A total of 158 psoriasis patients were included. Our study population was typical for a
psoriasis population with 48% of subjects being male (mean age 37 (32-48)
years) and 52% female (mean age 39.7 ± 12.1) (Table I). 76% were ethnically Emirati and 24% of other
ethnicities and 74% were married. Regarding cardiovascular risk factors 13% had
diabetes, 14% were hypertensive, 43% had a high low density lipoprotein level
(LDL), 33% had a raisedcholesterol level, 29% had a raised triglyceride level,
35% were overweight and 45% were obese - BMI: Normal (18.5-24.99 kg/m2),
Overweight (25-29.99 kg/m2) and Obese (>30 kg/m2) (Table 1). No
significant differences were found in cardiovascular risk factors between the
genders (Table 2,3) whilst hypertension was significantly more likely in the
married population and a raised triglyceride level more likely in the single
population (Table 4,5). Our study analyzed the relationship between certain
cardiovascular factors (obesity, diabetes, hypertension, dyslipidemia) with
psoriasis and the relationship of selected demographic data with the
cardiovascular risk factors among psoriatic patients in UAE. Previous studies
demonstrated that psoriatic patients have higher risk of cardiovascular
diseases and this risk increases with disease severity [6]. This association
was confirmed by studies that demonstrated overlapping proinflammatory cytokines
in both psoriasis and cardiovascular disease [7].
Hypertension was found in 14% of study population
compared to 13% in UAE population8.
Increased blood pressure is associated to the increased level of
angiotensin-converting enzyme (ACE), endothelin-1 (ET-1), and rennin [8-12].
Adipose tissues release angiotensinogen which is converted to angiotensin II
that stimulates T-cell proliferation [13]. Weight reduction may lower blood
pressure as it will reduce the angiotensin II [14]. Hypertension occurs more
frequently in patients with psoriasis [15-18]. However, recent literature does
not fully support this association 15. In our study, older age was
significantly associated with increased hypertension risk [p = 0.006] (Tables 2
and 5). This is consistent with previous studies which concluded that psoriasis
patients had an increased risk of hypertension after the age of 40 [19]. In our
study, a significant relationship between marital status and hypertension was
found. The prevalence of hypertension was higher among married patients [p =
0.017]. Our study showed that 43% of the patients had high LDL, 27% high
cholesterol, 21% high triglycerides comparedrespectively to 38.6%, 42% and 29%
among adult Emiratis [20]. Significantly higher prevalence of abnormal
triglycerides levels in single patients [34% vs. 17%; p = 0.025] and over
8-fold higher risk of abnormal triglycerides levels than married ones (p
<0.001). Older age was significantly associated with increased risk of
higher LDL [p = 0.025], higher cholesterol [p = 0.005] and risk of higher
triglycerides [p = 0.002].The relationship of dyslipidemia to psoriasis is
explained by the chronic elevation of proinflammatory cytokineswhich affect the
lipid metabolism. Other dyslipidemia causes in psoriasis patients include
patient’s lifestyle and treatment side effect [21].
Our resultsare consistent with previous studies that
psoriasis patients have higher concentrations of lipid levels [15-23]. Obesity
or overweight was found in majority of our patients (80%). The UAE population
is the one with world highest obesity level and obesity might be considered as
an epidemic. No significant relation was found with age. Adipose tissue, an
active endocrine tissue that releases pro-inflammatory cytokines [25,26]. The
increased risk of obesity may be secondary to the release of inflammatory
cytokines [27]. Obesity with high levels of C-reactive protein and raised
erythrocyte sedimentation rate in the absence of inflammatory conditions may
exacerbate skin lesions in patients with psoriasis [28]. Psoriasis patients
were found to have higher levels of leptin and lower level of adiponectin [29].
Cohort studies suggest that obesity is a risk factor for psoriasis development
[30,31]. Large databases of psoriatic patients found that BMI increased in
patients after psoriasis diagnosis which might indicate that obesity is
secondary to psoriasis.32Some cross-sectional studies found that increased BMI
correlates with more severe psoriasis [32,33]. Moreover other studies mentioned
that weight loss may improve psoriasis and treatment response [34-36]. Diabetes
was found in 13% of our patients compared to 8% in UAE general population 8.The
chronic inflammatory nature of psoriasis with the inflammatory mediators will
result in epidermal hyperplasia, antagonized insulin signalling and mediate
insulin resistance [29-37]. Previous study confirm the coexistence of diabetes
in patients with severe psoriasis in 7.1% and with mild psoriasis in 4.4%
compared to the control group (3.3%) [33]. Polish study showed slightly higher
levels of insulin in psoriasis patients compared to the control group, but at
the limit of statistical significance [38].
In our study, age was significantly different in
diabetic patients vs. non-diabetics [median, IQR: 53 (37.8-59) years for diabetics vs. 36
(31-45.5) for non-diabetics; p = 0.001]. Older age was significantly associated
with increased risk of diabetes [p = 0.001] and this was concurrent with
previous studies which found significantly increased odds ratio for developing
diabetes among psoriatic patients between 35 and 55 years of age [15-39]. Our
results showed significant pairwise associations between a variety of
cardiovascular risk factors including diabetes andhypertension [p<0.001],
high cholesterol [p = 0.017], high triglycerides [p = 0.034]; hypertension and
high cholesterol [p = 0.041], high triglycerides [p = 0.019]; high LDL and high
triglycerides [p<0.001] and high cholesterol and high triglycerides
[p<0.001]. The study highlights the importance of psoriasis and
cardiovascular risk factors relationship. Early routine screening is vital. A
previous study found, half of the dermatologists who were aware of the high
cardiovascular risk didn’t educate their patients [40]. Some studies showed
that biologics targeting TNF-alpha may reduce cardiovascular risk factors but
no recommended therapies based on that [41,42]. Routine United States-based
recommendations for all patients (not only psoriasis) include: 1) a blood
pressure check in patients 21 or older, (2) fasting glucose every 3 years in
patients above 45 or younger in patients with diabetes risk factors (3)
cholesterol screening every 5 years starting at age 20 1. In Abu Dhabi,
weqayaprogram was established in 2008 for cardiovascular risk factors screening
among UAE individuals [43].
