Psoriasis and cardiometabolic disorders

Abstract

Psoriasis is a chronic, inflammatory, autoimmune skin disease affecting 2-4% of general population. It is an important social issue, because of its confirmed associations with metabolic syndrome. Individals with psoriasis are at an increased risk of developing cardiovascular disorders and diabetes mellitus. Psoriasis and its comorbidities have multiple common pathogenic pathways including the chronic inflammatory process, immunological abnormalities, genetic links and different bioactive proteins secreted by the adipose tissue. Considering the above associations, it is advisable to perform screening tests in patients with psoriasis to detect metabolic disorders as they not only increase mortality in these individuals, but also decrease their life quality significantly. An essential issue is also the education and the improvement of doctor-patient relationship, as well as early introducing of preventive measures. streszczenie Łuszczyca jest przewlekłą, zapalną, autoimmunologiczną chorobą skóry dotyczącą 2-4% populacji. Stanowi istotny problem społeczny ze względu na związek z zespołem metabolicznym, co zwiększa ryzyko zachorowania na choroby układu sercowo-naczyniowego i cukrzycę. Łuszczyca i choroby z nią współistniejące mają wiele wspólnych szlaków patogenetycznych, m.in. przewlekły proces zapalny, zaburzenia immunologiczne, czynniki genetyczne oraz różne aktywne biologicznie substancje wydzielane przez tkankę tłuszczową. Ze względu na powyższe zależności celowe wydaje się wykonywanie u chorych na łuszczycę badań przesiewowych w kierunku zaburzeń kardiometabolicznych, gdyż nie tylko zwiększają one śmiertelność u tych chorych, lecz także znacznie obniżają jakość ich życia. Bardzo istotna jest też edukacja i poprawa relacji lekarz-pacjent oraz wczesne wdrażanie profilaktyki.

Aberrations in Lipid Expression and Metabolism in Psoriasis

“…Metabolic syndrome (MS) is a disorder that can be diagnosed if a patient meets three of the following five criteria: increased waist circumference of ≥80 cm in females and ≥94 cm in males; triglycerides serum concentration of >150 mg/dL or treatment of hyperglyceridemia; HDL-C (high-density lipoprotein) serum concentration of <40 mg/dL in males and <50 mg/dL in females or treatment of this disorder; fasting blood glucose of ≥100 mg/dL or treatment of type 2 diabetes mellitus; systolic blood pressure of ≥130 mm Hg or diastolic blood pressure of ≥85 mm or treatment of hypertension [ 8 ]. MS is also associated with atherosclerosis and liver disorders, particularly nonalcoholic fatty liver disease (NAFLD) [ 8 ].…”

“…MS is estimated to affect about 20% to 50% of patients with PSO [ 8 ]. It may lead to an increased risk of cardiovascular complications [ 9 ], and it has been proved that psoriatic patients live on average five years less than people without this condition [ 10 ].…”

“…There is a polymorphism in the FTO rs9930506 gene, which encodes 2-oxoglutarate-dependent nucleic acid demethylase and is associated with higher BMI and greater predisposition for obesity. At the same time, in subjects with such polymorphism, more severe psoriatic lesions are observed [ 8 , 13 ]. Moreover, the risk of PSO may be increased in obese people who possess the HLA Cw6 antigen [ 8 , 14 ].…”

“…At the same time, in subjects with such polymorphism, more severe psoriatic lesions are observed [ 8 , 13 ]. Moreover, the risk of PSO may be increased in obese people who possess the HLA Cw6 antigen [ 8 , 14 ]. Recently, a bidirectional relationship between PSO and obesity has been highlighted, namely PSO predisposing to obesity, and obesity enhancing psoriasis [ 15 ].…”

“…Among the basic systemic antipsoriatic agents, acitretin and cyclosporin A are known to cause hyperlipidemia as a side effect [ 8 ]. As for biological treatment, it has become the first-line treatment in the management of moderate-to-severe psoriasis [ 63 ].…”