanism of the immune system, uncontrolled formation of reactive oxygen and nitrogen species promotes excessive tissue damage and leads to disease development. In view of this, increased dietary salt intake has been found to damage redox systems in the vessel wall, resulting in endothelial dysfunction associated with NO uncoupling, inflammation, vascular wall remodeling and, eventually, atherosclerosis. Several studies have reported increased systemic oxidative stress accompanied by reduced antioxidant capacity following a high salt diet. In addition, vigorous ionic effects on the immune mechanisms, such as (trans)differentiation of T lymphocytes are emerging, which together with the evidence of NaCl accumulation in certain tissues warrants a re-examination of the data derived from in vitro research, in which the ionic influence was excluded. Psoriasis vulgaris (PV), as a primarily Th17-driven inflammatory skin disease with proven inflammation-induced accumulation of sodium chloride in the skin, merits our interest in the role of oxidative stress in the pathogenesis of PV, as well as in the possible beneficial effects that could be achieved through modulation of dietary salt intake and antioxidant supplementation.
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Affiliation(s)
- Ivana Krajina
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Marija Šola
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
| | - Martina Mihalj
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
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Arterial stiffness, the hidden face of cardiovascular risk in autoimmune and chronic inflammatory rheumatic diseases. Autoimmun Rev 2021; 20:102891. [PMID: 34229047 DOI: 10.1016/j.autrev.2021.102891] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular diseases (CVD) are the leading causes of death in chronic inflammatory rheumatic diseases and are not solely explained by the increased prevalence of cardiovascular (CV) risk factors in this population. Arterial stiffness, assessed primarily by pulse wave velocity (PWV) and more indirectly by augmentation index (AIx), is a surrogate marker of CVD that should be considered. The objective of this review was to investigate the relationship between arterial stiffness and chronic inflammatory and/or autoimmune diseases. METHODS We performed a systemic literature review of articles published in Medline from January 2012 to April 2020 restricted to English languages and to human adults. We selected relevant articles about the relationship between arterial stiffness and rheumatoid arthritis, systemic lupus erythematosus, psoriasis, Sjogren's syndrome and ankylosing spondylitis. For each selected article, data on PWV and AIx were extracted and factors that may have an impact on arterial stiffness were identified. RESULTS A total of 214 references were identified through database searching and 82 of them were retained for analysis. Arterial stiffness is increased in chronic inflammatory and autoimmune diseases. Traditional CV risk factors such as hypertension and dyslipidemia accentuate this relationship. Current data are insufficient to determine whether disease activity significantly influences arterial stiffness, whereas disease duration seems rather critical. TNF-alpha inhibitors and cardiorespiratory fitness tend to decrease arterial stiffness. Finally, increased arterial stiffness leads to diastolic dysfunction, which is the main mechanism of heart failure in chronic inflammatory rheumatic diseases. CONCLUSION CV risk assessment in chronic inflammatory and autoimmune diseases should also rely on PWV and AIx.
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Zwain A, Aldiwani M, Taqi H. The Association Between Psoriasis and Cardiovascular Diseases. Eur Cardiol 2021; 16:e19. [PMID: 34040653 PMCID: PMC8145074 DOI: 10.15420/ecr.2020.15.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular diseases and psoriasis have been well established as separate entities, however, there is uncertainty with regards to a link between the two diseases. A few environmental, psychological and social factors have been implicated as potential common risk factors that may exacerbate the two diseases, and an array of complex immune and non-immune inflammatory mediators can potentially explain a plausible link. Pharmacotherapy has also played a role in establishing a potential association, especially with the advent of biological agents which directly act on inflammatory factors shared by the two diseases. This review will look at existing evidence and ascertain a potential correlation between the two.
