Similarities in Coronary Function and Myocardial Deformation Between Psoriasis and Coronary Artery Disease: The Role of Oxidative Stress and Inflammation

Background: Psoriasis has been associated with increased risk for coronary artery disease (CAD). We investigated the presence of vascular and subclinical left ventricular (LV) dysfunction in patients with psoriasis compared with patients with CAD. Methods: We compared 59 patients with psoriasis without evidence of CAD (psoriasis area and severity index [PASI], 11.5 +/- 8) with 59 patients with angiographically documented CAD and 40 controls. We measured (1) the carotid-femoral pulse wave velocity (PWVc) and central augmentation index (CAI), (2) coronary flow reserve (CFR) by Doppler echocardiography, (3) flow-]mediated dilation (FMD) of the brachial artery and carotid intima media thickness (IMT), (4) LV global longitudinal strain (GLS) and GLS rate (GLSR) using speckle tracking echocardiography, and (5) malondialdehyde (MDA) and interleukin-6 (IL-6) levels. Results: Patients with psoriasis had higher PWVc, CAI, IMT, MDA, and IL-6 levels and lower FMD, CFR, GLS, and GLSR than did controls (P < 0.05), but they had values of these markers that were similar to those of patients with CAD (P > 0.05) after adjustment for atherosclerotic risk factors: (PWVc [m/s], 10.4 +/- 1.8 vs 8.6 +/- 1.5 vs 10.3 +/- 2, respectively; CFR, 2.4 +/- 0.1 vs 3.4 +/- 0.6 vs 2.6 +/- 0.6, respectively; GLS [%], -16.2 +/- 4 vs -21.9 +/- 1.6 vs -16.6 +/- 4.5, respectively; GLSR [L/sec], -0.85 +/- 0.2 vs -1.2 +/- 0.12 vs -0.9 +/- 0.4, respectively; MDA [nM/L], 1.68 vs 1.76 vs 1.01, respectively; IL-6 [pg/mL], 2.26 vs 2.2 vs 1.7, respectively; P < 0.05 for all comparisons). PASI was related to IMT (r = 0.67; P < 0.01). Decreased GLS was associated with increased MDA, IL-6, PWVc, CAI, and reduced CFR (P < 0.05). Conclusions: Psoriasis and CAD present similar vascular and LV myocardial dysfunction, possibly because of similar underlying inflammatory and oxidative stress processes. Vascular dysfunction in psoriasis is linked to abnormal LV myocardial deformation.