Skip to main content

Advertisement

Log in

Increased frequency of pulmonary hypertension in psoriasis patients

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Several reports have demonstrated an association between psoriasis and cardiovascular diseases such as hypertension, valvular disease and arrhythmia. However, the data is scarce. Forty-seven psoriasis patients and 20 healthy people underwent transthoracic echocardiographic examination including pulse- and tissue Doppler analysis and 24-h ambulatory electrocardiographic monitoring including heart rate variability (HRV) analysis. Patients having systemic hypertension, diabetes mellitus, history of structural or ischemic heart disease, chronic obstructive pulmonary disease and any associated systemic disease were excluded. Psoriasis Area and Severity Index (PASI) was calculated and severe psoriasis was defined in the case of history of hospitalizations for psoriasis and/or getting systemic therapy. Mean age of the patients was 35.7 ± 12.9 years and disease duration was 123.2 ± 84.3 (3–360) months. PASI ranged from 0.4 to 34.0 (mean ± SD: 7.1 ± 6.6) and 20 (42.6%) patients had severe psoriasis. There were no significant differences between psoriasis patients and control group with respect to mean values of blood pressure, body mass index, lipid profile and cardiac dimensions. However, frequency of being overweight was significantly higher in psoriasis patients (42.6 vs. 10.0%, P = 0.011). No patient had valvular disease. Mild pulmonary hypertension (PH) (30–40 mmHg) was significantly more frequent in psoriasis patients (31.9 vs. 0%, P = 0.003). Pulse wave mitral Doppler deceleration and isovolumetric relaxation times were significantly longer in psoriasis patients (195.9 ± 29.7 vs. 191.6 ± 14.7 ms, P = 0.002 and 91.6 ± 14.7 vs. 79.6 ± 10.5 ms, P = 0.001, respectively). However, frequency of diastolic dysfunction was not significantly different than the control group (8.5 vs. 0%, P = 0.309). HRV parameters and frequency of supraventricular and ventricular premature beats were not significantly different between the groups. No patient had ventricular tachycardia. Echocardiographic follow-up of psoriasis patients may be important due to possible association of PH. However, incidences of structural heart disease and arrythmia are not increased in psoriasis according to our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Biyik I, Narin A, Bozok MA, Ergene O (2006) Echocardiographic and clinical abnormalities in patients with psoriasis. J Int Med Res 34:632–639

    PubMed  CAS  Google Scholar 

  2. Carvalho M, Soares R, Ribeiro F, Gaião L, Rosa M, Rodrigues M, Silva J, Queiroz MV, Carrageta M (1990) Rhythm profile in patients with psoriatic arthritis. Rev Port Cardiol 9:311–317

    PubMed  CAS  Google Scholar 

  3. Christophers E (2007) Comorbidities in psoriasis. Clin Dermatol 25:529–534

    Article  PubMed  Google Scholar 

  4. Cristofaro P, Opal SM (2006) Role of Toll-like receptors in infection and immunity: clinical implications. Drugs 66:15–29

    Article  PubMed  CAS  Google Scholar 

  5. Dawson JK, Goodson NG, Graham DR, Lynch MP (2000) Raised pulmonary artery pressures measured with Doppler echocardiography in rheumatoid arthritis patients. Rheumatology 39:1320–1325

    Article  PubMed  CAS  Google Scholar 

  6. Dorfmüller P, Perros F, Balabanian K, Humbert M (2003) Inflammation in pulmonary arterial hypertension. Eur Respir J 22:358–363

    Article  PubMed  Google Scholar 

  7. Fredriksson T, Pettersson U (1978) Severe psoriasis-oral therapy with a new retinoid. Dermatologica 157:238–244

    PubMed  CAS  Google Scholar 

  8. Gaspari AA (2006) Innate and adaptive immunity and the pathophysiology of psoriasis. J Am Acad Dermatol 54:S67–S80

    Article  PubMed  Google Scholar 

  9. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB (2006) Risk of myocardial infarction in patients with psoriasis. JAMA 296:1735–1741

    Article  PubMed  CAS  Google Scholar 

  10. Ghoreschi K, Thomas P, Breit S, Dugas M, Mailhammer R, van Eden W, van der Zee R, Biedermann T, Prinz J, Mack M, Mrowietz U, Christophers E, Schlöndorff D, Plewig G, Sander CA, Röcken M (2003) Interleukin-4 therapy of psoriasis induces Th2 responses and improves human autoimmune disease. Nat Med 9:40–46

    Article  PubMed  CAS  Google Scholar 

  11. Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA, Testa A, Revuelta J, Garcia-Porrua C, Martin J, Llorca J, Gonzalez-Gay MA (2006) Lack of echocardiographic and Doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerotic risk factors. Semin Arthritis Rheum 35:333–339