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Affiliation(s)
- Ahmed Zwain
- North West Deanery, Aintree University Hospital Liverpool, UK
| | - Mohanad Aldiwani
- East Midlands Deanery, University Hospitals of Leicester NHS Trust Leicester, UK
| | - Hussein Taqi
- East Midlands Deanery, Royal Derby Hospital Derby, UK
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Balani P, Lopez AR, Nobleza CMN, Siddiqui M, Shah PV, Khan S. Can Pioglitazone Safeguard Patients of Lichen Planus Against Homocysteine Induced Accelerated Cardiovascular Aging and Reduced Myocardial Performance: A Systematic Review. Cureus 2020; 12:e12372. [PMID: 33527053 PMCID: PMC7842239 DOI: 10.7759/cureus.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lichen planus (L.P.) is a long-standing mucocutaneous inflammatory condition. A less familiar but essential illness association is increased arterial stiffness, endothelial dysfunction, and advanced atherosclerosis. Enhanced cardiac reconditioning and reduced performance of the heart have been suggested. Thiazolidinediones were commenced to manage hyperglycemia in diabetes mellitus. Recently, the class attained popularity after its action on vascular physiology was discovered. With this review, we attempted to explore whether an antidiabetic drug, pioglitazone (PIO), a peroxisome proliferator‑activated receptor γ (PPAR gamma) agonist, can defend patients of lichen planus against increased arterial stiffness and cardiac changes. We methodically screened numerous databases using focused words and phrases for relevant articles. After a comprehensive exploration, we applied the inclusion and exclusion criteria and performed a quality appraisal. Items retained were exhaustively studied. High homocysteine (HHcy) levels in lichen planus play a significant role in modifying the arteries and leading to their dysfunction. Not only does homocysteine affect the precursor cells, but it also increases the free radical damage. Arterial damage and upraised resistance encountered by the heart reduce its performance. After an exhaustive analysis, in our opinion, pioglitazone works in various miscellaneous ways to mitigate the homocysteine mediated changes. Early inclusion of the drug in managing patients with lichen planus seems promising in minimizing the harmful effects of high homocysteine. Evaluating the risk-benefit ratio, we believe that a trial of pioglitazone could be given to patients without underlying cardiac conditions.
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Affiliation(s)
- Prachi Balani
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Angel R Lopez
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chelsea Mae N Nobleza
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mariah Siddiqui
- Neurology, St. George's University, True Blue, GRD.,Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Parth V Shah
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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7
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Abstract
Psoriasis is a common inflammatory disease that can involve the skin, joints, or both. The abnormalities of innate immunity play crucial roles in the pathogenesis of psoriasis. Neutrophils are the most abundant leukocytes in the circulation. Emerging evidences have demonstrated that neutrophils may play a role in autoimmune diseases. The neutrophil-to-lymphocyte ratio (NLR), the activity of neutrophils, and the number of NETotic cells were significantly higher in psoriasis patients compared to healthy controls. The number of low-density granulocytes (LDGs) in the blood of psoriasis patients was significantly higher than those in the control blood. Furthermore, neutrophils may play important roles in the cardiovascular risk in psoriasis. However, the exact role of neutrophils in psoriasis remains unclear. In this review, we highlight the role of neutrophils in the pathogenesis of psoriasis.
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Impairment of myocardial functions and arterial stiffness in patients with lichen planus. An Bras Dermatol 2020; 95:180-186. [PMID: 32146010 PMCID: PMC7175034 DOI: 10.1016/j.abd.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/30/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities. OBJECTIVE The purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group. METHODS Fifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry. RESULTS No statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p=0.006, and p=0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p<0.001, and p=0.005, respectively). STUDY LIMITATIONS Relatively low number of patients. CONCLUSION The positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.
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Paliogiannis P, Satta R, Deligia G, Farina G, Bassu S, Mangoni AA, Carru C, Zinellu A. Associations between the neutrophil-to-lymphocyte and the platelet-to-lymphocyte ratios and the presence and severity of psoriasis: a systematic review and meta-analysis. Clin Exp Med 2018; 19:37-45. [PMID: 30478648 DOI: 10.1007/s10238-018-0538-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022]
Abstract
The diagnosis of psoriasis, an immune-mediated disease that affects 2% of the population in Western countries, is largely based on history and clinical examination. The aim of this systematic review and meta-analysis was to investigate the associations between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the presence and clinical severity of psoriasis. A systematic literature search was conducted in PubMed, Web of Science, and Scopus, from inception to January 2018. Twelve case-control studies enrolling 1067 psoriasis patients (537 males and 530 females) and 799 healthy controls (404 males and 395 females) were included in the meta-analysis. The NLR was evaluated in all the studies, while the PLR was assessed in four studies. Pooled results showed that both the NLR and the PLR values were significantly higher in patients with psoriasis (SMD = 0.69, 95% CI 0.53-1.85, p < 0.001, and SMD = 0.40, 95% CI 0.12-0.68, p = 0.006, respectively). There were no significant differences in NLR values according to the severity of disease (p = 0.52). The NLR and the PLR are significantly associated with the presence, but not with the severity, of psoriasis. Further studies are required to determine the additional utility of these haematological indexes in the diagnosis of psoriasis.
