Psoriasis als unabhängiger Risikofaktor für die Entwicklung einer koronaren Herzkrankheit

Zusammenfassung

Psoriasis ist eine chronisch-entzündliche Dermatose mit schubweisem Verlauf. Die bekannteste Komorbidität stellt die Psoriasisarthritis dar. Im klinischen Alltag fällt auf, dass Psoriasispatienten häufiger klassische kardiovaskuläre Risikofaktoren wie Adipositas, Diabetes mellitus, Hyperliproteinämie, arterielle Hypertonie, Nikotinabusus bis hin zum Metabolischen Syndrom aufweisen und häufiger an koronarer Herzerkrankung leiden als Nichtpsoriatiker. Dies konnte durch zahlreiche klinische und epidemiologische Studien belegt werden. In den letzten Jahren kristallisiert sich zunehmend die Rolle der Psoriasis als eigenständiger kardiovaskulärer Risikofaktor heraus, unabhängig von begleitenden klassischen Risikofaktoren. Dieser Artikel fasst den bisherigen Stand der Kenntnisse zur Komorbidität zwischen Psoriasis und koronarer Herzerkrankung zusammen und diskutiert mögliche gemeinsame immunpathologische Mechanismen.

Abstract

Psoriasis is a chronic inflammtory dermatosis with a relapsing course. The best known comorbidity is psoriatic arthritis. In daily clinical practise it is well known, that patients with psoriasis show more often classic cardiovaskular risk factors such as obesity, Diabetes mellitus, hyperlipoproteinemia, hypertension, nicotine abuse often presenting as Metabolic Syndrome and suffer more often from coronary heart disease than patients without psoriasis. This could be demonstraded in numerous clinical and epidemiologic studies. In the last few years there is increasing evidence for psoriasis beeing an independent cardiovascular risk factor despite of concomitant classic risk factors. This review summarizes the current state of research and discusses possible common immunpathogenetic mechanisms.

Psoriasis - koronare Herzkrankheit - Myokardinfarkt - Risikofaktoren - Entzündung

Psoriasis - coronary artery disease - myocardial infarction - risk factors - inflammation

