Cardiovascular Risk Among Patients With Moderate-to-Severe Plaque Psoriasis in Southern Sri Lanka: A Case-Control Study

TL;DR

This study found that patients with moderate-to-severe plaque psoriasis in Sri Lanka have higher comorbidity and lipid levels compared to controls, suggesting a need for more comprehensive care.

Contribution

The study provides new evidence on cardiovascular risk and comorbidity in plaque psoriasis patients from Southern Sri Lanka.

Findings

Patients with CPP had higher median CCI values and dyslipidaemia compared to controls.

CPP patients showed elevated triglycerides and TG/HDL ratios compared to controls.

CV risk scores were higher in CPP patients but not significantly different from controls.

Abstract

Introduction: Psoriasis is a chronic inflammatory skin condition associated with increased cardiovascular (CV) risk and a higher prevalence of comorbidities. The study aimed to assess CV risk and contributory factors in patients with chronic plaque psoriasis (CPP).

Methods: This case-control study included 80 patients with CPP attending selected dermatology clinics in Southern Sri Lanka, along with 80 age- and sex-matched controls from their neighbourhood. Data on demographic and disease-related factors were collected using an interviewer-administered questionnaire from consecutive patients with moderate to severe psoriasis, as defined by body surface area (BSA) and the Psoriasis Area and Severity Index (PASI). Anthropometric measurements, blood glucose, and lipid assays were conducted for both groups. Comorbidity was assessed using the Charlson Comorbidity Index (CCI) while CV risk was estimated using the Framingham Risk Score (FRS) and the Atherosclerotic Cardiovascular Disease (ASCVD) 10-year risk score.

Results: Mean (standard deviation, or SD) age of patients with CPP (n=80) was 51 (11) years, with 41 being male. The corresponding values of controls were 50 (10) years, with 41 being male. The median (interquartile range, or IQR) duration of psoriasis was 10 (6-20) years, median (IQR) BSA was 11.3% (5.5-20.4%), and median (IQR) PASI was 6.7 (5.3-10.8). Patients with psoriasis had a higher median CCI value (1 (1-3) vs. 0 (1-2); U=1819, p < 0.001) and higher occurrence of dyslipidaemia (odds ratio (OR) 5.69; confidence interval (CI): 2.03-15.93) compared to controls. Patients with CPP had higher triglycerides (TG) and triglyceride-to-high-density lipoprotein (TG/HDL) ratios compared to controls (p < 0.05 for both). Although CV risk scores were higher among patients with CPP, they did not differ significantly from those of controls.

Conclusion: Patients with CPP have higher comorbidity and unadjusted lipid levels. This highlights the need to educate healthcare professionals to adopt a more holistic approach in evaluating patients with CPP.