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Affiliation(s)
- Panagiotis Paliogiannis
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Rosanna Satta
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Giovanni Deligia
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Giuseppina Farina
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Stefania Bassu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
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Patschan D, Sugiarto N, Henze E, Mößner R, Mohr J, Müller GA, Patschan S. Early endothelial progenitor cells and vascular stiffness in psoriasis and psoriatic arthritis. Eur J Med Res 2018; 23:56. [PMID: 30413175 PMCID: PMC6225664 DOI: 10.1186/s40001-018-0352-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/21/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Both psoriasis (Ps) and psoriasis arthritis (PsA) have been associated with increased cardiovascular risk. Also, both are characterized by increased neovascularization. Endothelial progenitor cells (EPCs) have been implicated in promoting vascular repair in ischemic diseases. The aim of the study was to correlate the EPC system with CV risk factors and with parameters of vascular stiffness in Ps and PsA. METHODS Twenty-six healthy subjects, 30 patients with Ps, and 31 patients PsA were included in the study. eEPC regeneration was evaluated by a colony-forming assay, circulating eEPCs were measured by cytometric analysis. For vascular analysis, all subjects underwent quantification of pulse wave velocity (PWV) and augmentation index (AIX). RESULTS Patients were categorized upon the duration of disease, severity of skin involvement (PASI-Ps), individual pain as reflected by the VAS (PsA), CRP values, and history of treatment with one or more biologicals. Regarding the eEPC system, no significant differences were observed between the respective categories. Correlation analyses between parameters of vascular stiffness (PWV and AIX) and patterns of colony formation/circulating eEPCs did not show any correlation at all. CONCLUSION Parameters of vascular stiffness are not significantly deteriorated in Ps/PsA. Thus, pulse wave analysis may not be suitable for CVR assessment in certain autoimmune-mediated diseases. Regenerative activity of the eEPC system/circulating eEPC numbers are not altered in Ps/PsA. One may conclude that malfunctions of the eEPC are not substantially involved in perpetuating the micro-/macrovascular alterations in Ps/PsA.
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Affiliation(s)
- D Patschan
- Department of Medicine I, Cardiology-Angiology-Nephrology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany. .,Clinic of Nephrology and Rheumatology, University Hospital Göttingen, Göttingen, Germany.
| | - N Sugiarto
- Clinic of Nephrology and Rheumatology, University Hospital Göttingen, Göttingen, Germany
| | - E Henze
- Clinic of Nephrology and Rheumatology, University Hospital Göttingen, Göttingen, Germany
| | - R Mößner
- Department of Dermatology and Venerology, University Hospital Göttingen, Göttingen, Germany
| | - J Mohr
- Department of Dermatology and Venerology, University Hospital Göttingen, Göttingen, Germany
| | - G A Müller
- Clinic of Nephrology and Rheumatology, University Hospital Göttingen, Göttingen, Germany
| | - S Patschan
- Department of Medicine I, Cardiology-Angiology-Nephrology, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Germany
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Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci 2017; 19:ijms19010058. [PMID: 29295598 PMCID: PMC5796008 DOI: 10.3390/ijms19010058] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
There is solid epidemiologic evidence linking psoriasis and psoriatic arthritis (PsA) to cardiovascular risk factors and an increased risk of developing cardiovascular disease. Chronic inflammation, with shared pathways and cytokines common to metabolic syndrome, atherosclerosis and psoriasis, might provide the basis for the cardiovascular and metabolic comorbidities of psoriasis and PsA. The purpose of this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of cardiovascular risk factors and cardiovascular disease in patients with psoriasis and/or PsA; the use of analytical determinations, physiologic measures and imaging techniques as surrogate biomarkers of atherosclerosis, endothelial dysfunction and cardiovascular disease in these patients; and the epidemiological and clinical data, including results of clinical trials, supporting a cardioprotective role of anti-inflammatory and disease-modifying treatment in psoriasis and PsA.
