Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance

Abstract

BackgroundPsoriasis is associated with an increased risk of cardiovascular disease (CVD) at younger ages that is not identifiable by traditional risk factors. Screening for subclinical atherosclerosis with ultrasound has only been investigated in carotid arteries. Femoral artery ultrasound has never been considered for this purpose. The link between psoriasis and accelerated atherosclerosis has not yet been established.ObjectiveTo study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis in psoriasis. We also investigated its possible relationship with changes in insulin resistance.MethodsWe conducted a cross-sectional study in 140 participants, 70 patients with moderate-to-severe psoriasis and 70 healthy controls, matched 1:1 for age, sex, and BMI. Femoral and carotid atherosclerotic plaques were evaluated by ultrasonography. Insulin resistance was assessed by the homeostasis model assessment method (HOMA-IR).ResultsFemoral atherosclerotic plaque prevalence was significantly higher in patients with psoriasis (44.64%) than in controls (19.07%) (p<0.005), but no significant difference was found in carotid plaque prevalence (p<0.3). Femoral plaques were significantly more prevalent than carotid plaques (21.42%) among patients with psoriasis (p<0.001). In the regression analysis, insulin resistance was the most influential determinant of atherosclerosis in psoriasis and C-reactive protein the most significant predictor of insulin resistance.ConclusionsUltrasound screening for femoral atherosclerotic plaques improves the detection of subclinical atherosclerosis in patients with psoriasis, whereas the study of carotid arteries is not sufficiently accurate. Insulin resistance appears to play a greater role in the development of atherosclerosis in these patients in comparison to other classical CVD risk factors.

Management of psoriasis as a systemic disease: what is the evidence?

“…In these studies, patients with moderate‐to‐severe psoriasis demonstrate subclinical inflammation in the liver, joints and tendons, in addition to significantly increased global arterial and subcutaneous inflammation, and patients with mild psoriasis had subclinical inflammation in the aorta . Also, ultrasound of femoral arteries can improve detection of subclinical atherosclerosis in patients with moderate‐to‐severe psoriasis and insulin resistance helps to provide a better prediction of subclinical atherosclerosis than traditional CVD risk factors . Such observations have led to a better understanding of how a subset of inflammatory molecules diffuse into the systemic circulation and then to various organ systems; this may contribute to the pathology of common inflammatory comorbidities in psoriasis (Fig.…”

“…[20][21][22] Also, ultrasound of femoral arteries can improve detection of subclinical atherosclerosis in patients with moderate-to-severe psoriasis and insulin resistance helps to provide a better prediction of subclinical atherosclerosis than traditional CVD risk factors. 23 Such observations have led to a better understanding of how a subset of inflammatory molecules diffuse into the systemic circulation and then to various organ systems; this may contribute to the pathology of common inflammatory comorbidities in psoriasis ( Fig. 2).…”

Exploring the Pathogenesis of Psoriasis Complicated With Atherosclerosis via Microarray Data Analysis

“…Insulin resistance induced by the inflammatory response in psoriasis can cause atherosclerosis. Research showed that a variety of inflammatory markers can be detected in the blood of patients with psoriasis, confirming that the body was in a systemic inflammatory state during the onset of psoriasis, which induced insulin resistance and reduced the release of vasodilator factors, then it provided an environmental basis for the formation of atherosclerotic plaques ( 19 ). Studies have shown that psoriasis is associated with atherosclerosis through dyslipidemia, including increased levels of total cholesterol, triglycerides, low-density lipoprotein, ultra-low-density lipoprotein and lipoprotein a, and the reduction of high-density lipoprotein and apolipoprotein B levels ( 20 ).…”

Psoriasis and Cardiovascular Disease: A Narrative Review

“…40) Moreover, ultrasound can be used to detect subclinical atherosclerosis in femoral arteries. Gonzalez-Cantero et al 41) demonstrated that femoral atherosclerotic plaque was more prevalent in patients with psoriasis than in those without, and that it was more prevalent than carotid plaque, thereby improving its detection in subclinical stages. These data make ultrasound a low-cost, high-performance technique that allows assessment of atherosclerotic damage in patients with psoriasis.…”