Monday, January 11, 2010

Psoriasis linked to atherosclerosis: An unsolved mystery?

During the last years several studies have reported that patients with psoriasis are more likely to have traditional cardiovascular risk factors, such as hyperlipidemia, hypertension, diabetes, obesity, tobacco use, and a history of previous myocardial infarction (1, 2).
Very recently a new study has suggested that psoriac patients have more propensity for coronary artery, cerebrovascular and peripheral vascular diseases resulting in increased mortality. This study compared rates of heart disease, stroke-related vascular disease and peripheral artery disease (PAD), and death among 3.236 people with psoriasis (mostly men between 50-60 years) and 2.500 people without this condition. Overall people with psoriasis were nearly twice as likely to have been diagnosed with heart disease, stroke related vascular disease or PAD. What’s more, 19.6% of people with psoriasis died during the study, compared with 9.9% of participants who did not have psoriasis (3).
In reality many recent studies are showing the prevalence of subclinical atherosclerosis in patients with psoriasis compared with health patients, through a marked increase in the carotid artery intima-media thickness, measured by ultrasonography (4,5,6 ,7,8).
Also, a study has shown that subclinical atherosclerosis in psoriac patients is significantly associated with increased sugar and triglyceride levels (6)
Other studies have shown that metabolic systems may be disturbed in association with psoriasis, with many compounds formed in excess from glucose, like lactic acid (9). It is interesting to notice that Boyd and Menter found that 13 (62%) of 21 patients with erythroderma, the most severe form of psoriasis, had elevated serum lactic deydrogenase (10). Another study have indicated a shift of enzymatic activity of lactate deydrogenase in erythrocyte in psoriasis towards LDH2 and LDH1, and thus to enhanced energy production by oxidation in psoriatic patients as compared with normal controls (11).
According to some researchers the mechanism by which premature atherosclerosis develops in psoriasis remains an unsolved mystery, becoming a focus of current research to further elucidate the pathophysiology underlying and connecting these two diseases (12).
Taking in view the above findings I think the acidity theory may offer a valid and potential pathophysiological mechanism to explain the link psoriasis/atherosclerosis (13)

1) Matthew Meier and Pranav B. Sheth, Clinical Spectrum and Severity of Psoriasis. Curr Probl Dermatol. Basel, Karger, 2009, vol 38, pp 1–20. Full free paper at
2) Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2009 Dec 27.
3) Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG.. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009 Jun;145(6):700-3.
4) El-Mongy S, Fathy H, Abdelaziz A, Omran E, George S, Neseem N, El-Nour N. Subclinical atherosclerosis in patients with chronic psoriasis: a potential association. J Eur Acad Dermatol Venereol. 2009 Nov 2
5) Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, Seyfeli E, Inandi T, Egilmez E. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol. 2009 Jan;23(1):1-6.
6) Tam LS, Shang Q, Li EK, Tomlinson B, Chu TT, Li M, Leung YY, Kwok LW, Wong KC, Li TK, Yu T, Zhu TY, Kun EW, Yip GW, Yu CM. Subclinical carotid atherosclerosis in patients with psoriatic arthritis. Arthritis Rheum. 2008 Sep 15;59(9):1322-31.
7) Eder L, Zisman D, Barzilai M, Laor A, Rahat M, Rozenbaum M, Bitterman H, Feld J, Rimar D, Rosner I. Subclinical atherosclerosis in psoriatic arthritis: a case-control study. J Rheumatol. 2008 May;35(5):877-82.
8) Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007 Aug 15;57(6):1074-80.
9) Meynadier J, Guilhou JJ, The biochemistry of psoriasis. Ann Dermatol Syphiligr (Paris). 1976;103(5-6):525-45.
10) A. Boyd, A. Menter, Erythrodermic psoriasis: Precipitating factors, course, and prognosis in 50 patients.Journal of the American Academy of Dermatology, 1989, Volume 21, Issue 5, Pages 985-991
11) Malina L, Volek V, Bielicky T. The activity of lactate dehydrogenase in the erythrocytes in psoriasis. Z Haut Geschlechtskr. 1969 Oct 1;44(19):877-9.
12) Shelling ML, Federman DG, Prodanovich S, Kirsner RS. Psoriasis and vascular disease: an unsolved mystery. Am J Med. 2008 May;121(5):360-5.
13) Carlos ETB Monteiro, Acidic environment evoked by chronic stress: A novel mechanism to explain atherogenesis. Available from Infarct Combat Project, January 28, 2008 at

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