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12
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Alba BK, Greaney JL, Ferguson SB, Alexander LM. Endothelial function is impaired in the cutaneous microcirculation of adults with psoriasis through reductions in nitric oxide-dependent vasodilation. Am J Physiol Heart Circ Physiol 2017; 314:H343-H349. [PMID: 29054972 DOI: 10.1152/ajpheart.00446.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psoriasis is an independent risk factor for cardiovascular disease; however, the underlying mechanisms are not fully understood. Deficits in conduit arterial function are evident in patients with psoriasis, but potential impairments in microcirculatory endothelial function remain unclear. We hypothesized that cutaneous microvascular dysfunction would be detectable in otherwise healthy individuals with psoriasis. Two intradermal microdialysis fibers were placed in (nonlesional) forearm skin of nine patients (3 men and 6 women, 39 ± 5 yr) with moderate (16 ± 2% of body surface area) plaque psoriasis and nine healthy (nonpsoriatic) control subjects (3 men and 6 women, 38 ± 5 yr) for local delivery of 1) lactated Ringer solution (control) and 2) 10 mM l-ascorbate (a nonspecific antioxidant). An index of skin blood flow was measured using laser-Doppler flowmetry during local heating (42°C). Nitric oxide (NO)-dependent vasodilation was directly quantified after perfusion of the nonspecific NO synthase inhibitor NG-nitro-l-arginine methyl ester (15 mM). A third fiber was perfused with increasing concentrations (10-10 - 10-2 M) of norepinephrine to elicit adrenoreceptor-mediated cutaneous vasoconstriction. NO-dependent vasodilation was attenuated in patients with psoriasis (57 ± 5% and 39 ± 7% maximum cutaneous vascular conductance in control subjects and adults with psoriasis, respectively, P < 0.01). l-Ascorbate did not improve NO-dependent vasodilation ( P > 0.05). There was no group difference in maximal vasoconstriction or microvascular sensitivity to norepinephrine ( P > 0.05). These data suggest that NO bioavailability is reduced in otherwise healthy individuals with psoriasis, which contributes to systemic microvascular dysfunction. NEW & NOTEWORTHY In adults with psoriasis, reduced nitric oxide bioavailability mediates impaired endothelium-dependent vasodilation, independent of increases in oxidative stress. Furthermore, the degree of psoriatic symptomology is directly related to greater reductions in nitric oxide-dependent vasodilation.
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Affiliation(s)
- Billie K Alba
- Department of Kinesiology, The Pennsylvania State University, Noll Laboratory , University Park, Pennsylvania
| | - Jody L Greaney
- Department of Kinesiology, The Pennsylvania State University, Noll Laboratory , University Park, Pennsylvania
| | - Sara B Ferguson
- Penn State Hershey Medical Group , State College, Pennsylvania
| | - Lacy M Alexander
- Department of Kinesiology, The Pennsylvania State University, Noll Laboratory , University Park, Pennsylvania
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Dattilo G, Imbalzano E, Casale M, Guarneri C, Borgia F, Mondello S, Laganà P, Romano P, Oreto G, Cannavò S. Psoriasis and Cardiovascular Risk: Correlation Between Psoriasis and Cardiovascular Functional Indices. Angiology 2017; 69:31-37. [DOI: 10.1177/0003319717699329] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evidence suggests that psoriasis together with other cardiovascular (CV) risk factors is associated with increased vascular morbidity, but it is not clear whether psoriasis is an independent risk factor. Consecutive patients (n = 33; 35.6 ± 5.7 years; 13 females) with mild psoriasis (Psoriasis Area and Severity Index <10) without comorbidities and 33 healthy participants (36.3 ± 5.9 years; 15 females) were enrolled. Both groups underwent echocardiography, speckle tracking (2-dimensional strain echocardiography [2D-SE]), and pulse wave velocity (PWV) testing. Clinical and conventional echocardiographic characteristics were comparable between both groups. Global longitudinal strain (GLS) was significantly lower ( P = .002) in the psoriasis group (22.39% ± 2.28%) than in controls (24.15% ± 2.17%). The PWV was significantly lower ( P = .004) in controls (8.06 ± 1.68 m/s) than in the psoriasis group (9.23 ± 1.53 m/s). Significant correlations between GLS and disease duration ( r = −.66, P < .0001) and between GLS and patient age at diagnosis ( r = .48, P = .0043) were found. Psoriasis may be an independent CV risk factor, causing cardiac and vascular impairment. Both 2D-SE and PWV may be useful tools for the screening of CV risk in these patients.
