Carotid intima-media thickness, nonalcoholic fatty liver disease, and hemoglobin A1c are independently associated with the severity of psoriasis

Background: Systemic inflammation plays an important role in the pathogenesis of atherosclerosis in psoriasis patients. Carotid artery intima-media thickness (CIMT) and nonalcoholic fatty liver disease (NAFLD) are accepted important markers for subclinical atherosclerosis and cardiovascular risk prediction. Objectives: The aim of this study was to evaluate the potential association between subclinical atherosclerosis and chronic plaque psoriasis without traditional cardiovascular risk factors. Methods: Sixty consecutive patients with chronic plaque psoriasis (patient group) attending our dermatology outpatient clinic and 60 age-and sex-matched healthy controls (control group) were included in this study. Demographic and biochemical data, and Psoriasis Area and Severity Index (PASI) score of the psoriasis group were recorded. CIMT and NAFLD values were compared. Results: Patients with psoriasis had significantly higher systolic and diastolic blood pressure, fasting levels of glucose, and hemoglobin A1c (HbA1c) compared with controls. Patients with psoriasis had greater CIMT and NAFLD values than matched controls. PASI score was significantly positively correlated with systolic and diastolic blood pressure, body mass index, waist circumference, psoriasis duration, HbA1c, the presence of NAFLD, moderate-severe NAFLD, and CIMT in psoriatic patients. In multivariate linear regression analysis, HbA1c, moderate-severe NAFLD, and CIMT were significantly and independently associated with PASI score, and CIMT showed the most significant association with PASI score. Conclusion: Our data suggest a need for aggressive treatment of the inflammatory process in psoriatic patients as well as better monitoring of nontraditional atherosclerotic risk factors to reduce cardiovascular mortality/morbidity and liver diseases. Abdominal and carotid ultrasonography appear to be useful, simple, and noninvasive examinations to investigate the presence of subclinical atherosclerosis even in psoriatic patients who seem to be otherwise healthy. Copyright (C) 2016, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC.