Psoriasis on your CV: NMR helps spot heart disease link

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  • Published: Dec 1, 2011
  • Author: David Bradley
  • Channels: NMR Knowledge Base
thumbnail image: Psoriasis on your CV: NMR helps spot heart disease link

Skin and stroke

NMR has been used to measure lipid levels in psoriasis patients and the results point to a possible explanation for a link with cardiovascular disease.

A multidisciplinary collaboration between the Penn Medicine Cardiovascular Institute, the Division of Cardiovascular Medicine, Department of Dermatology, and the Division of Translational Medicine and Human Genetics has found an explanation for the discovery that people with moderate to severe forms of the skin disorder psoriasis may have an increased risk of heart attack, stroke and cardiovascular death.

Psoriasis is an autoimmune disease that commonly presents as red and white scaly patches on the skin, although for some patients there are no dermatological symptoms. It arises when the immune system erroneously identifies skin cells as pathogenic and so triggers an acceleration of the skin cell growth cycle. Five forms of psoriasis have been identified: plaque, guttate, inverse, pustular and erythrodermic, with plaque psoriasis being the most common. An association with an increased risk of cardiovascular disease and stroke in particular has been suspected since at least the 1990s. However, a Danish study of 4.5 million people spanning the period 1997 to 2006 and published in the European Heart Journal in August 2011 confirmed the link and hinted that young people with severe psoriasis were at greatest risk of stroke among sufferers.

Now, Penn researchers have uncovered a potential mechanism by which the inflammatory skin disorder can affect cardiovascular health detrimentally and so believe they can explain the increase in stroke risk and hearth problems.

Session on the heart

The researchers presented two studies at the 2011 American Heart Association Scientific Sessions, in which they demonstrated that the systemic inflammatory effects of psoriasis can alter both the makeup of cholesterol particles and numbers, as well as impair the function of high density lipoprotein (HDL), the so-called "good" cholesterol.

"Anecdotally, many researchers have observed that HDL levels may be lower in states of inflammation, such as rheumatoid arthritis, psoriasis and even obesity," explains lead author of the research Nehal Mehta, who is director of Inflammatory Risk in Preventive Cardiology at Penn. "However, these new findings suggest that in addition to lower levels, chronic inflammation associated with conditions like psoriasis may change the composition and decrease the function of HDL as well."

In this latest research, the team recruited 78 patients with psoriasis and 84 control subjects. In the first experiment, the researchers measured fasting lipid levels and examined the number and size of cholesterol particles using NMR spectroscopy. The results were fairly unequivocal: patients with psoriasis had a higher number of smaller LDL particles, or "bad" cholesterol. The level was independent of the more usual risk factors such as obesity and type II diabetes.

"It was striking that the NMR profiles from patients with psoriasis resembled those seen in patients with diabetes, and that these patients with psoriasis had otherwise normal traditional lipid panels," Mehta adds.


In the second experiment, the researchers measured how well the patients' HDL can remove cholesterol from those cells involved in atherosclerosis, the HDL efflux. This process of reverse cholesterol transport is thought to be what makes HDL cardioprotective and is, according to Penn researchers, a better marker of cardiovascular risk than simply measuring HDL levels alone.

The team found that in this same group of patients with otherwise normal cholesterol levels those with psoriasis showed dramatically reduced HDL efflux capacity compared to controls. Even when the team adjusted for variations in standard risk factors, such as body mass index (BMI), the negative association was still apparent.

"Patients with psoriasis had an approximate 25 percent reduction in the HDL efflux capacity than the controls, despite their relatively normal overall lipid profiles which leads to the question of whether function is more important than concentration in chronic inflammatory states," Mehta explains.

The two-pronged link between having psoriasis and cardiovascular risk now requires larger studies to validate the findings. Senior author Joel Gefland, assistant professor of Dermatology and Epidemiology, explains: "We've been able to show that psoriasis is an important risk factor for vascular disease, and now we may finally be able to identify and ultimately treat the pathways by which psoriasis increases these risks."


The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

 NMR has been used to measure lipid levels in psoriasis patients and the results point to a possible explanation for a link with cardiovascular disease. Wiki photo by
NMR helps explain link between psoriasis and cardiovascular disease

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