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Affiliation(s)
- Giuseppe Dattilo
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Egidio Imbalzano
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Matteo Casale
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Borgia
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Stefania Mondello
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Pasqualina Laganà
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Pietro Romano
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Oreto
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sarafinella Cannavò
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Yang ZS, Lin NN, Li L, Li Y. The Effect of TNF Inhibitors on Cardiovascular Events in Psoriasis and Psoriatic Arthritis: an Updated Meta-Analysis. Clin Rev Allergy Immunol 2017; 51:240-7. [PMID: 27300248 DOI: 10.1007/s12016-016-8560-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
TNF inhibitors have been used in psoriasis (Pso) and psoriatic arthritis (PsA), which were associated with increased risk of cardiac and cerebrovascular events. However, whether TNF inhibitors reduce cardiovascular event is still unclear. Therefore, we aimed to evaluate the effect of TNF inhibitors on adverse cardiovascular events (CVEs) in Pso with or without PsA. We undertook a meta-analysis of clinical trials identified in systematic searches of MEDLINE, EMBASE, Wanfang database, Cochrane Database, and Google scholar through December 31, 2015. Five studies (49,795 patients) were included. Overall, compared with topical/photo treatment, TNF inhibitors were associated with a significant lower risk of CVE (RR, 0.58; 95 % CI, 0.43 to 0.77; P < 0.001; I (2) = 66.2 %). Additionally, compared with methotrexate (MTX) treatment, risk of CVE was also markedly decreased in the TNF inhibitor group (RR, 0.67; 95 % CI, 0.52 to 0.88; P = 0.003; I (2) = 9.3 %). Meanwhile, TNF inhibitors were linked to reduced incidence of myocardial infarction compared with topical/photo or MTX treatment (RR, 0.73; 95 % CI, 0.59 to 0.90; P = 0.003; I (2) = 56.2 % and RR, 0.65; 95 % CI, 0.48 to 0.89; P = 0.007; I (2) = 0.0 %, respectively). Furthermore, there was a trend of decreased rate of mortality in the TNF inhibitor group compared with other therapy (RR, 0.90; 95 % CI, 0.54 to 1.50; P = 0.68; I (2) = 70.9 %). TNF inhibitors appear to have net clinical benefits with regard to adverse cardiovascular events in Pso and/or PsA. Rigorous randomized controlled trials will need to evaluate whether TNF inhibitors truly result in reduction of cardiovascular diseases.
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Affiliation(s)
- Zheng-Sheng Yang
- Department of Dermatology, The First Hospital of Qinhuangdao, No. 258, Wenhua Road, Qinhuangdao, Hebei, China.
| | - Ning-Ning Lin
- Department of Dermatology, The First Hospital of Qinhuangdao, No. 258, Wenhua Road, Qinhuangdao, Hebei, China
| | - Li Li
- Department of Infection, The First Hospital of Qinhuangdao, Qinhuagdao, Hebei, China
| | - Yang Li
- Department of Scientific Research Management, The First Hospital of Qinhuangdao, Qinhuagdao, Hebei, China
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Cai K, Luo Q, Zhu B, Han L, Wu D, Dai Z, Wang K. Neutrophil-lymphocyte ratio is associated with arterial stiffness in patients with peritoneal dialysis. BMC Nephrol 2016; 17:191. [PMID: 27881094 PMCID: PMC5122148 DOI: 10.1186/s12882-016-0394-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 11/09/2016] [Indexed: 01/28/2023] Open
Abstract
Background Patients with peritoneal dialysis are in the persistent inflammation state and have elevated arterial stiffness. Neutrophil-lymphocyte ratio(NLR) is a new inflammatory marker in renal and cardiac disorders. Brachial-ankle pulse wave velocity (baPWV) is a non-invasive measurement, which is widely used as a surrogate marker of arterial stiffness. However, there is little evidence to show an association between NLR and baPWV in patients with peritoneal dialysis. The aim of this cross-section study was to investigate the relationship between NLR and arterial stiffness measured by baPWV in patients with peritoneal dialysis. Methods In this cross-section study, 101 patients with peritoneal dialysis were enrolled from January 2014 to June 2015. According to average baPWV level (1847.54 cm/s), the patients were categorized into two groups, low group and high group. baPWV, which reflects arterial stiffness, was calculated using the single-point method. Clinical data were collected in details. NLR was calculated using complete blood count. Associations between NLR and baPWV were assessed using Pearson’s correlation and linear regression analysis. Results The NLR was significantly lower in the low baPWV group than in the high baPWV group (p = 0.03). There were positive correlations between baPWV and neutrophil count (r = 0.24, p = 0.01) and NRL(r = 0.43, P < 0.01), and there was a negative correlation between baPWV and lymphocyte count (r = -0.23, p = 0.01). In addition, albumin, phosphorous and intact parathyroid hormone showed negative correlations with baPWV (r = −0.32, p < 0.01; r = −0.28, p < 0.01; r = −0.25, p = 0.01, respectively). Age and hsCRP showed positive correlations with baPWV (r = 0.47, p < 0.01; r = 0.25, p = 0.01). In multivariate analysis, NLR independently correlated with baPWV in patients with peritoneal dialysis (β = 0.33, p < 0.01), even after adjustment for various confounders. Conclusion Our study suggests that NLR was an independently associated with arterial stiffness in patients with peritoneal dialysis. However, further prospective studies are needed to confirm cause-and-effect relationship between NLR and baPWV, and to investigate whether anti-inflammatory treatment could improve arterial stiffness in patients with peritoneal dialysis. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0394-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kedan Cai
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
| | - Qun Luo
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China.