Literatur

• 1 Aicher A, Heeschen C, Mohaupt M. et al . Nicotine strongly activates dentritic cell-mediated adaptive immunitiy: potential role for progression of atherosclerotic lesions.  Circulation. 2003;  107 604-611
• 2 Alberti K G, Zimmet P Z. Definition, diagnosis of diabetes mellitus and its complications, I: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.  Diabet Med. 1998;  15 539-553
• 3 Alexandroff A B, Pariah Camp R DR, Lang C C, Struthers A D, Armstrong D J. More than skin deep: atherosclerosis as a systemic manifesation of psoriasis.  Br J Dermatol. 2009;  161 1-7
• 4 Boehncke W H, Buerger C, Boehncke S. Komorbiditäten bei Psoriasis vulgaris.  Hautarzt. 2009;  60 116-121
• 5 Boehncke S, Thaci D, Beschmann H. et al . Psoriasis patients show signs of insulin resistance.  Br J Dermatol. 2007;  157 1249-1251
• 6 Choi K H, Hernan M A, Seeger J D. et al . Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study.  Lancet. 2002;  359 1173-1177
• 7 Christophers E. Psoriasis – epidemiology and clinical spectrum.  Clin Exp Dermatol. 2001;  26 314-320
• 8 Schwandt P, Richter W O. Adipostas.  In: Classen M, Diehl V, Kochsiek K, Innere Medizin. 4. Auflage. Urban und Schwarzenberg; 1998: 787
• 9 Dixon W G, Watson K D, Lunt M. et al . Reduction oin the incidence of myokardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register.  Arthritis Rheum. 2007;  56 2905-2912
• 10 Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Panel III).  JAMA. 1998;  285 2486-2497
• 11 Friedewald V E, Cather C C, Gelfand J M. et al . AJC Editor’s Consensus: Psoriasis and Coronary Artery Disease.  Am J Cardiol. 2008;  102 1631-1643
• 12 Fritsch P. Erythematosquamöse Dermatosen.  In: Fritsch P, Dermatologie Venerologie. 2. Auflage. Berlin Heidelberg New York: Springer-Verlag; 2004: 360-374
• 13 Gelfand J M, Weinstein R, Porter S B. et al . Prevalence and treatment of psoriasis in the United Kingdom: a population based study.  Arch Dermatol. 2005;  141 11537-11541
• 14 Gelfand J M, Neimann A L, Shin D B. et al . Risk of myocardial infarction in patients with psoriasis.  JAMA. 2006;  296 1735-1741
• 15 Gelfand J M, Troxel A B, Lewis J D. et al . The risk of mortality in patients with psoriasis: results from a population-based study.  Arch Dermatol. 2007;  143 1493-1499
• 16 Gisondi P, Tessari G, Conti A, Piaserico S, Peserico A, Gianetti A, Girolomoni G. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-besed case-control study.  Br J Dermatol. 2007;  157 68-73
• 17 Hansson G K. Inflammation, Atherosclerosis and Coronary Artery Disease.  N Engl J Med. 2005;  352 1685-1695
• 18 Henseler T, Christophers E. Disease concomitance in psoriasis.  J Am Acad Dermatol. 1995;  32 982-986
• 19 Herron M D, Hinckley M, Hofman M S. et al . Impact of obesity and smoking om psoriasis presentation and management.  Arch Dermatol. 2005;  141 1527-1534
• 20 Jacobsson L T, Turesson C, Gülfe A. et al . Treatment with tunor necrosis factor blockers is associated with a lower incidence of first cardiovascular events im patients with rheumatoid arthritis.  J Rheumatol. 2005;  32 1213-1218
• 21 Katz H I, Waalen J, Leach E E. Acitretin in psoriasis: an overview of adverse effects.  J Am Acad Dermatol. 1999;  41 S7-S12
• 22 Kremers H M, Crowson C S, Nicola P J, Ballmann K V. et al . Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study.  Arthritis Rheum. 2005;  52 402-411
• 23 Kremers H M, Mc Evoy M T, Dann F. et al . Heart disease in psoriasis.  J Am Acad Dermatol. 2007;  57 347-354
• 24 Kwak B, Mulhaupt F, Myit S, Mach F. Statins as a mewly recognized type of immunomodulator.  Nat Med. 2000;  6 1399-1402
• 25 Lakka H M, Laaksonen D E, Lakka T A. et al . The metabolic syndrome and cardiovascular disease mortality in middle-aged man.  JAMA. 2002;  288 2709-2716
• 26 Lindegard B. Diseases associated withpsoriasis in a generl population of 159.200 middle-aged, urban, native Swedes.  Dermatologica. 1986;  172 298-304
• 27 Ludwig R J, Herzog C, Rostock A, Ochsendorf F R, Zollner T M, Thaci D, Vogl T J, Boehncke W H. Psoriasis: a possible risk factor for development of coronary artery calcification.  Br J Dermatol. 2006;  156 271-276
• 28 Mallbirs L, Akre O, Granath F. et al . Increased risk for cardiovaskular mortality in psoriasis inpatients but not in outpatients.  Eur J Epidemiol. 2004;  19 225-230
• 29 Mallbris L, Granath F, Hamsten A, Stahle M. Psoriasis is associated with lipid abnormalities at the onset of skin disease.  J Am Acad Dermatol. 2006;  54 614-621
• 30 Mann D L, McMurray J JV, Packer M, Swedberg K. et al . Targeted anticytokine therapy in patients with chronic heart failure: Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL).  Circulation. 2004;  109 1594-1602
• 31 McCarey D W, McInnes I B, Mashok R. et al . Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomised Placebo-controlled trial.  Lancet. 2004;  363 2015-2021
• 32 McDonald C J, Calabresi P. Complication of Psoriasis.  JAMA. 1973;  224 629
• 33 McDonald C J, Calabresi P. Occlusive vascular disease in psoriatic patients.  N Engl J Med. 1973;  288 912
• 34 Mehta N N, Azfar R S, Shin D B, Neimann A L, Troxel A B, Gelfand J M. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database.  Eur Heart J. 2010;  31 1000-1006
• 35 Naldi L. Cigarette smoking and psoriasis.  Clin Dermatol. 1998;  16 571-574
• 36 Naldi L, Chatenoud L, Linder D. et al . Cigarette smoking, body mass index and stressfull life events as risk factors for psoriasis: results from an Italian case control study.  J Invest Dermatol. 2005;  125 61-67
• 37 Neimann A L, Shin D B, Xingmei W, Margolis D J, Troxel A B, Gelfland J M. Prevalence of cardiovascular risk factors in patients with psoriasis.  J Am Acad Dermatol. 2006;  55 829-835
• 38 Neimann A L, Porter S B, Gelfand J M. Epidemiology of psoriasis.  Expert Rev Dermatol. 2006;  1 63-75
• 39 Prodanovich S, Ma F, Taylor J R. et al . Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis.  J Am Acad Dermatol. 2005;  52 262-267
• 40 Ridker P M. Testing the inflammatory hypothesis of atherothrombosis: scientific rationle for the cardiovascular inflammation reduction trial (CIRT).  J Throm Haemost. 2009;  7 (Suppl. 1) 332-339
• 41 Ridker P M, Danielson E, Fonesca F HA. et al . Reduction in C-reactive protein and LDL cholesterol and cardiovacular event rates after initiation of rosuvastatin: a prospective study oft he JUPITER trial.  Lancet. 2009;  373 1175-1182
• 42 Rocha-Pereira P, Santos-Silva A, Rebelo I. et al . Dislipidemia and oxidative stress in mild and severe psoriasis as a risk for cardiovascular disease.  Clin Chim Acta. 2001;  303 33-39
• 43 Schoen T, Boehncke H W. Psoriasis.  N Engl J Med. 2005;  352 1899-1912
• 44 Setty A R, Curhan G, Choi H K. Obesity, waist circumference, weight change and the risk of psoriasis in women: Nurses Health Study II.  Arch Intern Med. 2007;  167 1670-1675
• 45 Sommer D M, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis.  Arch Dermatol Res. 2006;  298 321-328
• 46 Sopori M. Effects of cigarette smoke on the immune system.  Nat Rev Immunol. 2002;  2 372-377
• 47 Stern R S, Fitzgerald E, Ellis C N. et al . The saftey of etretinate as long-term therapy for psoriasis: results of the etretinate follow-up study.  J Am Acad Dermatol. 1995;  33 44-52
• 48 Taler S j, Textor C S, Canzanello V J, Schwartz L. Cyclosporin-induced hypertension: incidence, pathogenesis and management.  Drug Saf. 1999;  20 437-449
• 49 Wakkee M, Thio H B, Prens E P, Sijbrands E JG, Neumann H AM. Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients.  Atheroslerosis. 2007;  190 1-9
• 50 Xiao J, Chen L H, TU Y T, Deng X H, Tao J. Prevalence of myocardial infarction in patients with psoriasis in central China.  JEADV. 2009;  23 1311-1315