    Article  PubMed  Google Scholar 

  12. Kimura H, Kasahara Y, Kurosu K, Sugito K, Takiguchi Y, Terai M, Mikata A, Natsume M, Mukaida N, Matsushima K, Kuriyama T (1998) Alleviation of monocrotaline-induced pulmonary hypertension by antibodies to monocyte chemotactic and activating factor/monocyte chemoattractant protein-1. Lab Invest 78:571–581

    PubMed  CAS  Google Scholar 

  13. Kremers HM, McEvoy MT, Dann FJ, Gabriel SE (2007) Heart disease in psoriasis. J Am Acad Dermatol 57:347–354

    Article  PubMed  Google Scholar 

  14. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  15. Libby P (2002) Inflammation in atherosclerosis. Nature 420:868–874

    Article  PubMed  CAS  Google Scholar 

  16. Ludwig RJ, Herzog C, Rostock A, Ochsendorf FR, Zollner TM, Thaci D, Kaufmann R, Vogl TJ, Boehncke WH (2007) Psoriasis: a possible risk factor for development of coronary artery calcification. Br J Dermatol 156:271–276

    Article  PubMed  CAS  Google Scholar 

  17. Ludwig RJ, Schultz JE, Boehncke WH, Podda M, Tandi C, Krombach F, Baatz H, Kaufmann R, von Andrian UH, Zollner TM (2004) Activated, but not resting platelets increase leukocyte rolling in murine skin utilizing a distinct set of adhesion molecules. J Invest Dermatol 122:830–836

    Article  PubMed  CAS  Google Scholar 

  18. Magliano M, Isenberg DA, Hillson J (2002) Pulmonary hypertension in autoimmune rheumatic diseases. Where are we now? Arthritis Rheum 46:1997–2009

    Article  PubMed  CAS  Google Scholar 

  19. Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejowska AS, Zalewska A (2007) Heart rate and arrhythmia in patients with psoriasis vulgaris. Arch Med Res 38:64–69

    Article  PubMed  Google Scholar 

  20. Marongiu F, Sorano GG, Bibbo C, Pistis MP, Conti M, Mulas P, Balestrieri A, Biggio P (1994) Abnormalities of blood coagulation and fibrinolysis in psoriasis. Dermatology 189:32–37

    Article  PubMed  CAS  Google Scholar 

  21. Moya JL, Sanchez M, Morales MD, Brito E (1987) Mitral valve prolapse in psoriatic arthritis. Arch Intern Med 147:992

    Article  PubMed  CAS  Google Scholar 

  22. Muna WF, Roller DH, Craft J, Shaw RK, Ross AM (1980) Psoriatic arthritis and aortic regurgitation. JAMA 244:363–365

    Article  PubMed  CAS  Google Scholar 

  23. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533

    Article  PubMed  CAS  Google Scholar 

  24. Naldi L, Chatenoud L, Linder D, Belloni Fortina A, Peserico A, Virgili AR, Bruni PL, Ingordo V, Lo Scocco G, Solaroli C, Schena D, Barba A, Di Landro A, Pezzarossa E, Arcangeli F, Gianni C, Betti R, Carli P, Farris A, Barabino GF, La Vecchia C (2005) Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case–control study. J Invest Dermatol 125:61–67

    Article  PubMed  CAS  Google Scholar 

  25. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH (2006) Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on obesity and heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 113:898–918

    Article  PubMed  Google Scholar 

  26. Saricaoglu H, Gullulu S, Bulbul Baskan E, Cordan J, Tunali S (2003) Echocardiographic findings in subjects with psoriatic arthropathy. J Eur Acad Dermatol Venereol 17:414–417

    Article  PubMed  CAS  Google Scholar 

  27. Schön M, Boehncke WH (2005) Psoriasis–immunopathogenesis, genetics and therapeutic perspectives. N Engl J Med 352:1899–1912

    Article  PubMed  Google Scholar 

  28. Shapiro J, Cohen AD, David M, Hodak E, Chodik G, Viner A, Kremer E, Heymann A (2007) The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case–control study. J Am Acad Dermatol 56:629–634

    Article  PubMed  Google Scholar 

  29. Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M (2006) Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 298:321–328

    Article  PubMed  Google Scholar 

  30. Wolff B, Lodziewski S, Bollmann T, Opitz CF, Ewert R (2007) Impaired peripheral endothelial function in severe idiopathic pulmonary hypertension correlates with the pulmonary vascular response to inhaled iloprost. Am Heart J 153:1088.e1–e7

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yilmaz Gunes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gunes, Y., Tuncer, M., Calka, O. et al. Increased frequency of pulmonary hypertension in psoriasis patients. Arch Dermatol Res 300, 435–440 (2008). https://doi.org/10.1007/s00403-008-0859-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-008-0859-9

Keywords

Navigation