| | - Beixia Zhu
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
| | - Lina Han
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
| | - Dan Wu
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
| | - Zhiwei Dai
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
| | - Kaiyue Wang
- Department of Nephrology, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Zhejiang, China
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Yanartas O, Sunbul M, Durmus E, Kivrak T, Senkal Z, Subasi N, Karaer G, Ergun S, Sari I, Sayar K. Severity of Depression and Anxiety Symptoms is Associated with Increased Arterial Stiffness in Depressive Disorder Patients Undergoing Psychiatric Treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20160325085828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Omer Yanartas
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
| | - Murat Sunbul
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Erdal Durmus
- Silifke State Hospital, Cardiology Clinic, Mersin - Turkey
| | - Tarik Kivrak
- Sivas Numune Hospital, Cardiology Clinic, Sivas - Turkey
| | - Zeynep Senkal
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
| | - Nilufer Subasi
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
| | - Gulhan Karaer
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
| | - Serhat Ergun
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
| | - Ibrahim Sari
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Kemal Sayar
- Marmara University, Faculty of Medicine, Department of Psychiatry, Istanbul - Turkey
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The usefulness of brachial-ankle pulse wave velocity in predicting long-term cardiovascular events in younger patients. Heart Vessels 2016; 32:660-667. [PMID: 27822742 DOI: 10.1007/s00380-016-0919-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/04/2016] [Indexed: 12/30/2022]
Abstract
Brachial-ankle pulse wave velocity (baPWV) is known as a significant predictor of cardiovascular events. However, the previous studies have not considered age, which can affect the baPWV value. We evaluated the predictive value of baPWV for cardiovascular events in various age groups. From January 2005 to December 2012, all patients admitted to our department with any cardiovascular disease and underwent ankle-brachial index (ABI) measurement were enrolled in the IMPACT-ABI registry. The primary endpoints included major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke). Of the 3131 patients enrolled, 2554 were included in the analysis, whereas 577 were excluded due to missing baPWV data, ABI ≤0.9 and/or >1.4, and the previous endovascular therapy and/or surgical treatment for peripheral artery disease. Patients were divided according to age 30-59 years (n = 580), 60-69 years (n = 730), 70-79 years (n = 862), and ≥80 years (n = 330). The cumulative incidence of MACE through 5 year was significantly higher in the high baPWV group (>1644 cm/s) than in the low baPWV group (≤1644 cm/s; 8.7 vs. 4.6%; log-rank: p < 0.001). However, among the age groups, only the 30-59-year group showed a significant difference in MACE incidence between those with high and low baPWV (7.0 vs. 0.9%; log-rank: p = 0.001). In conclusion, the baPWV could serve as a useful marker to predict cardiovascular events, particularly among younger patients.
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Solak B, Dikicier BS, Erdem T. Impact of Elevated Serum Uric Acid Levels on Systemic Inflammation in Patients With Psoriasis. Angiology 2016; 68:266-270. [PMID: 27401209 DOI: 10.1177/0003319716657980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with psoriasis have increased systemic inflammation and serum uric acid (SUA) levels compared with the general population. However, the role of SUA in modulating inflammation in these patients is not known. We evaluated the associations of SUA with inflammation and psoriasis severity; 199 patients with psoriasis and 54 healthy volunteers were included in the study. Demographic features, Psoriasis Area and Severity Index (PASI) scores, and laboratory data including SUA, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were collected. Patients with psoriasis had higher fasting blood glucose, body mass index (BMI), CRP, SUA, white blood cell (WBC) count, neutrophil count, and NLR compared with controls. The PASI score positively correlated only with CRP ( r = .185, P = .012) and NLR ( r = .313, P < .001). The BMI, WBC count, PASI score, and CRP, but not SUA, appeared as independent associates of NLR in patients with psoriasis in linear regression analysis. Neutrophil to lymphocyte ratio and SUA were significantly increased in patients with psoriasis compared with controls. Neutrophil to lymphocyte ratio and CRP were independent predictors of PASI score, whereas SUA was not. Serum uric acid seemed not to modulate the inflammation seen in patients with psoriasis in our cohort.
