Lipid Ratios as Predictors of Cardiovascular Complications in Psoriasis
Keywords:
psoriasis; dyslipidemia; lipid ratios; cardiovascular risk; metabolic syndromeAbstract
Background: Psoriasis is a chronic inflammatory disorder associated with metabolic syndrome and increased cardiovascular risk. Lipid ratios (LDL/HDL, non-HDL/HDL, TG/HDL, TC/HDL) are superior to isolated lipid levels in predicting atherogenic dyslipidemia.
Objective: To compare lipid ratios between psoriasis patients and healthy controls and assess their potential as predictors of complications.
Methods: A case-control study included 100 psoriasis patients and 60 age‑/sex‑matched controls. Fasting lipid profiles were used to calculate LDL/HDL, non-HDL/HDL, TG/HDL, and TC/HDL ratios. Groups were compared using the Mann‑Whitney U test (one‑tailed, α=0.05).
Results: All four lipid ratios were significantly higher in psoriasis patients than in controls (U=0, p<0.05 for each ratio). Mean values in patients vs. controls were: LDL/HDL 3.64 vs. 1.91; non‑HDL/HDL 4.51 vs. 2.35; TG/HDL 4.36 vs. 2.25; TC/HDL 5.51 vs. 3.25.
Conclusion: Psoriasis patients exhibit markedly worse lipid ratios, indicating elevated risk of atherosclerosis, insulin resistance, and cardiovascular events. Larger prospective studies are warranted to validate these findings and guide preventive therapy.
References
Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021;397(10281):1301 1315.
Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296(14):1735 1741.
Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010;31(8):1000 1006.
Holzer M, Wolf P, Curcic S, et al. Psoriasis alters HDL composition and function. Biochim Biophys Acta. 2014;1841(9):1254 1261.
Millán J, Pintó X, Muñoz A, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag. 2009;5:757 765.
McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139(10):802 809.
Boehncke WH, Boehncke S, Tobin AM, Kirby B. The ‘psoriatic march’: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011;20(4):303 307.
Lowes MA, Suárez Fariñas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227 255.
Feingold KR, Grunfeld C. The effect of inflammation and infection on lipids and lipoproteins. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 .
Preiss D, Sattar N. Lipids, lipid modifying agents and cardiovascular risk: a review of the evidence. Clin Endocrinol (Oxf). 2009;70(6):815 828.
Langan SM, Seminara NM, Shin DB, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population based study in the United Kingdom. J Invest Dermatol. 2012;132(3 Pt 1):556 562.
Miller IM, Ellervik C, Yazdanyar S, Jemec GB. Meta analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol. 2013;69(6):1014 1024.
Bittner V, Johnson BD, Zineh I, et al. The triglyceride/high density lipoprotein cholesterol ratio predicts all cause mortality in women with suspected myocardial ischemia: a report from the Women’s Ischemia Syndrome Evaluation (WISE). Am Heart J. 2009;157(3):548 555.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082 e1143.
Sniderman AD, Williams K, Contois JH, et al. A meta analysis of low density lipoprotein cholesterol, non high density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011;4(3):337 345.
Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet. 2014;384(9943):626 635.
Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017;120(1):229 243.
Gisondi P, Del Giglio M, Girolomoni G. Lipid profile in patients with psoriasis. Expert Rev Dermatol. 2011;6(3):287 293.
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111 188.
Reich K, Langley RG, Lebwohl M, et al. Cardiovascular safety of ustekinumab in patients with moderate to severe psoriasis: results of integrated analyses of data from phase II and III clinical studies. Br J Dermatol. 2011;164(4):862 872.
von Stebut E, Reich K, Thaçi D, et al. Impact of secukinumab on endothelial dysfunction and other cardiovascular risk factors in patients with moderate to severe plaque psoriasis over 52 weeks. J Dermatol Treat. 2021;32(5):496 504.
Rungapiromnan W, Yiu ZZN, Warren RB, Griffiths CEM, Ashcroft DM. Impact of biologic therapies on risk of major adverse cardiovascular events in patients with psoriasis: systematic review and meta analysis of randomized controlled trials. Br J Dermatol. 2017;176(4):890 901.
Egeberg A, Skov L, Gislason GH, Thyssen JP, Mallbris L. Duration of psoriasis is associated with increased risk of cardiovascular disease: a nationwide cohort study. J Am Acad Dermatol. 2016;74(4):668 675.
Duewell P, Kono H, Rayner KJ, et al. NLRP3 inflammasomes are required for atherogenesis and activated by cholesterol crystals. Nature. 2010;464(7293):1357 1361.
Mansouri B, Kivelevitch D, Natarajan B, et al. Comparison of coronary artery calcium scores between patients with psoriasis and type 2 diabetes. JAMA Dermatol. 2016;152(11):1244 1250.
