Cardiac and Vascular Impairment in Patients with Mild Psoriasis: A Longitudinal Study

Psoriasis is a chronic inflammatory immune-mediated skin disease associated with several comorbidities [1, 2]. Despite the evidence of a link with cardiovascular (CV) diseases [3-6], there are unresolved questions: 1) its role as an independent CV risk factor, 2) the relationship between severity and duration of psoriasis and CV damage, and, 3) reliable markers to stratify CV risk in these patients [7-9]. We previously [10] evaluated 33 patients with mild psoriasis without comorbidities and 33 healthy subjects. All patients had an echocardiogram with evaluation of 2-dimensional strain (2D-SE) and pulse wave velocity (PWV) of the common carotid arteries. Clinical and conventional echocardiographic parameters were comparable between groups. Global Longitudinal Strain (GLS) was significantly lower (p=0.002) in the psoriasis group (22.39±2.28%) than in controls (24.15±2.17%). PWV was significantly lower (p=0.004) in controls (8.06±1.68 m/sec) than in the psoriasis group (9.23±1.53 m/sec). Significant correlations between GLS and disease duration and patient age at diagnosis were found, as in coronary artery disease (CAD) and cardiomyopathies [11-14]. These results suggested that psoriasis, in absence of other CV risk factors, is associated with subclinical impairment of cardiac function and increased arterial stiffness [10]. However, the contribution of psoriasis is not clearly defined in terms of development and progression of overt myocardial and vascular damage over long-term periods. We performed a 2 year follow-up of the psoriasis group; there were no significant changes in demographic or clinical characteristics. No patient needed any systemic therapy (6 needed an increase in topical drugs). The PASI (Psoriasis Area and Severity Index) score did not change significantly. None of the patients developed any conventional CV risk factor. There were no significant differences in echographic parameters (see table). No CV events (e.g. CAD or stroke) occurred. According to our data, mild psoriasis determines subclinical cardiac and vascular damage but after an additional 2 years did not cause CV changes in initially healthy patients. A longer follow-up and larger numbers of patients may be needed to evaluate overt vascular damage or echographic changes.