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Affiliation(s)
- Berna Solak
- 1 Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Bahar Sevimli Dikicier
- 2 Department of Dermatology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Teoman Erdem
- 1 Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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19
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Yanartas O, Sunbul M, Senkal Z, Durmus E, Kivrak T, Subasi N, Karaer G, Ergun S, Sari I, Sayar K. Increased arterial stiffness parameters in panic disorder patients in long term treatment period. Ann Gen Psychiatry 2016; 15:14. [PMID: 27279893 PMCID: PMC4898398 DOI: 10.1186/s12991-016-0102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. METHODS The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. RESULTS While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). CONCLUSION We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.
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Affiliation(s)
- Omer Yanartas
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Zeynep Senkal
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Erdal Durmus
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tarik Kivrak
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nilufer Subasi
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Gulhan Karaer
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhat Ergun
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Ibrahim Sari
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kemal Sayar
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
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20
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Sunbul M, Cagman Z, Gerin F, Ozgen Z, Durmus E, Seckin D, Ahmad S, Uras F, Agirbasli M. Growth arrest-specific 6 and cardiometabolic risk factors in patients with psoriasis. Cardiovasc Ther 2015; 33:56-61. [PMID: 25752901 DOI: 10.1111/1755-5922.12112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES An increased risk for cardiovascular disease with psoriasis has been reported. Growth Arrest-Specific 6 (GAS6) amplifies pro-inflammatory endothelial cell activation via TAM receptors. However, it also inhibits inflammation by multiple mechanisms including phagocytosis. The objective of this study was to investigate whether plasma GAS6 levels are associated with conventional cardiometabolic (CM) risk factors in patients with psoriasis. METHODS Forty patients diagnosed with psoriasis (22 male, mean age: 43.3 ± 13.8 years) and 40 age-/sex-matched healthy controls (22 male, mean age: 39.3 ± 8.9 years) were included in the study. CM risk factors (hypertension, hyperlipidemia, diabetes mellitus, and cigarette smoking) were identified. GAS6 levels were measured by ELISA. RESULTS There were no significant differences between the plasma GAS6 levels of patients with psoriasis compared to the control group (6.6 ± 2.0 ng/mL, 7.6 ± 2.8 ng/mL, respectively, P > 0.05). However, GAS6 levels of patients with psoriasis having a smoking history (n = 11) were significantly lower than both patients with psoriasis who had no smoking history (n = 29) and controls (5.5 ± 1.7 ng/mL, 6.9 ± 1.9 ng/mL, 7.6 ± 2.8 ng/mL, respectively, P < 0.05). Similarly, psoriasis patients with at least one CM risk factor showed lower GAS6 levels compared to subjects without any CM risk factor (5.7 ± 1.7 ng/mL, 7.3 ± 2.0 ng/mL, P < 0.01). There was no correlation between the GAS6 level, disease duration or PASI score (r = 0.150, -0.150, and P = 0.310, 0.398, respectively). CONCLUSIONS This pilot study provides the first evidence in humans for an association between low plasma GAS6 levels and conventional risk factors in psoriasis. Further large scale, prospective studies are needed to confirm these results.
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Affiliation(s)
- Murat Sunbul
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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21
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Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis. Hypertension 2015; 67:183-90. [PMID: 26597821 DOI: 10.1161/hypertensionaha.115.06066] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/28/2015] [Indexed: 12/27/2022]
Abstract
Accumulating evidence suggests that central blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. A systematic review assessing the relationship of central versus brachial BP with preclinical target-organ damage was performed. Meta-analysis of cross-sectional data showed that central compared with brachial systolic BP was more closely associated with (1) left ventricular mass index (12 studies, n=6431; weighted age [SD], 49.9 [13.1] years; 51% hypertensives): pooled correlation coefficients r=0.30; 95% confidence interval (CI), 0.23-0.37 versus r=0.26; 95% CI, 0.19-0.33, respectively; P<0.01 for difference; (2) carotid intima-media thickness (7 studies, n=6136; weighted age, 55.6 [13.2] years; 48% hypertensives): r=0.27; 95% CI, 0.19-0.34 versus r=0.23; 95% CI, 0.16-0.30, respectively; P<0.01 for difference; (3) pulse-wave velocity (14 studies, n=3699; weighted age, 53.9 [13.3] years; 53% hypertensives): r=0.42; 95% CI, 0.37-0.47 versus r=0.39; 95% CI, 0.33-0.45, respectively; P<0.01 for difference. Four studies assessing urine albumin excretion (n=3718; weighted age, 56.4 [5] years; 69% hypertensives) reported similar correlations (P=not significant) with central (r=0.22; 95% CI, 0.14-0.29) and brachial systolic BP (r=0.22; 95% CI, 0.12-0.32). Similar findings were observed for central compared with brachial pulse pressure in terms of relationship with target-organ damage. Metaregression analyses did not reveal any significant effect of age. In conclusion, central compared with brachial BP seems to be more strongly associated with most of the investigated indices of preclinical organ damage.
