Subclinical Atherosclerosis in Psoriatic Patients: Relation with Vitamin D

Abstract

Cardiovascular disease (CVD) is a common comorbidity associated with psoriasis and psoriatic arthritis (PsA). Vitamin D deficiency is observed in numerous chronic systemic inflammatory diseases including psoriasis and has been associated with increased risk of metabolic and CVD. Carotid intima-media thickness (CIMT) is a marker for arterial vascular disease and could detect subclinical atherosclerosis and early CVD. Coronary artery calcification score (CACS) is a non-invasive and highly reliable method to measure coronary atherosclerosis. Objective: To detect subclinical atherosclerosis and study its relation with serum levels of 25-hydroxyvitamin D in psoriatic patients with and without arthritis. Patients and Methods: This study was carried out on 25 Egyptian psoriatic patients aged 20- 50 years and 25 matched healthy controls. Patients were classified into 2 groups; 13 had PsA and 12 without arthritic manifestations. Assessment of serum levels of 25-OH vitamin D, ESR, CRP, uric acid (SUA) and lipid profile were done to all patients and controls, in addition to measurement of CIMT and CACS using carotid duplex and coronary CT respectively. Results: Patients with PsA had lower values of vitamin D than psoriatic patients and controls despite being statistically insignificant (median; 5, 5.5 & 11 ng/ml respectively). Both CIMT and CACS were significantly higher among PsA patients compared to controls (CIMT mean±SD; 0.57±0.12, 0.52±0.16 & 0.44±0.09mm) and (CACS median; 53, 1.5 & 0) respectively. Vitamin D was found to be negatively correlated with CACS in psoriatic patients (r=-0.491, p=<0.05). Both CIMT and CACS showed significant positive correlation with age, SUA and cholesterol. In addition, CIMT and CACS, were positively correlated. Conclusion: Psoriatic patients especially those with PsA had lower vitamin D values than controls despite being statistically insignificant. Vitamin D negatively correlated with CACS in psoriatic patients. Those patients suffered from increased risk of CVDs and subclinical atherosclerosis mostly due to increased burden of inflammation and lack of physical activity