Psoriasis And Coronary Artery Disease

Background:Recently, the association between psoriasis and coronary heart disease (CHD) has got more and more focus among foreign clinic experts; however, to our knowledge, there are few reports of similar studies in China. The incidence of psoriasis in comorbidity with CHD is as more than one fold high as that of general population. On one hand, the proportion of comorbidity with traditional CHD risk factors such as smoking, hypertension, dyslipidemia, diabetes mellitus etc. among psoriatic patients is larger than that of general population, moreover, some drugs that treat for psoriasis may cause or worsen CHD; On the other hand, it remains controversial that whether psoriasis is an independent risk factor of CHD or not. Therefore, the exact relationship between psoriasis and coronary heart disease is still unclear.Object:This two-case report, which was about two psoriatic patients who were both diagnosed as CHD---one also suffered from hypertension and dyslipidemia, while the other one was totally in the absence of traditional CHD risk factors, tends to draw attentions among clinic practitioners to the relationship between psoriasis and coronary heart disease, and subsequently to advance related studies in the future.Methods:A retrospective analysis, with subsequent review on related literatures, was carried out on the basis of the clinical data about2psoriatic patients who were both diagnosed as CHD, one also suffered from hypertension and dyslipidemia, while the other one was in the absence of traditional CHD risk factors, in the Cardiological Department in Shandong Provincial Hospital in2011.Case1:This patient, male,37years old, his chief complaint was "chest distress and chest pain on exertion for1month." He was found to has been suffered from hypertension for4years with a upmost blood pressure of160/90mmHg, which was treated with ACE inhibitor and calcium channel blocker, and was well under control. However, histories of smoking, dyslipidemia, diabetes mellitus, as well as familial history of early-onset CHD were all denied. A history with duration of13-year period of psoriasis was reported, which was only under intermittent topical treatment of clobetasol ointment; otherwise, all of other treatments were denied. Physical examination:this patient was obese, and his blood pressure was135/85mmHg; Only scattered erythema marginally covered by scale was observed on the sides of his limbic extensors, otherwise, no other significant positive signs were observed. Laboratory tests:concentrations of LDL-C and TG were elevated, while concentration of HDL was decreased in his lipid profiles, fast plasma glucose, hepatic and renal function, ESR were all within normal range; and cTn (-). Electrocardiogram (ECG) on admission, and chest X-ray test was also normal; however, ST segment elevations,>0.1mV, with an ischemic pattern, were observed on V1-V4leads in the treadmill test, and ultrasonocardiogram showed segmental movement impairment in his left ventricle. Primary diagnoses:1. coronary atherosclerotic heart disease, unstable angina pectoris;2. Hypertension (grade2, extreme risk);3. psoriasis vulgaris. Coronary angiography during hospitalization showed that there was a significant80%stenosis at the proximal segment of his left anterior descended branch, thus, a stent was implemented. Episode of exertional chest pain or chest distress has not been reported during the next3-month follow-up period.Case2:This Patient, male,33years old, with occasional alcoholic consumption, denied history of smoking, hypertension, dyslipidemia, diabetes mellitus, as well as familial history of early-onset CHD. However, a history with duration of13-year period of psoriasis was complained. Only intermittent topical treatment of Calcipotriol ointment as well as several herbal medication years age was confirmed; otherwise, all of other treatments were denied. His chief complaint was exertional chest pain for3months with a worsening period during the past4days. Physical examination:this patient was not obese, and his blood pressure was135/80mmHg; Only scattered erythema marginally covered by scale was observed on the sides of his limbic extensors, otherwise, no other significant positive signs were observed. Laboratory testes:fast plasma glucose, lipid profiles, hepatic and renal function, ESR were all within normal range; and cTn (-). Electrocardiogram (ECG) on admission, as well as ultrasonocardiogram and chest X-ray test was also normal, however, ST segment elevations,>0.1mV, with an ischemic pattern, were observed on I, aVL and V4-V6leads in the treadmill test. Primary diagnoses:1. coronary atherosclerotic heart disease, unstable angina pectoris;2. psoriasis vulgaris. Coronary angiography during hospitalization showed that there was a significant85%stenosis at the proximal segment of his left circumflex branch, thus, a stent was implemented. Episode of exertional chest pain has not been reported during the next3-month follow-up period. Results:These two psoriatic patients in this scenario who were both diagnosed as CHD, one also suffered from hypertension and dyslipidemia, while the other one, was totally in the absence of traditional CHD risk factors, such as smoking, hypertension, dyslipidemia, diabetes mellitus etc.Conclusions:It might support the hypothesis that psoriasis can predispose patient to CHD not only by in comorbidity with higher prevalence of cardiovascular risk factors, but also itself serves as an independent risk factor of CHD.