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Affiliation(s)
- Anastasios Kollias
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Styliani Lagou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Maria Elena Zeniodi
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - Nadia Boubouchairopoulou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece
| | - George S Stergiou
- From the Third University Department of Medicine, Hypertension Center, STRIDE-7, Sotiria Hospital, Athens, Greece.
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Mastrolonardo M, D'Arienzo G, Grimaldi M, Caivano M, Bonamonte D, Di Biase M, Brunetti ND. Increased prevalence of early repolarization in electrocardiograms of psoriatic patients. Heart Vessels 2015; 31:408-15. [PMID: 25549808 DOI: 10.1007/s00380-014-0619-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022]
Abstract
Psoriasis (Ps) is a chronic-relapsing, inflammatory, and proliferative condition of the skin: prior studies hypothesized a link between Ps and anomalies in β-adrenergic tone. We therefore aimed to ascertain the prevalence of early repolarization pattern (ERP) in resting electrocardiograms (ECGs) of psoriatic patients compared with an appropriate control group. We performed a retrospective study of resting ECGs of 100 consecutive psoriatic patients and 100 healthy controls. The presence of ERP in at least two contiguous leads at rest ECG was recorded, and findings were also categorized according to the lead group where ERP was detected (anterior, lateral, inferior). An ERP in ≥ 2 contiguous leads occurred in 40 % of psoriatic patients, compared with 14 % of control subjects (p < 0.001). (36 vs 10 % in anterior leads, p < 0.001; 6 vs 3 % in inferior leads, p n.s.; 10 vs 2 % in lateral leads). After adjustment for sex, age, heart rate, and level of physical activity, the odds ratios for the presence of ERP were 8.6 (95 % CI, 2.1-35.2, p < 0.01), and 7.1 (95 % CI, 1.6-31.8, p < 0.05) in anterior leads. In a small case/control study, increased rates of ECGs showing ERP have been observed among psoriatic patients. Clinical significance of such finding needs to be assessed in further observational studies.
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Affiliation(s)
- Mario Mastrolonardo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy
| | - Girolamo D'Arienzo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy
| | - Massimo Grimaldi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy
| | - Marica Caivano
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy
| | - Domenico Bonamonte
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100, Foggia, Italy.
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Pulse wave analysis of the aortic pressure waveform in patients with vasovagal syncope. Heart Vessels 2014; 31:74-9. [PMID: 25164239 DOI: 10.1007/s00380-014-0576-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
Vascular reflex mechanisms contribute to vasovagal syncope. However, the alterations in central haemodynamics in patients with vasovagal syncope are unknown. 30 consecutive patients (36.5 ± 15 years, 14 females) with recurrent vasovagal syncope (VVS) and a positive tilt table test were compared to 39 age- and sex-matched controls (36.9 ± 16 years, 15 females) with a negative tilt table result and no history of syncope. Central aortic pressure parameters including augmentation index and central pulse pressure as markers of aortic stiffness were generated non-invasively by applanation tonometry of the radial artery and use of a validated mathematical transfer function. No difference in aortic augmentation index was observed between groups. (VVS 9 ± 2.6 vs. Control 11 ± 2.4, p = 0.8). However, in patients with vasovagal syncope the aortic pressure waveform significantly differed from healthy controls. A prolonged time to the peak of aortic pressure wave (aortic T2) was observed in patients with vasovagal syncope (226 ± 24 vs. 208 ± 21 ms, p = 0.001). Furthermore time to the first shoulder of the aortic pressure wave (aortic T1) was slightly shorter compared to healthy controls, but did not reach statistical significance (106 ± 22 vs. 110 ± 12 ms, p = 0.33). Patients with vasovagal syncope have an altered aortic pressure waveform at rest, but no signs of elevated aortic stiffness. The underlying mechanisms for these findings may potentially result from a complex imbalance of the autonomic nervous system with a continuous deregulation of the sympathetic and parasympathetic reflex arcs.
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24
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Her AY, Ann SH, Lee JH, Kim JM, Kim YH, Garg S, Singh GB, Shin ES. Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation. Heart Vessels 2014; 30:740-5. [PMID: 25062712 DOI: 10.1007/s00380-014-0550-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/27/2014] [Indexed: 12/27/2022]
Abstract
We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ≤20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22-4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1-7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04-2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Soe Hee Ann
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea
| | - Jun Ho Lee
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea
| | - Jong Min Kim
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Gillian Balbir Singh
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
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